Home' GP Pulse : GP Pulse March 2014 Contents Guest Column
P6 : ISSUE 31 : March 2014
By Helen Rodenburg, Clinical Director, Long Term Conditions, Ministry of Health
Long-term, or chronic conditions as they
are often called, were defined by the New
Zealand National Health Committee (NHC)
in 2007 as any ongoing, long-term or recurring
condition that can have a significant impact on
Long-term Conditions (LTCs) are a ‘burning
platform’ that places growing pressure on our
health services, especially in primary care.
Evidence shows that effective primary care is
key to a high performing chronic care system.
We are seeing increasing examples of change
within New Zealand primary care that is
helping people to improve their health – a
positive future is possible.
– New Zealand overview
LTCs such as cardiovascular diseases and
diabetes are leading causes of deaths in New
Zealand. Two-thirds of New Zealand adults
and one-third of children have at least one
LTC. It is estimated that 75% of the health
spend is on people with LTCs.
Brian’s stor y
Brian was first diagnosed with Type 2
diabetes almost 10 years ago.
He says it was a real surprise. ‘T here hadn’t
been any family history of diabetes that
we know of.’ But since his diagnosis, he has
attended a self-management course, gained
new self-confidence, lost weight and now
has good control of his diabetes.
Brian, now 72, has been managing his
diabetes by moderating his diet and having
regular three-monthly check-ups with the
Brian’s says the biggest ongoing challenge is
his ‘healthy appetite’.
Over time, he has learned which foods he
can eat in moderation and those best to
avoid. Chocolate is out, but he still likes to
enjoy a cool beer on a hot summer’s day,
even if it’s a low-alcohol, low-sugar brand!
A few years ago, Brian’s GP suggested the
green prescription programme as a way
to maintain weight and increase activity.
Joining the local gym with an individual
programme has increased his mobility and
‘ I must admit, I really enjoy the sociability of
I’m really pleased with the results, and I feel
He also takes par t in many of the green
activities such as group walks.
Brian’s advice to people new to diabetes
is to ‘look after yourself, eat well and
exercise, but don’t give up on all of life’s
for LTCs such as diabetes and chronic
Up to 80 percent of premature hear t
disease, Type 2 diabetes and stroke could be
prevented by modification of risk factors in
The Ministry of Health’s vision is that New
Zealanders living with LTCs can expect:
high quality, patient-focused care that is
integrated across the health system
to be regarded as leading par tners in their
The Ministry’s LTC programme of work
suppor ts the health sector through a people
and systems approach.
LTC patient-focused care means having
adequate time to ask people ‘what matters
to you?’ (not ‘what’s the matter?’). It means
working with the patient (and his or her family/
whanau) to develop their own goals with
action plans and to improve their wellbeing.
People living with long-term conditions need
enough information to make shared decisions
and understand their medication requirements.
Although people are generally living longer in
full health, many are entering older age with
multiple long-term health conditions.
LTCs account for a higher propor tion of
illnesses and deaths among Maori, Pacific
people and people on low incomes than
the general population, contributing to their
worsened health outcomes.
Lifestyle factors such as smoking, unhealthy
food choices, physical inactivity and harmful
use of alcohol are the main risk factors
What matters is functional status and social
par ticipation. Mental health problems can be a
barrier to good health and evidence suggests
that improving self-management can also
improve mood as well as other health indices.
This can, in turn, lead to reduced ED, hospital
and GP visits.
People living with LTCs need enough
information to make shared decisions and
understand their medication requirements.
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