Religion as a means of resilience and adjustment to chronic illness

This qualitative study describes the understanding of health and belief practices among elderly Greek Australians. In particular, the role of religion is discussed as a means of resilience and adjustment to illness, as religious faith often influences individual’s thoughts, feelings, and how they may accept or understand their particular health condition. Adjustment has a strong psychological or emotional component that is likely to be affected by culturally determined conceptualizations of health. As such, the particular background of a population may be very significant in the level and means of adaptation of individuals and groups.

Co-morbid depression and chronic illness related to coping and physical and mental health status

A partial latent structural regression analysis was used to evaluate the role of coping resources, depression, diet and exercise on mental and physical health status. The sample consisted of 113 participants (59 females and 54 males) with a mean age of 59.38 years (SD = 10.52). Coping resources, depression and exercise explained 52 and 26% of the variance in mental and physical health status, respectively. Fewer coping resources predicted higher levels of depression and both predicted worse mental health. Only higher levels of depression predicted worse physical health status. There were also significant indirect effects of coping on mental and physical health status through depression. The development of cognitive, social and emotional coping strategies is important for managing depression and supporting positive mental health. These results highlight the important role of health psychologists in the care of individuals with chronic illness. Additionally, the management of depression is important in maintaining positive physical health.

Statistically modelling the relationships between Type D personality and social support, health behaviors and symptom severity in chronic illness groups

OBJECTIVE: The study aimed to develop a predictive model of how Type D personality influences health behaviours, social support and symptom severity and assess its generalisability to a range of chronic illnesses.

DESIGN: Participants were classified as either healthy (n = 182) or having a chronic illness (n = 207). Participants completed an online survey measuring Type D and a range of health-related variables. Chronic illness participants were classified as having either a functional somatic syndrome (i.e. chronic fatigue syndrome or fibromyalgia), where the underlying pathological processes were unclear, or illnesses such as type 2 diabetes, osteoarthritis or rheumatoid arthritis, where the causes are well understood.

MAIN OUTCOME MEASURES: Outcome measures were health behaviours, social support and both physical and psychological symptoms.

RESULTS: The rate of Type D was higher in chronic illness participants (53%) than in healthy controls (39%). Negative affectivity (NA) and social inhibition (SI) both correlated with outcome measures, although NA was generally the stronger predictor. Using NA and SI as independent subscales led to superior prediction of health outcomes than using categorical or continuous representations.

CONCLUSION: Findings suggest that the relationship between Type D and health outcomes may generalise across different chronic illnesses.

SA HealthPlus : a controlled trial of a statewide application of a generic model of chronic illness care

SA HealthPlus, one of nine national Australian coordinated care trials, addressed chronic illness care by testing whether coordinated care would improve health outcomes at the cost of usual care. SA HealthPlus compared a generic model of coordinated care for 3,115 intervention patients with the usual care for 1,488 controls. Service coordinators and the behavioral and care-planning approach were new. The health status (SF-36) in six of eight projects improved, and those patients who had been hospitalized in the year immediately preceding the trial were the most likely to save on costs. A mid-trial review found that health benefits from coordinated care depended more on patients' self-management than the severity of their illness, a factor leading to the Flinders Model of Self-Management Support.

Small-scale rural pilot programs in chronic illness management - what next?

In recent years, rural SA has been the recipient of significant funding to support a range of new primary health care initiatives. Much of this funding, additional to normal recurrent budgets in our health system, has facilitated effective change and development through demonstration and research projects across the state. The resultant work involves programs such as: ? coordinated care trials (COAG) ? more allied health services (MAHS) ? Commonwealth regional health service initiatives (CRHS) ? quality use of medicines (QUM) ? community packages for aged care services ? Indigenous chronic disease self-management pilot programs (CDSM) ? chronic disease self-management (CDSM) programs - Sharing Health Care SA ? chronic disease self-management (CDSM) programs in Indigenous communities. In addition to the resources listed above, funding was also provided by the Commonwealth to establish the South Australian Centre for Rural and Remote Health (SACRRH) and develop the University Department of Rural Health in Whyalla. While this new funding has led to substantial developmental work in chronic illness management in particular, one needs to ask whether the time might not be right now for these hitherto small-scale change initiatives to be transformed into ongoing mainstream programs, informed and guided by research outcomes to date. Is it time to move beyond tentative chronic illness programs and into mainstream reform? We have shown that there is much to be gained, both for patients and for the system, from improved coordination of primary care services and initiatives such as self-management programs for patients with chronic conditions. Better management leads to improved patient health outcomes and can reduce demand for unplanned hospital and emergency services. Many admissions to rural hospitals requiring expensive services, in terms of infrastructure and staffing, could be either prevented, or patients could be managed more effectively in the community as part of a wider primary health care program.