Chronic Disease Prevention and Management in Ontario's Acute Care Sector

As an Emergency Department nurse and now a leader in Quality and Patient Safety for a large acute care health service system, there are many chronic diseases relevant to my practice. In the sector of acute care hospitals, we continue to see recurrent disease presentations resulting in required admissions. Among the most common and complex presentations resulting in the longest length of stay and thereby creating the greatest strain on acute care resources are:

• Chronic Obstructive Pulmonary Disease

• Congestive Heart Failure

• Stroke

• Diabetes

• Depression, Anxiety

• Various forms of cancer

When I dive deeper and examine the rates of some of the chronic diseases in my local community, region and province, I can see the following:

Chronic Obstructive Pulmonary Disease

Worldwide COPD is the leading cause of mortality and morbidity. The overall estimated prevalence of physician-diagnosed COPD in Ontario was 11.8% in 2014/15. The prevalence of COPD increased by 36.6% from 1996/97 to 2014/15. COPD is the second most frequent diagnosis requiring hospitalization after childbirth.

The Mississauga Halton Local Health Integration Network sees 10.5 Emergency Department visits, the lowest in Ontario. In Ontario, from 2008 to 2011, people with COPD accounted for 24% of hospitalizations, 24% of emergency department visits, 21% of ambulatory care visits, 30% of home care services, and 35% of long-term care residents (Evidence to Improve Care: COPD, 2023).

Congestive Heart Failure

Heart failure is a common, progressive chronic condition that ultimately is fatal. 50% of people with heart failure die within 5 years of diagnosis and over 90% die within 10 years. roughly 250,000 people had been diagnosed with heart failure or about 1.8% of the province’s entire population. Prevalence varied across the province, from 1.34% in the Mississauga Halton Local Health Integration Network (LHIN) to 2.53% in the North East LHIN. Heart failure is one of the five leading causes of hospitalization and 30-day readmissions and the most common cause of hospitalization for people over age 65. (Health Quality Ontario, 2019)

The primary determinants of chronic disease in my practice are laid out below. When we examine the determinants for COPD, we can note the disease typically affects those over the age of 35 years. The primary cause is linked to smoking – both active and passive exposure. (Public Health Agencies of Canada, 2018). Other risk factors include exposure to chemicals and air pollution and certain genetic deficiencies such as Alpha-1 deficiency. (COPD Causes and Risk Factors, 2022).

The Centre for Disease Control indicates that when compared to those at a normal weight, people with overweight or obesity are at increased risk of heart disease and stroke and their risk factors, including high blood pressure, high cholesterol, and type 2 diabetes. Physical inactivity can also lead to heart disease. The most significant modifiable behaviours associated with cardiovascular disease are age, sex, unhealthy diet, sedentary lifestyle, smoking and the excessive use of alcohol (Mishra R, 2019).

Works Cited

COPD Causes and Risk Factors. (2022, November 17). Retrieved from American Lung Association: https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/what-causes-copd#:~:text=Approximately%2085%20to%2090%20percent,Exposure%20to%20air%20pollution

Evidence to Improve Care: COPD. (2023). Retrieved from Health Quality Ontario: https://www.hqontario.ca/Evidence-to-Improve-Care/Quality-Standards/View-all-Quality-Standards/Chronic-Obstructive-Pulmonary-Disease/About

Health Quality Ontario. (2019). Quality Standards: Heart Failure.

Mishra R, M. (2019). Determinants of cardiovascular disease and sequential decision-making for treatment among women: A Heckman's approach. SSM Popul Health, 1-7.

Public Health Agencies of Canada. (2018, April). Asthma and Chronic Obstructive Pulmonary Disease (COPD) in Canada, 2018. Retrieved from Government of Canada: https://www.canada.ca/en/public-health/services/publications/diseases-conditions/asthma-chronic-obstructive-pulmonary-disease-canada-2018.html