Diabetes is a complicated chronic illness that requires continuous critical medical attention and care .Some of the intervention strategies for diabetic patients revolve around a series of multi-factorial awareness and risk education strategies that extend beyond just glucose control. According to American Diabetes Association: Standards of Medical Care in Diabetes—2017, ongoing patient self-management and other additional care, support and education are very critical in prevention of the risks of acute complications associated with diabetes and reduction of occurrence of other long-term complications. These elements therefore highlight the need and the critical significance of person-centered care for diabetic patients. The world Health organization recognizes that this approach of person-centered care system is a remarkable concept through which provision of care and management services can be extended to incorporate not only the health and wellbeing of an individual but also that of the entire family (Sperry, 2010). This paper therefore discusses diabetes as one of the major health concern and priority for Australian government and the healthcare system and the implications of person-centered healthcare practices and principles in relation to Australian healthcare principles and their impact on diabetic patients and families with diabetic patients.
According to the Australian Government and the Australian institute of health and welfare, 1 in every 17 Australian adults; approximately 1.2 million people had diabetes in in 2014-2015. Further analysis reveals that there were approximately one million hospitalizations associated with diabetes diagnosis and that 1 in every 10 Australian deaths had diabetes as an underlying or associated cause of death. The Australian national health survey statistics indicate that the rate of diabetes tends to increase with age. The highest prevalence rates for diabetes recorded were from People who are 85 years and over. Men reported slightly higher rates of diabetes than women. According to the survey, prevalence rates for diabetes are twice in indigenous (Aboriginal and the strait islands people) compared to non-indigenous Australians (AIWH 2016). There are various elements that influence these statistical outcomes and the disparities in prevalence rates. Some of these elements include social, economic and political forces that impact either positively or negatively, the lives of diabetes patients and their respective families (Borus, 2013).
According to Adler & Newman, social and economic status underlines the significant determinants of health that is, HealthCare quality, environmental behavior, and health behavior. Therefore Socio-economic status whether assessed by determining the level of income, occupation or education, is directly is directly linked to diabetes which is one of the outlining health complications in Australia. This implies that disparities in levels of income, as well as education, have had a compounding effect on the development, diagnosis, and management of diabetes for the low-income earners in Australia (Abouzeid, Philpot, Janus, Coates, & Dunbar, 2013). The surveys were done by the Australian bureau of statistics, diabetes prevalence rate is almost 3 times in high in the lower social, economic group as compared to the highest socio-economic class. Even the rates of deaths and hospitalizations of the lower socio-economic group are two times higher (ABS 2015). This is because of people in the lower economic class experience hard economic and living conditions which cumulatively result in s of weak physical and mental health; the predisposing factors for diabetes (Cryer, 1995). Due to their low-income status, diabetic patients in the lower socio-economic class receive insufficient, low quality and sometimes inappropriate healthcare services resulting in late detection and diagnosis and management. The treatment and care requirements of diabetes have significant effects on the occupation of the patients since they are continuously forced to leave work for various health reasons. The cost of diabetes management is significantly high especially for the poor in Australia.
According to (Elrayah-Eliadarous et al., 2017), life expectancy for the lower socio-economic class is relatively low. This is because low income earning contributes to a wider array of factors such as unhealthy and unbalanced eating lifestyle and diet, lack of proper physical activity and mental stability. These are compounded by stress and unrest due to lack of job security and stability. The majority in the low socio-economic group does not have proper education and therefore are not able to secure stable and reliable jobs. This lack of proper education implies that very few people in this group are able to identify and report early symptoms of diabetes which are very crucial for early diagnosis and onset of treatment and management.
Exposure to differential living and working environment amongst poor people results in differential vulnerabilities to adverse health outcomes such as diabetes(Goldman, & Smith, 2002).Goldman and Smith in their findings explain that “those in the lower education group (illiterates and school dropouts) face a triple threat of diabetes.” This is because they make up the majority of people with considerably higher chances of being undiagnosed and treated for diabetic conditions. They further describe that even when the diagnosis is made, uneducated diabetic patients have considerable difficulties in maintaining continuous proper self-management of the condition. The management process involves a series of complex but effective treatment procedures which are important in order to reduce the chances of the negative health consequences associated with diabetes. From these findings, it is evident that poverty directly links the relationship between the high diabetes prevalence rates, morbidity and mortality rates among the lower socio-economic groups in Australia. It is imperative to note that although the link between poverty and diabetes is clear, the dynamics and mechanisms responsible for these outcomes are not clearly ascertained and understood. Therefore there is additional need for the Australian government to formulate policy remedies that can eliminate or significantly reduce the gaping disparities in health and healthcare outcomes in relation to chronic conditions such as diabetes. Education is perhaps one of the most basic and immediate elements that need to be addressed to reduce these disparities for the long-term in upcoming generations. This is relevant because education makes up the fundamental tool that shapes an individual’s future occupational opportunities and earning potential. It imparts essential life skills that enable individuals to access information and resources that are essential for promoting good health and healthy living conditions (Sullivan, & Joseph, 1998).
Diabetes has not only direct physical impact on patients but also their immediate families and relations. There are several elements of struggle associated with diabetic patients as well as families with members who are diabetic patients. Some of these elements include emotional distress and mental struggles. Berry et al. acknowledge that mental and emotional distress is some of the immediate responses individual experiences after diagnosis with a chronic condition. After diagnosis, the immediate demands for significant changes in lifestyle as well as the irreversible medical demands for diabetes management contributes to the psychological distress experienced by most individuals and families. Other elements such as an individual’s perception of support and protection significantly contribute to elevated levels of distress. According to Barry et al., “diabetes aside from affecting an individual’s physical health also impacts on their mental wellbeing. This is because, for the largest majority of families and individuals, a positive diagnosis for diabetes means taking up demanding subsets of additional responsibilities, planning, and self-monitoring. These are considered critical for continuous effective management of diabetes and thus necessitate a remarkable readjustment of daily life which according to Barry et al., can be physical, emotionally and psychologically draining. The effects eventually permeate throughout an individual’s social and economic environment (Bery et al., 2015).Some of the objective enshrined in the principles of person-centered care for diabetics include continued encouragement, support and empowerment of families and diabetic patients to actively engage in self-care plans as much as possible ("American Diabetes Association: Standards Of Medical Care In Diabetes—2017", 2017).
Diabetes has numerous challenging aspects that must be met and adhered to. These include continuous glucose checks and insulin administration, dieting, exercises and other elements needed for proper self-care. Meeting most of these demands on a daily basis can be daunting even for the most supportive and motivated patients and families (Borus 2013).In most cases of adolescent diabetics, most of these demands prove to be too burdensome, and as a result, most of the teens struggle with the implications of their diabetic status. Borus further supports that greater numbers of teens with diabetes suffer from chronic depression and other psychological struggles, A good example if how the implications of chronic conditions such as diabetes and the related struggles can be drawn from the case example of the Spackman family in Queensland, which experiences lifestyle change struggles and diabetes. The lifestyle behaviors depicted in the article are entirely contrary to the core principles of person-centered care. Every individual shares in the responsibility for health and the success of the healthcare provision. Whichever choices each individual makes about his or her lifestyle and other personal risk behaviors directly impacts their health risks and outcomes. Healthcare professionals are mandated to provide clear communication and guidance about the underlying implications of a positive diabetes diagnosis including the choices available for treatment and management. However, this can only work if every patient takes an active role in taking responsibility for managing their own health (Australian Institute of Health and Welfare (AIHW), 2007).
The Australian healthcare system is a multifaceted web of public and private healthcare providers. These contribute significantly towards primary healthcare provision, emergency services; hospital-based treatment as well as palliative care for diabetes patients. The government recognizes that diabetes is a chronic condition that requires series of various healthcare services in order to control and manage and therefore the healthcare system is modeled to include most of these services. There are various options available for treatment and management of diabetes in Australia including services aimed at controlling blood sugar, blood pressure, blood lipid levels as well as reducing the symptoms and the associated risks of complication development. The principles for Australian Health system contain guidelines that are tailored to foster and enhance the quality of life for all its citizens.
The initial contact point for people with diabetes are usually the general medical practitioners who help with the regular monitoring of patient’s weight changes, blood levels, and their general health status. The practitioners only refer the patients to another specialist when complications associated with diabetes develop. As such, the government in collaboration with other healthcare sectors and providers have formulated and implemented initiatives for public awareness campaigns highlighting the importance of early detection and diagnosis of diabetes and management. There are also support structures in place to ensure that continuous research is done in diabetes and other related chronic illnesses as well as maintain continuous monitoring and surveillance measures (Australian Department of Health 2015).
According to the Australian department of health, there are various programs in place for the support treatment and management of diabetes. These include Medicare benefits schedule which subsidizes the cost of patient care and Medicare items necessary for planning and management of chronic conditions such as diabetes; There is also the comprehensive pharmaceutical benefits scheme which continually provides subsidies for medicines used in treatment and management of diabetes. The new Australian National Diabetics strategy 2016-2022 is aimed at directing how existing resources are coordinated and prioritized in response to diabetes through an emphasis on prevention, early diagnosis, interventions, treatment and management (Australian Department of Health 2015).
The Australian commission on safety and quality in healthcare defines person-centered care as “a patient-centered care that is respectful of and responsive to the individual patient's values, needs, and preferences. The values and principles underlining the Australian healthcare system are in line with cultural and person-centered care principles. The principle of Support for a more comprehensive healthcare system acknowledges that people have a multiplicity of different health needs and these vary and change based on certain elements. Therefore, there is a need for a healthcare system that encompasses all that. The aims of person-centered care system are to achieve and sustain optimal well-being by supporting and encouraging diabetic patients to actively and continuously manage their health condition in the context of their life and lifestyle and in accordance with their values and preferences (Johanson 2015). Patient-centered care should encompass consultations which include assessment of clinical signs and symptoms taking into consideration their fears, thoughts, experiences and expectations as well as their socio-cultural values. This way a proper management plan can be formulated and tailor-made to specifically meet each particular patient’s needs (Maclimans et al. 2011).
In conclusion, it is recommendable that the Australian Government has made significant progress in the fight against diabetes. The current healthcare system is considerable especially since it outlines the need for maintenance of high ethical standards that ensures the dignity of every patient is preserved without compromise on the quality of healthcare accorded. From the survey statistics, there is still much to be done in order to level the disparities n diabetes cases among various communities and socio-economic groups. There is also need for the measure and a continued awareness campaigns to enlighten the public on the risks and the predisposing factors for diabetes. Even though patient-centered care is appropriate, there are challenges such as lack of a controllable environment for the diabetes patients hence escalated risks of developing complications due to poor or lack of proper personal management at home. More research needs to be done on other additional healthcare quality improvement needs and better ways to prevent, manage or treat chronic conditions such as diabetes.
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