Managing Long-term Conditions and Chronic Illness in Primary Care

229 Pages·2022·4.085 MB·English

by  Judith Carrier

Managing Long-term Conditions and
Chronic Illness in Primary Care
This practical guide will assist healthcare practitioners to manage and meet the
physical and pyscho-social needs of people with complex chronic diseases/long-term
conditions.
Systematic and evidence-based care which takes account of the expert patient and
reduces unnecessary hospital admissions is vital to support those with long-term con-
ditions/chronic diseases and those who care for them. Effective management of long-
term conditions is an essential part of contemporary nursing and healthcare policy
and practice globally. Reflecting recent changes in the curriculum, this fully updated
multidisciplinary edition highlights the key issues in managing long-term conditions.
It provides a practical and accessible guide for nurses and allied health professionals
in the primary care environment including:
• case studies on HIV and dementia and content on mental health
• the physical and psychosocial impact of living with long-term conditions
• effective case management
• self-management and the expert patient
• behavioural change strategies and motivational counselling
Packed with helpful, clearly written information, Managing Long-term Conditions
and Chronic Illness in Primary Care includes case studies, fact boxes and pointers for
practice.
It is ideal reading for pre- and post-registration nursing students taking modules on
long-term conditions and will be a valuable companion for pre-registration students
on community placements.
Judith Carrier is Professor in Primary Care/Public Health Nursing at Cardiff
University School of Healthcare Sciences, she was Director of the Wales Centre for
Evidence Based Care: a JBI Centre of Excellence from 2012 until 2022. Her PhD fo-
cused on the social organisation of practice nurses’ use of knowledge, and her clinical
background was in practice nursing where she specialised in the care of people with
diabetes. Her research and teaching interests include both evidence synthesis and im-
plementation, long-term condition management and global health. Judith has pub-
lished numerous systematic reviews and research papers in peer-reviewed journals,
in addition to two previous editions of a textbook on the management of long-term
conditions in primary care and several book chapters.

Managing Long-term Conditions
and Chronic Illness in Primary Care
A Guide to Good Practice
Third Edition
Judith Carrier
Cover image: © Getty Images
First published 2023
by Routledge
4 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
605 Third Avenue, New York, NY 10158
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2023 Judith Carrier
The right of Judith Carrier to be identified as author of this work has been
asserted in accordance with sections 77 and 78 of the Copyright, Designs and
Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced or
utilised in any form or by any electronic, mechanical, or other means, now
known or hereafter invented, including photocopying and recording, or in any
information storage or retrieval system, without permission in writing from the
publishers.
Trademark notice: Product or corporate names may be trademarks or registered
trademarks, and are used only for identification and explanation without intent
to infringe.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library
ISBN: 978-0-367-89708-6 (hbk)
ISBN: 978-0-367-89707-9 (pbk)
ISBN: 978-1-003-02065-3 (ebk)
DOI: 10.4324/9781003020653
Typeset in Times New Roman
by codeMantra
This book is dedicated to: my father Reginald Henson who lost his battle
against chronic illness on 4 January 2000 and to my mother Barbara
Henson who also lost her battle for life on 9 September 2009.
I would also like to dedicate this book to Dr Julian Costello 1954–2021
and his wife Kerri who has had to rebuild her life without him. As well as
being a very dear family friend, Jules was a popular GP and Founding
Fellow of the Faculty of Clinical Informatics and gave me my frst job as
a general practice nurse. Jules-we miss your friendship, generosity, and
sense of humour.
https://facultyofclinicalinformatics.org.uk/blog/faculty-of-clinical-informatics-
news-1/post/obituary-dr-julian-costello-49

Contents
List of figures xi
List of tables xiii
List of boxes xv
Foreword xvii
Acknowledgements xix
1 Social and political background 1
JUDITH CARRIER
Definition 1
National and international models of support for management of LTCs 4
Key points 8
Policy drivers – United Kingdom 9
Further areas to consider 17
2 Physical, psychological and psychosocial impact of living with a
long-term condition and social influences on health 18
JUDITH CARRIER
Introduction 18
Physical impact 19
Psychological/psychosocial impact 29
Social influences on health 30
Key points 34
Further areas to consider 34
3 Care coordination and the role of multi-disciplinary teams 35
JUDITH CARRIER, ANNA JONES AND GINA NEWBURY
Introduction 35
Case management/care coordination 36
Disease-specific care management 38
Role of the district nurse in the management of people with LTCs 39
Role of the general practice nurse in the management
of people with LTCs 41
viii Contents
Roles and responsibilities 45
Role of the multi-disciplinary team in the management of people with LTCs 46
Conclusion 48
Key points 49
Further areas to consider 49
4 Importance of self-management 50
JUDITH CARRIER
Introduction and defnition 50
Evidence supporting self-management interventions 52
Components of supported self-management 53
Social prescribing 56
Who’s suitable for self-care? 57
Self-management programmes 58
Key points 60
Further areas to consider 60
Organisations that advise on self-management 60
5 Behaviour change strategies 63
CHARLOTTE EMMA HILTON
Behaviour change within primary care 63
Ambivalence 63
Sources of motivation 64
Refective exercise guidance 66
Mind the gap! Knowledge and behaviour 67
Theoretical contributions to understanding behaviour change 68
Behaviour change guidance and initiatives 69
Therapeutic approaches 71
Motivational interviewing 72
Planning and goal setting 79
Developing profciency in Motivational Interviewing 82
Summary and key messages 83
6 How to identify a person with a long-term condition 84
JUDITH CARRIER
Introduction 84
Conditions 85
Respiratory conditions 94
Musculoskeletal conditions 96
Conclusion 99
Key points 99
Further areas to consider 99
Contents ix
7 Effective management of people with a long-term condition 100
JUDITH CARRIER
Introduction 100
Protocols 101
The 3 Rs – registration/recall/review 103
Teamwork and referral criteria 110
Quality improvement and audit 110
Digital health interventions 112
Rehabilitation and palliative (end of life) care 114
Conclusion 116
Key points 117
Further areas to consider 117
8 Evidence-based healthcare 118
JUDITH CARRIER AND ANNA JONES
Introduction 118
Defnitions and brief history of evidence-based healthcare (EBHC) 119
Applying evidence to practice 121
Evidence implementation/quality improvement 128
Defning quality 128
So how can you improve quality in healthcare? 130
Quality improvement approaches 130
Model for improvement 131
Sustainability 132
Conclusion 133
Key points 133
Further areas to consider 133
9 Case scenarios 134
JUDITH CARRIER
Introduction 134
PART ONE
Respiratory conditions 135
Diabetes 142
Musculoskeletal conditions 145
Skin conditions 148
PART TWO
People with more complex needs 149
Neurological conditions 156
Conclusion 162
Key points 163
Further areas to consider 163