After studying this chapter, you should be able to:• explain how the macro level of the Innovative Care for Chronic Conditions Framework addresses care for the person with a chronic condition• understand the importance of national health policy and strategic initiatives to improve primary care services• describe quality and monitoring systems within a chronic care nursing context• understand the importance of education for the nurse and other health professionals in the specialty of chronic care.
The macro level of the Innovative Care for Chronic Conditions Framework (ICCCF) reviews policy development and resource allocation. This level also considers the legislative framework and the ability of policymakers to adapt policies to meet changes in health care requirements and create effective intersectoral links. The fragmentation of financial incentives and its impact on health outcomes and services are considered. Maintaining quality health care and monitoring systems are included, together with continuing education for registered nurses.
A positive policy environment is the macro level that is required to support the micro and meso levels of the ICCCF. It is this level that provides the leadership, regulation and financial support for the health organisation, community and patient interaction (Epping-Jordan, Pruitt, Bengoa & Wagner, 2004).
Chronic conditions can be viewed as being on a continuum, spanning those with the condition to those without the condition, as these conditions develop over time, beginning with risk, developing into diagnosis and then moving into complications. An awareness of this continuum is required to understand the need to invest at all points in the development of chronic conditions in order to manage them effectively – this is why the ICCCF requires three levels in order to manage chronic conditions (Epping-Jordan et al., 2004).
Table 2.1 identifies the national competency standards for the registered nurse from the Nursing and Midwifery Board of Australia (NMBA) and the Nursing Council of New Zealand (NCNZ) that are addressed in this chapter.
Describing the macro level
The macro level of the ICCCF describes the positive policy environment that supports the care provided for people with chronic conditions (see Figure 2.1).