Unit 5 Chronic Disease in BC

Chronic Disease Relevant to my Practice

Chronic Disease Management in British Columbia

I have chosen the following three chronic diseases pertinent to British Columbians. These diseases are diabetes mellitus, COPD (chronic obstructive pulmonary disease), and hypertension. I see patients with these diseases regularly and have shown the inter-relationship between them in this blog. Many of the clients I see are in the age range of 35 to 75 years, whom have multiple comorbidities and are usually diagnosed with one or two of the chronic diseases mentioned.

Diabetes mellitus is a chronic disease whereby the body has difficulty with the production of insulin or the properly use of insulin it's already producing. This can result in excessive glucose in the bloodstream. Glucose or sugar is an energy food source for the body. Too much glucose in the bloodstream is called hyperglycemia, too little is hypoglycemia. Many health problems can result due to mismanagement of diabetes (Diabetes Canada, 2018).

Diabetes affects many people in Canada. According to Diabetes Canada, (2018), in a 2017 report, British Columbia has approximately 29 percent or 1.4 million people living with diabetes, prediabetes, or undiagnosed diabetes. The projected rise of affected people affected is a staggering 32 percent, or 1.9 million people.

Working in the community, or in the Urgent Primary Centre, I see clients regularly who live with Type 1 (insulin-dependent) and Type 2 (non-insulin dependent) diabetes. The policies and procedures that guide my practice include Diabetes Canada Clinical Practice Guidelines, (Diabetes Canada, 2018) and the British Columbia College of Nursing Professionals (2016). In my current practice, approximately 10 percent of my clients have a diagnosis of diabetes and are between 35 to 50 years of age. In the local health authority, according to a 2014 report by the British Columbia Centre for Disease Control (BCCDC), from 2012-2013, there were 584 cases of Type 1 and Type 2 Diabetes cases (BCCDC,2014).

When considering the primary determinants for diabetes, I have included the following socioeconomic and physical conditions to include where people age, grow, live, work, amount of income, level of education, housing and access to nutritious food. According to Statistics Canada (2017), BC 's South Asian and Chinese population make up 7.3% and 10% respectively. The Aboriginal population in BC is the second highest in Canada, sitting behind Ontario. These three ethnic groups are risk factors for diabetes. Aboriginal people are more at risk due to several factors including food insecurity and limited access to healthy options, higher rates of obesity and overweightness, lack of exercise, sedentary lifestyle, limited access to healthy community programs and services, and poor infrastructure. Also, poor housing education and income are factors as well (Diabetes Canada, 2017, p. 4,5). According to the newsletter Healthline (2018) the age range of 45-64 years, is the most common age group for a diabetes diagnosis. Many of my clients are within this age range. According to NCCAH (2009), lack of exercise and poor diet increase the risk of type 2 diabetes in youths and adults. Poverty and family history as also strong risk factors for the disease. Fixed income plays a role when buying good quality, and nutritious food. Social supports and interactions are considered as older clients do not always have a good support system; many have lost close connections, and family members don't spend time with aging parents and siblings. Some residential segregation exists as the Aboriginal clients live on reserve land and stick to traditional ideals regarding medicine and healing. This can delay the start of modern treatment and set back healing. Lack of education and understanding about the disease is important as this can allow for medication errors etc., with self-administration and self-monitoring of the disease process.

Diabetes Mellitus

References

BCCDC. (2014). BC community health document. Public Health Documents. Retrieved fromhttps://www.bccdc.ca/pop-public-health/Documents/kamloops.pdf

Diabetes Canada. (2018). Clinical practice guidelines expert committee. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. 2018;42(Suppl 1):S1-S325.

Diabetes Canada. (2017). 2017 Report on Diabetes in BC. Retrieved from https://www.diabetes.ca/getmedia/8e38f0cd-a2c4-4c17-a7df-9a2b385df961/sv-2017-

Diabetes-in-BC_final_HQ.aspxDiabetes Canada.Government of British Columbia. (n.d.). Diabetes care. British Columbia Guidelines. Retrieved from https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/diabetes

Healthwise. (2018). Type 1 diabetes. Government of British Columbia. Retrieved fromhttps://www.healthlinkbc.ca/health-topics/hw34303

Barhum, L. (2017). How are diabetes and hypertension linked? Medical News Today. Retrievedfrom https://www.medicalnewstoday.com/articles/317220.php

Reading, C., & Wien, F. (2009). Health inequalities and the social determinants of AboriginalPeoples' health. National Collaborating Centre for Aboriginal Health. Retrieved fromhttps://www.ccnsa-nccah.ca/docs/determinants/RPT-HealthInequalities-Reading-Wien-EN.pdf

COPD (chronic obstructive pulmonary disease)

COPD is described as a chronic inflammatory lung disease that obstructs airflow from the lungs. People with this disease experience shortness of breath, coughing, wheezing, and mucus production with coughing. These people are more at risk for other diseases including lung cancer (Mayo Clinic, 2017). BC COPD Full Guidelines (2017), states COPD presents as persistent limitation of airflow, not completely reversible, with an abnormal response to inflammation by the lungs to noxious gases and other environmental particles such as dust and smoke. Chronic bronchitis (inflammation of the bronchioles) and emphysema (the destruction of alveoli) fall under the category of COPD. Smoking is the most common cause as it irritates airways and destroys the ability of the airways to stretch (BC COPD Full Guidelines, 2017).

According to the BC Medical Journal (2018), even though COPD is a prevalent and chronic health condition in British Columbia and worldwide, there is a lack of awareness of this disease amongst medical professionals and the general population. By the year 2020, it is estimated to be the third leading cause of death. The population of people with COPD in British Columbia varies in estimates at 5% - 15%, in the age range of 45 years and older. The challenge with the disease relies partially with diagnosing it, as pulmonary airway obstructive may not present itself until the disease is quite advanced. A common admission diagnosis for these clients to hospital is an exacerbation of COPD; symptoms include increased shortness of breath, and increased cough with or without sputum production outside of regular symptom management. "Patients who experience an acute exacerbation have a significantly higher mortality rate than those with stable COPD. This mortality risk increases as the number of exacerbations increases" (BC COPD Full Guidelines, 2017, p.1).

"The 2003-2004 prevalence estimate for COPD in BC was 4.4% for men and 4.0% for women, representing 73747 British Columbians aged 45 years and older, with the prevalence increasing to 16% for individuals aged 85 years and older" (BCMJ,2018). Relevant to my nursing practice in the community, as I see several these clients in this age group with a COPD diagnosis. The number of people aged 45 years or greater diagnosed in BC with COPD is approximately 138,500 or 6% of the population. Many remain undiagnosed or underdiagnosed. In 2013, there were 701 new diagnosed patients in BC (Chronic Disease Registries, BC Ministry of Health, 2012, p. 15).

Primary determinants of health include social and environmental factors including air pollution such as smoking and excessive use of alcohol, which in turn increase the risk of heart disease and lung cancer (NCCAH,2009). Several clients live near major city road and large complexes. Several are on home oxygen therefore getting around to exercise, shop for groceries, etc., is challenging as well, noxious fumes from the main highway is a concern. Lower income as several clients on disability income, some medications are not covered.

References

Camp, P., & Levy, R. (2008). A snapshot of chronic obstructive pulmonary disease in BritishColumbia and Canada. British Columbia Medical Journal, 50(2). Retrieved from https://www.bcmj.org/articles/snapshot-chronic-obstructive-pulmonary-disease-british-columbia-and-canada

Government of BC. (2017). Chronic Obstructive Pulmonary Disease (COPD): Diagnosis andManagement. BC Guidelines and Protocols Advisory Committee. Retrieved fromhttps://www2.gov.bc.ca/assets/gov/health/practitioner-pro/bc-guidelines/copd_full_guideline.pdf

Government of BC . (2014). Chronic Obstructive Pulmonary Disease (COPD): Diagnosis and Management. BC Guidelines. Retrieved from https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/copd

Canadian Foundation for Healthcare Improvement. (2015). COPD in Western Canada: health,care and costs. Retrieved from https://www.cfhi-fcass.ca/sf-docs/default-source/newsevents/inspired-roundtable-resources/western-copd-fact-sheet.pdf

Healthwise Staff. (2017). COPD learn about COPD. Healthlink BC. Retrieved from https://www.healthlinkbc.ca/health-topics/center1009

General Practice Services Committee. (n.d.). COPD Management in BC. Retrieved from file:///C:/Users/Owner/Downloads/copd_management_in_bc_a_system_approach.pdf

Healthwise Staff. (2018). COPD (Chronic Obstructive Pulmonary Disease). Healthlink BC Retrieved from https://www.healthlinkbc.ca/health-topics/hw32559

Lung Institute (2015). The connection of COPD and hypertension. Retrieved from https://lunginstitute.com/blog/copd-and-hypertension/

Mayo Clinic. (2017). COPD - Symptoms and causes. Retrieved from https://www.mayoclinic.org/diseases-conditions/copd/symptoms-causes/syc-20353679

Reading, C., & Wien, F. (2009). National Collaborating Centre for Aboriginal Health. Health Inequalities and the Social Determinants of Aboriginal Peoples' Health. Retrieved from https://www.ccnsa-nccah.ca/docs/determinants/RPT-HealthInequalities-Reading-Wien-EN.pdf

Province of British Columbia. (2017.). Chronic Obstructive Pulmonary Disease: Resource Guidefor Patients Retrieved from https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/bc-guidelines/copd_patient_resource_guide.pdf

Hypertension

"High blood pressure or hypertension is a common condition in which the long-term force of the blood against your artery walls is high enough that it may eventually cause health problems, such as heart disease. Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries" (Mayo Clinic, 2018). Considered a 'silent killer', it can put people at risk for heart disease including heart attacks and cerebral vascular accidents or strokes (Mayo Clinic, 2018). Healthlink BC (2018) states blood vessel, heart and kidney damage can occur because of hypertension. As arteries stiffen, blood supply can be affected, damaging other organs. A reading of 140/90 may be indicative of hypertension and follow-up with a medical professional is encouraged.

According to Chronic Disease Registries, BC Ministry of Health, (2013), there were 1160 newly diagnosed patients with hypertension in Kamloops. In that same year, there were 710 newly diagnosed patients with diabetes, type 1 or 2. There is a correlation between hypertension and diabetes mellitus, many of these clients are seen in my regular practice with both chronic diseases. It is believed that 1:3 diabetic patients have hypertension.

"Diabetes does three things that may increase blood pressure: decreasing the blood vessels' ability to stretch, increasing the amount of fluid in the body, changing the way the body manages insulin. Hypertension and diabetes generally coexist because they share similar risk factors, including being overweight, following an unhealthy diet, and living an inactive lifestyle" (NCCAH, 2013).

Primary determinants of health for hypertension include smoking history, inactive lifestyle, lack of healthy nutritious food. Foods high in salt content change the way kidneys remove water from the body increasing additional volume in the bloodstream. A common thread for my clients with their overall deconditioning due to chronic disease is the inability to access grocery stores close to their residence, many are on home oxygen, don't drive, and are on a fixed income. They lack the energy to walk long distances, and additional costs for transport, fresh fruit and vegetables are factored in.

In one year, number of people in Kamloops IHA newly diagnosed with:

Depression or Anxiety* 1,320

Asthma 426

COPD 701

High blood pressure 1,160

Heart failure 423

Diabetes (type 1 or 2) 710

(Chronic Disease Registries, BC Ministry of Health, 2013, p.15)

References

Barhum, L. (2017). How are diabetes and hypertension linked? Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/317220.php 

BCCDC. (2015). Health status and chronic diseases. BC Community Health Data. Retrieved from https://communityhealth.phsa.ca/HealthProfiles/HealthReportHealthStatusAndChronicDisease/Kamloops

Core Public Health functions for BC. (2010). Model Core Program Paper:Chronic Disease. Retrieved from BC Ministry of Healthy Living and Sport Population and Public Health.website: https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/public-health/healthy-living-and-healthy-communities/chronic_disease-model_core_program_paper.pdf

Government of BC. (2018). High Blood Pressure. Healthlink BC. Retrieved from https://www.healthlinkbc.ca/health-topics/hw62787#aa26888

Government of BC. (2016). Hypertension - diagnosis and management. BC Guidelines. Retrieved from https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/hypertension

Government of BC. (2017). Secondary high blood pressure. Healthlink BC. Retrieved from https://www.healthlinkbc.ca/health-topics/hw214416

Heart and Stroke. (n.d.). High blood pressure. Risk and Prevention. Retrieved from https://www.heartandstroke.ca/heart/risk-and-prevention/condition-risk-factors/high-blood-pressure

Reading, C., & Wien, F. (2009). Health inequalities and the social determinants of Aboriginal Peoples' Health. National Collaborating Centre for Aboriginal Health. Retrieved from https://www.ccnsa-nccah.ca/docs/determinants/RPT-HealthInequalities-Reading-Wien-EN.pdf

Saint Peter's Healthcare System. (2014, September 9). What is Hypertension? [Video file]. Retrieved from https://www.youtube.com/watch?v=rTWx1DE-kOM

Statistics Canada. (2015). High Blood Pressure 2014. Retrieved from https://www150.statcan.gc.ca/n1/pub/82-625-x/2015001/article/14184-eng.htm

Professional Practice Guidelines

BCCNP. (2016). Adult Decision Support Tools: Adult Cardio-Pulmonary Assessment. Retrieved from https://www.bccnp.ca/Standards/RN_NP/CertifiedPractice/Documents/FirstCall/697AdultCardioRespDST.pdf#search=chronic%20disease%20best%20practice

Diabetes Canada. (2018). Clinical Practice Guidelines. Canadian Journal of Diabetes. Retrieved from https://guidelines.diabetes.ca/docs/CPG-2018-full-EN

Province of British Columbia. (n.d.). Diabetes Care. Retrieved from https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/diabetes