Management of chronic diseases

1
Management of chronic diseases

• Nature
• Incurable
• Mostly silent
• Persisting pain if at all
• No correlation between complaints and lab data.
• Uncertain progress
• Lifestyle related

• Treatment
• Important
• Variable effects
• Patients need self discipline
• Costs are mental, professional, social and
  financial

• Patients
• Need to control it even though incurable
• Juggle between treatment and life
• As vigilance lessens problems increase
• Has to be trained to handle acute crisis.

• Doctors
• Prescribe but not control fully
• Need to share knowledge and foster attitudes
• Intervene in emergency
• Detect complications early
• Should work in a team

2
Two types of responses to initial shock of
chronic illness

• Integration Process
• Disbelief
• Revolt (accusation)
• Depression (sadness for health lost)
• Confronting reality
• Consenting (coping) with serenity

• Distancing Process
• Anguish (medical team could cause it)
• Denial of emotions (sense of shame/ suffer in
  silence)
• Passive resignation
• Meloncholia (may need psychiatric help)

Lacroix A., Therapeutic Education 2003
3
Doctors role of patients health belief model

• Patient should be convinced that he is ill.
• He must believe there could be serious
  consequences because of this illness
• He must believe treatment will be beneficial
• He must believe that the benefits will be more
  than psycho-social and financial side effects of
  the treatment.
• These can be discovered only by semi
  directive interviews which convince the patient
  that interest being shown in him is not merely
  biological.
• This shifts the locus of control to the
  patient.

4
Empathy is the key to success

• Empathy is not sympathy
• Empathy is adult to adult
• Empathy demands sincerity
• Empathy demands dedication
• Empathy creates trust and loyalty

5
Th. Arrivaali (the knowlegeble)

• Likes to be independent

• Knows the severity of the ailment

• Believes prevention is better than cure

• Well-informed collects printed articles on
  diabetes attends seminars

• Positive about life despite diabetes. Follows
  diet and leads a disciplined life

• Motivated enough to exercise regularly, believes
  in timely medication, does not add sugar to food

• Practices self monitoring and self injection,
  visits doctor less often, family involvement is
  very high, calm and collected during hypos -
  knows what to do.

6
Th. Bhayanthavar (the Scared)
Age40-45 years

• Constantly curses his fate Why me??

Recently diagnosed

• Dependence on others lack of faith in self

• Gender
• Equal proportion
• of males females

• Apathy in gaining knowledge about diabetes

• Looks upon diabetes as a demon controlling his
  life

• Resents the rigid lifestyle. Claims that he
  feels dead from within.

• Visits the doctor every 7 - 15 days and hoping
  to achieve better sugar control thereby

Region Northern Western India but a rare
case in the south

• Cannot overcome the craving for sugar and
  sweets, family involvement in managing diabetes
  in low

• Dependence on others for taking insulin injections

7
Th. Parkalaam (the casual)
Age 40 years

• Feels defeated. Dislikes rigid and disciplined
  lifestyle

Living with the disease for long

• Relaxed attitude towards self care, health and
  diabetesno drive to seek knowledge

• Gender
• higher proportion amongst housewives than males

• Considers self as least important member of the
  family. Family too attaches low importance to her
  health.

• Believes, God gives so he will manage it

• Ignores diabetes until complications set in

Region Northern Western India but a rare
case in the south

• No exercise, poor compliance to dosage schedule
  and no diet control

• Visits doctor only for emergencies

8
Th. Kurukku vazhi (the myopic)
Age 50 - 60 years

• Wants maximum results with minimum effort.
  Thinks only of short term

Diagnosed since at least 8 -9 yrs.

• Convenience very important, looks for excuses to
  postpone treatment

• Gender
• Equal proportion amongst Males and Females

• Low awareness and lacks interest to increase it.
  Looks for ways to end the treatment. Keeps asking
  how long treatment will go on

• Convinces the doctor to postpone insulin
  treatment, continues on orals even when they have
  failed

• Maintains good diet control. Avoids oil and
  sugar completely.

Region Spread across regions, fewer in south

• Does not find even 10 minutes for regular
  exercise, cites paucity of time as main reason

9
Th. Yavum Arivom ( I Know it all)
Age 40 - 45 years

• Low awareness, but claims knowledge

Recently diagnosed

• Experiments with different medications without
  the doctors consent

• Gender
• Mainly Males

• Gets information from diabetic friends
  relatives rather than professionals

• Takes risk. Will try all the possible remedies
  including unproven and herbal

Region Not very region specific, but none found
in South

• Avoids visiting the doctor to labs feels it is
  a waste of money

10
Patient segments
Knowledgeable
Positive attitude to treatment
I Know it all
Low levels of awareness
High levels of awareness
Myopic
Scared
Negative attitude to treatment
Casual