Living with chronic illness and managing well: implications for primary health care policy and practice

Abstract

The prevalence of chronic conditions, such as chronic obstructive pulmonary disease (COPD), is predicted to increase as the population ages, and this creates significant challenges for health systems. Primary healthcare plays a key role in maintaining the success of Australian health outcomes. The Chronic Care Model has led redesign of healthcare, including primary healthcare, to meet the needs of people living with chronic conditions and has informed the Australian health system reform agenda. At the current time, the main Commonwealth policy lever to reduce the social and economic burden of chronic conditions such as COPD through health service delivery is assumed to reside in the general practice setting. However, there is limited evidence to support this assumption. There is a need for evidence of the role of general practice to inform health policy to strengthen primary healthcare policy and practice into the future. This thesis used a mixed methods design to investigate how people living withCOPD interact with general practice and other services to manage their illness. It used a systematic review of international literature to establish how evidence portrays the role of general practice in the healthcare of people living with COPD. Presence of this role was then sought in the construction of meaning for 'managing well' by people living with COPD. A critical interpretative lens exposed the social structures, including general practice, embedded in the reality of the everyday world of people living with COPD. The study demonstrates that spontaneous descriptions of strategies that might be understood as reflecting the Chronic Care Model are present in interviews conducted with people living with COPD and multiple other chronic conditions. However, the strategies are focused on wellness, are numerous and are developed following support from various people including healthcare professionals in general practice. Study participants presented themselves as confident, capable people who are in control of their total wellbeing. Living with a chronic condition was one aspect of their lives that was controlled in order to keep well. Confidence mediates access to healthcare because healthcare professionals are placed in the role of 'assistants7. General practice was one of many social structures influencing the way people manage their chronic condition and 'manage well'. Thus general practice plays a minor role in how people living with COPD 'manage well' At the present time Commonwealth health policy to strengthen primary healthcare is reliant, for the most part, on people attending general practice. This study indicates that opportunities to strengthen the role of general practice could be found in strengthening the way general practice links with other services. Furthermore, these results suggest there is also a lot to be gained from strengthening the primary healthcare system beyond general practice. Show more