Primary Health Care

Introduction

Primary health care is the first care which is mainly provided by GP practices, dentalpractices,community pharmacies and spec saveropticians. 90% peoplecontactwith primary care services. Primary health care providers refer the patientsto secondary care services which needs special medical care.

Secondary care service provided by medical specialists who generally don’t have first contact with patients, care is mainly provided by hospitals and clinics.

Tertiary care refers to those services which are highly technical and special services mostly provided by private medical professionals. It includes intensive care units and advanced diagnostic support services.

Aspect of discussion

I would like to discuss on the most common disease that is diabetes mellitus which is one of the fastest growing disease in this era. It is a complex metabolic disorder in which a person has high blood sugar. It may be resulting from defects in insulin secretions or insulin action. In this condition blood has a high level of glucose because body cannot use it in right way. Pancreas produces certain types of hormones and enzymes which helps to digest food and regulates blood glucose. These are produced by tiny cells known as islet on Langerhans. Most of the cells are beta cells which produce and store insulin. Also locate the alpha cells which produce and store glycogen. Glycogen counteracts the effect of insulin. After taking a meal carbohydrates in the meal converted into the glucose in the intestine and in liver and then enter the blood stream. After that beta cells sense the glucose level in the blood stream and secrete insulin. But because of any dis-functioning when pancreas does not produce any insulin and allows glucose to enter the body cells is called diabetes. It may be hereditary or mostly occurs in over 40 age-group people.

Mainly Diabetes Is Of Two Types

1. Type 1 occurs when body fails to produce insulin and the person needs to inject insulin it is called insulin dependent diabetes mellitus.
2. In type 2 cell fails to use insulin properly it is called non-insulin dependent diabetes mellitus.

Gestational diabetes occurs in pregnant women, in this type blood glucose level become high during pregnancy then it may lead to development of type 2 diabetes.

Signs and Symptom

Both types have similar signs

1. Polyuria
2. Polydipsia
3. Polyphagia
4. Fatigue
5. Blurred vision
6.  Feeling of numbness
7.  Dry itchy skin
8.  Slow healing of cuts and wounds
9.  Genital itching

Epidemiological Overview

Worldwide many people suffer from diabetes. 2.8% population has this disease its number increases rapidly. InUKnumber of people diagnosed has increased by more than 150,000.The data from GP practices shows that one in twenty of population is treated for diabetes and one in ten for obesity which is the main reason of diabetes.

InLuton9,000 peoples registered with GP who have diabetes. In this 4.3% are men and 5.0% are women and it is estimated that 350 new cases are found every year related to diabetes.

Complications

1. Heart disease and stroke
2. Nerve damage
3. Retinopathy
4. Kidney disease
5.  Joint pain
6.  Foot problems
7. Hypoglycemia
8. Visual impairment
9. Sexual dysfunction
10.  Miscarriage and stillbirth
11. Amputation

Controling Measures

1. Self-care is essential.
2. Always eat notorious food.
3. Take regular exercise.
4. Regular check -up of urine for albumin is important to manage diabetes.
5. Weight management programs for adults and children
6. Keep your weight under control
7. Never smoke.
8. Take medicine at time and if there is need to check sugar then learn how to check.
9. Take sugar free diet which is available.
10. By taking these minor things in mind one can control diabetes.

Screening and Prevention:

Screen tests are vital for diabetic complications i.e. foot examinations, retinopathy screening, and retinopathy symptoms. Good balanced diet is also helpful. Physical activities should be increased, keep your diabetes under control, eyes, feet, skin, teeth and gums should be keep healthy

Treatment

Type1 of diabetes is always treated with insulin injections.
Type2 mainly requires healthy balanced diet, good exercise, physical activities to lose weight, some people need medication or insulin injection to get normal glucose level. Insulin can be given in different ways. It is of six types. Health care team decided which type is effective for a patient. Insulin is given via an injection,

by use of a syringe, pen device or by using an insulin pump. Mainly it is given under skin (subcutaneously) it may be administer in the stomach, thighs and inupper arms. When insulin is injected it is absorbed by blood vessels, then reaches in the bloodstream. Some medicines are also used to control glucose level. The best treatment is to adopt healthy lifestyle and early detection of disease.

In my area people are served in easy ways nurse is the first who would know the history of patient. There are some other resources for diabetic patients:

1. Support groups
2.  Supporting membership
3.  Care line and advocacy
4. Languages Centre
5. Insurance

These services offer advice, provide support, information, care events, latest research news and share experiences with group of diabetic patients as well as to their friends and family members.

It is very easy, first patient comes to GP when he recognizes the symptom of diabetes. They ask the patient about his family history, signs of experience etc. Then they will take urine and blood sample. They check it for glucose level; if urine contains glucose then blood test for glucose is essential. Fasting blood sample is most reliable to check diabetes. Oral glucose tolerance test is also available for the patients whose blood glucose level is not high enough for GP to diagnose diabetes.

Urine test for glucose level is simple and takes few minutes, on the other hands in FBS cases the patient has to go GP earlier with empty stomach but in OGT test the patient have to wait for some hours because they have drink a glucose drink after that in every half an hour or two hours blood tests are taken for testing how the body is reacting with glucose. In this type of test the patient have to wait for some hours but this type of test is taken in rare cases.

As everybody knows that diabetes is not a cure able disease, it can be controlled by medication or by injecting insulin. The patient who is receiving the care should know the clinical qualities to improve the health by taking the preventive, diagnostic, therapeutic and rehabilitative measures like eat healthy food.

Take regular exercise to reduce body weight, should not smoke because it induces vasoconstriction, and take regular treatment and checkup to control glucose level people with diabetic have to follow guidelines and clinical care. These are designed to access self-education and management, It is the only nurse who comes to contact with patient. She makes good interpersonal relationship with him. She advices the patient about meal plan and explain procedures of insulin

for self- injection. She tells him to eat carbohydrate diet before exercise. She taught to assess feet, hands, soft tissue injuries, dryness of skin so the patient can identify the symptoms. Every nurse should have through knowledge and good experience to satisfy the patient. The evidence based knowledge tells NHS all knowledge and direct experience which they have to consult.

InLuton, most of people are Asian and Europeans. They have mostly this kind of disease; they did not know well English so in this area there are multilingual nurses who help health care services in identifying diabetic patients. She speaks with them in their own language and detects their problems. This is also helpful

to educating people about sign and symptoms, causes, treatment, prevention, facilities given and to supporting. She told them if they have related signs she took a finger prick test.so it is early detection to identify diabetes. Then she reports to nearby GP and patient get treated in best way.

Overviews On This Topic

It is clear that the care provisions to diabetic patients are excellent and fit for its purpose. Nursing interventions are good and helps the local people to maintain their health. Patients of this disease get accurate treatment and well supported by care providers. If patients follow right instructions then they are able to get control on this disease. It is not one sided work in this both patients and care centers co-ordination is necessary. An experienced and qualified nurse is always required for excellence service provision because sometimes patients are diagnosed wrongly. The main care is started from GP and its provision is fit for patient care which is its main purpose.

References

1. ABC of Diabetes, First edition 2002 (Author “Peter.J.Watkins” )
2. Care of people with Diabetes- A manual of nursing practice, Edition 2009 (Auther “Trisha Danning ).
3. www.nhs.uk