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Managing Chronic Disease in the Primary Care Setting

� Discuss the impact of chronic disease on health care as a whole.
� Examine how evidence based plans of care can reduce the health care cost burden
placed on Americans and discuss cost effectiveness achieved by the use of evidence based
plans of care.
� Discuss the role that advanced practice nurses play in caring for patients with chronic
illness from the standpoint of health promotion, medication management, and symptom
management, and the importance of this role.

Managing Chronic Disease in the Primary Care Setting

Caring for patients diagnosed with chronic illness involves strategic plans monitor and manage
their treatment plan. Approximately, 75% of healthcare costs in the USA are associated with
chronic illness. This has put a huge impact in the healthcare system, especially due to the
increase of aging population suffering chronic illnesses and shortage of the healthcare providers.
Therefore, there is need to establish the appropriate and cost effective strategy as guided by
evidence based practice (Hunt, Kreiner, & Brody, 2012). This paper discusses the impact of
chronic health complications in the healthcare system. This will help evaluate the evidence-based
practice that will help reduce the economic cost burden placed on the healthcare system.
Additionally, the advance practice nurse (APN) role in management of chronic ill patients will
be evaluated especially with reference to health promotion, medication adherence, and symptom
Evidence based practice

Managing Chronic Disease in the Primary Care Setting
Advancement in technology has extended the life expectancy periods. As the aging population
increases, the incidence rates of chronic illnesses have skyrocketed considerably. Research
estimates that chronic illness accounts for about 75% of the nation’s total health cost. The main
dilemma is that most of the healthcare systems are mainly designed to manage acute healthcare
complications. Therefore, the type of care being provided is very fragmented. According to the
National Council of Aging (NCOA), 80% of people above 65 years of age suffer from at least
one chronic illness and at least 50% of them have more than one healthcare complication
(Lindsay, Kingsnorth, & Hamdani, 2011).
Chronic disease impact every aspect of the patient lives. The patients have three main roles; a)
deal with medical management, b) lifestyle modification and c) learn to cope with the emotional
impact associated with the management of the disease. In some cases, the chronic diseases could
reduce patient’s cognitive function. This causes health distress to the family members and the
caregivers, and financial implication is even higher in scenarios where the chronic illness causes
disability. Therefore, the nurses have a very important role in preparing the population to mange
chronic illness. It is important for the patients to understand that most of their lives are spent
outside the healthcare system, thus they must learn on how to make conscious decisions about
their diets, exercises, and daily activities (Newsom et al., 2012).
The evidence-based practices indicate that the most effective interventions that can be used to
manage chronic diseases are self-management strategies. These strategies have been found to be
effective in the management of diabetes, COPD, asthma and hypertension. These self-
management strategies have been found to be effective to relieve pressures in acute healthcare
settings. However, poor health literacy and stringent health care policies acts as a barrier to
effective self-management strategies. According to the National Assessment of Adult literacy

Managing Chronic Disease in the Primary Care Setting
(NAAL), approximately 87% of people diagnosed with chronic diseases have low health literacy,
and only 13% of people are proficient with heath literacy. Some of the factors associated with
poor health literacy are reduced accessibility to care, as well as cultural and linguistic. Health
literacy has also been associated with ethnicity and the social economic factors (Strunk,
Townsend-Rocchiccioli, & Sanford, 2013).
One of the main factors that impede successful self-management of the disease is medication
adherence. Most of the patient fails to adhere to medication for many reasons including cost
issues, cultural values, forgetfulness, and fear of the medication side effects. The patient must be
well trained on the importance of maintaining the dietary restrictions and regular monitoring.
The will ensure that the patient manages the chronic disease appropriately (Pai, Ahna, &
Ostendorf, 2011).
A successful self-management plan ensures that the psychosocial issues are well identified and
managed. The patient psychosocial stability influences their ability to adhere to medication,
sustain their cognitive difficulty and to ensure that they embrace the health challenge positive.
Patient whose psychosocial status is unstable perceives the ailment as an intrusion to their daily
life activities. Most of the patients tend to remain isolated which could lead to health distress to
themselves and to close relatives. It is important to design a health care plan that will ensure that
the patient autonomy is maintained and establish ways that will minimize stigmatization (Artnak,
McGraw, & Stanley, 2011).
Health literacy is the key concept of effective self-management. Health literacy is a complex
phenomenon, which involves families, communities and individuals because it is within these
systems that one finds the patients, consumers, and caregivers. These individuals have varying
level of experiences including accessibility to health information, their skills, and ability to

Managing Chronic Disease in the Primary Care Setting
gather as well as comprehending the health information. The extent of knowledge and disabilities
influence how a person speaks, understands their past medication experiences and ability to
make informed choices on healthy behavior. Therefore, the APN have major role to play in
ensuring that strategic health care is provided to patients diagnosed with chronic diseases (Pai,
Ahna, & Ostendorf, 2011).
Low health literacy is associated with high health care cost. Low health literacy is a major source
of inefficiencies in the economy as it is reported that about $106 -$238 billion is lost to chronic
illness due to poor healthcare literacy. This amount accounts to about 7% of the total healthcare
that could be used in improving infrastructure to ensure that the quality of health care is
sustained (Artnak, McGraw, & Stanley, 2011).
The Role of APN
The APN and other healthcare providers should be adequately trained on self-management
strategies so that they can empower the patient they interact. The government and healthcare
regulatory bodies should ensure that there is a comprehensive approach that enables the
professionals better their skills, and are able to integrate the skills with their roles. APN are
effective at offering the self-management support training by linking them with community
health training (Pai, Ahna, & Ostendorf, 2011).
Health literacy and effective communication are the key strategies in ensuring that the patients
are able to self manage their health complications effectively. For health promotion, the APN
must ensure that that the patient understands his or her diagnosis, and the importance of
medication being administered. The APN must also educate the patients on the importance of the
preventive measures as well as treatment plans. The APN must conduct health assessment to
ensure that they identify the barriers as well as the facilitators of effective self-management. The

Managing Chronic Disease in the Primary Care Setting
APN must be research about the patient’s personal values and cultural believes to check if the
cause of the chronic illness. It is the APN roles to reform the issue of poor self-management
practices from the overlooked silent epidemic to improve quality of life, decreased costs, and
reduced medication errors (Artnak, McGraw, & Stanley, 2011).

Managing Chronic Disease in the Primary Care Setting
Artnak, K. E., McGraw, R. M., & Stanley, V. F. (2011). Health care accessibility for chronic
illness management and end-of-life care: A view from rural America. Journal Of Law,
Medicine & Ethics, 39(2), 140–155.
Hunt, L., Kreiner, M., & Brody, H. (2012). The changing face of chronic illness management in
primary care: a qualitative study of underlying influences and unintended outcomes.
Annals Of Family Medicine, 10(5), 452–460.
Lindsay, S., Kingsnorth, S., & Hamdani, Y. (2011). Barriers and facilitators of chronic illness
self-management among adolescents: A review and future directions. Journal of Nursing
& Healthcare of Chronic Illnesses, 3 (3)186–208.
Newsom, J., Huguet, N., McCarthy, M., Ramage-Morin, P., Kaplan, M., Bernier, J., & …
Oderkirk, J. (2012). Health behavior change following chronic illness in middle and later
life. The Journals Of Gerontology. Series B, Psychological Sciences And Social
Sciences, 67(3), 279–288.
Pai, Ahna L.H., & Ostendorf, H. (2011). Treatment adherence in adolescents and young adults
affected by chronic illness during the health care transition from pediatric to adult health
care: A literature review. Children’s Health Care, 40(1), 16–33.
Strunk, J. A., Townsend-Rocchiccioli, J., & Sanford, J. T. (2013). The aging Hispanic in
America: Challenges for nurses in a stressed health care environment. MEDSURG
Nursing, 22(1), 45–50

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