|Summative: Analytic Study of a Patient or patient Group (3000 words)
Students will present an analytical study of patient/ patient group and the way in which their chronic disease health and social care needs are managed. The study will conclude with recommendations for service delivery and development.
Students will be expected to demonstrate:
• Key issues in the management of long term conditions
• critical evaluation of relevant organisational, educational and clinical models to support practice
• Autonomous application of these theories in their work environment and discussion on ways in which the service for this group of patients maybe developed or improved
Evidence from practice may be used to support the case study and presented as an appendix to the main body of the work.
|The module aims are to enhance the students’ understanding and knowledge of the concepts and principles of chronic disease management
• To develop a critical understanding of models of chronic disease management
• To develop strategies to empower people to develop knowledge and skills to self care
• To equip students with the knowledge and skills to facilitate appropriate methods of chronic disease management and appropriate service referrals.
|By the end of the module the student will be able to:
Subject knowledge and understanding
• Critically explore and evaluate existing models of delivery of care for long term conditions
• Utilise a comprehensive knowledge and understanding of the global and national context of the management of long term conditions
• Critically evaluate understanding and beliefs of illness and disease across the life span
• Develop an in-depth understanding of the impact of cognitive and behavioural factors on people in relation to long term conditions
• Critically evaluate referral pathways for long-term conditions.
• Develop an appreciation of the legal and ethical parameters of chronic disease management
• Develop autonomy in skills for leadership, project management and practice organisation to arrange appropriate service delivery for chronic conditions
• Carry out risk assessment and stratification for a range of chronic diseases
• Develop advanced communication skills
• Demonstrate a critical understanding of the evidence base underpinning chronic disease management
• Critical evaluate information management systems and their importance in long term care
• Critical analyse guidelines, care pathways, roles and responsibilities in shared care
• Develop an in-depth understanding of models of education and empowerment and use this to advance understanding of the importance of self-care in long-term conditions.
• Demonstrate high level communication skills and strategies to work across boundaries within a multi-professional team
• Develop skills of critical reflection through case and family analysis
|Advanced Communication skills
Public health and the epidemiology of long term conditions
Political and service delivery systems affecting management
Information systems, disease registers, recall systems
Multi-agency care and the role of guidelines and care pathways in primary care
Leadership skills and team work in health care
Legal and ethical issues in chronic disease management
Characteristics of specialist and generalist practitioners
Organisational systems analysis
Models of empowerment and patient education
Models of rehabilitation
The expert patient
Effective self care
Risk assessment and stratification in chronic conditions e.g. in diabetes, cardiovascular, renal, respiratory and mental health
Risk assessment tools
Clinical decision making in the context of chronic disease management
|Methods of Teaching/Learning
|Taught: 48 hours
Self-directed/ workbased learning: 152 hours
Audit Commission (2004). Older People – Indpendence and Well-being: the Challenge for Public Services. Audit Commission. London
Corben S, Rosen (2005) – Self Management of Long term Conditions: Patients Perspective on the way ahead. Kings Fund, London
Department of Health (2002) Screening/Case finding: A practical aid to implementation in primary care
Department of Health (2004) Improving Chronic Disease Management Department of Health.
Department of Health (2005b) The National Service Frameworks for Long-term Conditions 265109, HMSO, London
Department of Health (2005c) Supporting People with Long-term Conditions to Self-Care 3853, HMSO, London
Department of Health (2006b) Supporting People with Long-term Conditions to Self-Care a Guide to Developing Local Strategies and Good Practice, 5411, HMSO, London
Department of Health (2006). A New Ambition for Old Age; implementing the NSF for Older People. Department of Health. London.
Department of Health (2008a) Cares at the Heart of 21st Century Families and Communities: A Caring System on your Side, a Life of your Own, 286149, HMSO, London
Department of Health (2008b) High Quality Care for All: NHS Next Stage Review Final Report, HMSO, London
Department of Health (2008). Healthcare Services for Older People. Department of Health. London.
Department of Health (2008) End of Life Care Strategy: promoting high quality care for adults at the end of life. Department of Health. London.
Disease Management (2001) New generation of predictive modelling tools emerging. Disease Management 6
Dixon J. et al (2004) Managing chronic disease: What can we learn from the US experience? London: King’s Fund
Freeman R. (2000) The Politics of Health in Europe (European Policy Research Unit S.) Manchester University Press.
Institute of Medicine (2001) Crossing the Quality Chasm: a new health system for the 21st Century National Academy Press, Washington DC
Iles V. & Sutherland K. (2001) Managing Change in the NHS : Organisational Change – available on www.sdo.lshtm.ac.uk
Kernick D. (Ed) (2004) Complexity & Healthcare Organization : A view from the street Radcliffe , Oxford.
Kemshall, H. and Littlechild, R. (eds) (2000) User involvement and participation in social care : research informing practice London : Jessica Kingsley.
Kings Fund (2006) Combined Predictive Modeul Final Report, Kings Fund, London
Managing Chronic Diseases BMJ Themed Issue 19 March 2005 (Vol 330, No 7492)
Metcalfe J (2005) The Management of Patients with Long Term Conditions, Nursing Standard 19 (45) July 10 p23-60
McHugh, G, Charmers, K, Luker, K. (2007) Caring for Patients with COPD and their Families in the Community, British Journal of Community Nursing, 12(5) 219-22
Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives: http://www.nmcuk.org
Peckham, S and Exworthy, M. (2003) Primary care in the UK : policy, organisation and management Basingstoke : Palgrave Macmillan
Pollack A. (2004) NHS PLC: The privatisation of our healthcare Verso Books
Singh, D. (2005) Transforming Chronic Care. Evidence about Improving Care for People with Long Term Conditions, University of Birmingham Health Services Management Centre
Stevenson J. Spencer L. (2002) Developing intermediate care : a guide for health and social
service professionals London : King's Fund
Rollmick, S, Miller, WR. (1995) What is Motivational Interviewing, Behavioural and Cognitive Psychology 23: 325-34
Wakley G. & Chambers R. (Eds) (2005) Chronic Disease Management in Primary Care: Quality and Outcomes Radclifffe, Oxford
Wanless D. (2002) Securing our Future Health: Taking a Long-Term View Final Report HM Treasury
Webster C .(2002) The National Health Service : a political history Oxford University Press
World Health Organisation (2002) Innovative Care for Chronic Conditions: Building Blocks for Action. Ref Type: Generic
Zimmerman, B., Lindberg, C. and Plsek, P. (1998) Edgeware, VHA inc, Irving, Texas
Journals and websites
Health Service Journal
Critical Social Policy
Department of Health (2009) Living well with Dementia, a National Dementia Stratagy
Supporting People With Long Term Conditions Homepage
Long Term Conditions on NHS Networks
Primary Care CDM
(click on Primary Care and select the Chronic Disease Management link).
Our Healthier Nation
(click on People and Communities and select Expert Patients).
Kings Fund Reading Lists
|3RD AUGUST 2010