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Chronic Disease Self-Management

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					Chronic Disease Self-Management


  A Patient-Centered Option for
Managing the Healthcare Challenge

                          Presentation prepared by:

                                John Irwin,
               Healthcare & Community Informatics Consultant,
  Stanford Licensed Chronic Disease Self-management Program Master Trainer
          Today you will hear…

   An introduction to chronic disease self-
    management

   A closer look at one evidence-based self-
    management program
              Impacts of Chronic Disease

   Chronic disease will increase 300% by 2049
   Chronic disease results in pain, debilitation,
    disability, dependence, lost physical function,
    and less mobility
   Chronic diseases include: heart disease,
    cancer, stroke, arthritis, asthma, lung disease,
    cancer, diabetes, hypertension, osteoporosis,
    multiple sclerosis, Parkinson’s disease…
Sources: NGA study; Stanford University Patient Education Center ,
http://www.stanford.edu/group/perc/
         Financial Reality - Rising costs…
   Chronic disease costs: 75-95% of health care
    expenditures!

   By 2030: Anticipated increase in healthcare
    costs tied to chronic disease, 25% to 54%
    Sources : Partnership for Solutions: Better Lives for People with Chronic Conditions, WA
    State ; Health Affairs, 2005; 24 (1) 80-92; Center for Healthy Aging (NCOA)
People With Chronic Disease Report…

      Significantly reduced productivity
      Living with less income
      Accomplishing less
      Spending more time in bed sick
      Having poor mental health

   Sources: Stanford University (Lorig, K.); Center on an Aging Society,
   National Institute on Aging
     Self-Management Definition

   “Involves [the person with the chronic disease]
   engaging in activities that protect and promote
health, monitoring and managing of symptoms and
signs of illness, managing the impacts of illness on
       functioning, emotions and interpersonal
 relationships and adhering to treatment regimes.”

Source: Center for Advancement in Health (1996). Indexed bibliography on Self-
management for People with Chronic Disease. Washington DC.. Page 1
Self-Management Benefits Patients…


 Builds confidence (self-efficacy) to perform 3 tasks
     - Disease management
     - Role Management
     - Emotional Management
 Focuses on improved health status and appropriate
 health care utilization
      Self-Management Differs
      From Patient Education
Self-Management
- Manage life with disease
- Increase skills & self-confidence
- Problem solve and make decisions

Patient Education
- Change behaviors
- Increase knowledge
- Use specific tools (e.g., Care Plans, Action Plans)
            Self-Management Also
                Encompasses

 The patient and health professional working together.
 Often involves the family.
 An holistic approach to care (i.e., medical and psycho-
  social components of a condition).
 Pro-active and adaptive strategies that aim to empower
  the individual.
             Patients Increasingly Want
              to Retain Independence
More people with chronic disease believe…

 They have a “right” to take part.
 They are capable of taking part, with the right
  supports.
 Patient assertiveness is necessary…and needed.


Source: California Healthcare Foundation
             Chronic Disease Self-
           Management Assumptions

   Patients with different chronic diseases have
    similar self-management problems and
    disease-related tasks.

   Patients can learn to take day-to-day
    responsibility for their diseases.

   Confident, knowledgeable patients practicing
    self-management will experience improved
    health status and use fewer health resources.
Source: Lorig and Holeman 2003
         Self-Management Framework

   Patients accept responsibility to manage or co-
    manage their own disease conditions.

   Patients become active participants in a system
    of coordinated health care, intervention and
    communication.

   Patients are encouraged to solve their own
    problems with information, but not orders, from
    professionals.
Sources: Stanford University Patient Education Center; Center for Healthy Aging (NCOA)
Self-Management Skills

  Problem-solving
  Decision-making

  Resource Utilization

  Formation of a patient-
   provider partnership
  Action-planning

  Self-tailoring


 Source: Lorig and Holeman 2003
Chronic Disease Self-Management Means…


    Taking care of your illness (using medicines,
     exercise, diet, technology, physician partnership)
    Carrying out normal activities (employment,
     chores, social life)
    Managing emotional changes (anger, uncertainty
     about the future, changed expectations and
     goals, and depression)
 It means having a combination of …
        SKILLS, SUPPORT, PRACTICE and CONFIDENCE
              Chronic Disease Self-
          Management Program (CDSMP)
              …the Stanford Model
   Developed by Stanford University’s patient education
    program
   Structured w/~15 participants in a six-week series
    of workshops
 Participative instruction with peer support
 Designed to enhance medical treatment
 Outcome-driven: impacts show potential for reduced
  or avoided costs
 Evidence-based: a tested model (intervention) that
  has demonstrated results
                  Stanford’s CDSMP
                  is Evidence-based

   Found to truly benefit targeted populations.

   Demonstrated it does not cause harm.

   Demonstrated it does not waste resources.
    Reference: http://www.aoa.gov/evidence/evidence.asp; www.healthyagingprograms.org
The Stanford CDSMP Model
 Why these techniques work…

      Peer educators
      Constant modeling
      Active problem-solving
      Formal brainstorming
      Goal-setting
      Action planning

   Source: National Council on Aging, http://www.ctb.1si.ukans.edu,
       www.healthyagingprograms.org
                     CDSMP Content

Content/Week                                                1   2   3   4   5   6
Overview of self-management and chronic health conditions   P
Making an action plan                                       P   P   P   P   P   P
Relaxation / Cognitive symptom management                   P       P   P   P   P
Feedback / Problem solving                                      P   P   P   P   P
Anger / Fear / Frustration                                      P
Fitness / Exercise                                              P   P
Better breathing                                                    P
Fatigue                                                             P
Nutrition                                                               P
Advance directives                                                      P
Communication                                                           P
Medications                                                                 P
Making treatment decisions                                                  P
Depression                                                                  P
Informing the healthcare team                                                   P
Working with your healthcare professional                                       P
Future plans                                                                    P
Participant’s Learn How to
Manage the Symptom Cycle
               Disease


   Fatigue                   Tense Muscles

              VICIOUS
               CYCLE

Depression                    Stress/Anxiety


         Anger/Frustration/Fear
Participant’s Learn and Practice
        Action Planning
     Something YOU want to do
     Reasonable
     Behavior-specific
     Answer the questions:
       What?
       How much?
       When?
       How often?
     Confidence level of 7 or more
      The Stanford Model: Content…
        “meets the test of common sense”

   Techniques to deal with frustration, fatigue, pain,
    and isolation.
   Exercises/activities for maintaining and improving
    strength, flexibility, and endurance.
   Medication management.
   Approaches for improving communication with
    friends, family and health professionals.
   Nutrition information.
   Treatment evaluation information.
         The Stanford Model: Impact

All studies looked at behavior, health status and utilization.
 Findings included:

    Improved self-efficacy
    Reduced use of doctors, hospital emergency
     rooms
    Improvements in health status - identified by
     BOTH the participant and the health provider

     Sources: Stanford University Patient Education Center; Society of Behavioral Medicine
     publication (2003)
             Impact (continued)…

 Improved quality of life
 Specific improvements in healthful behaviors
 Improvement in overall health status
 Decreased hospital stays: .49 days, per patient,
  over a two year time period
 Decreased physician/emergency room use: 2.5
  fewer visits to the emergency room and to
  physicians, per patient, over a two year time
  period

Source: Stanford University Patient Education Center; Center for Healthy
Specific health-related impacts…

 Increased physical activity
 Cognitive symptom management
 Improved communication with physicians
 Better self-reported general health
 Improved attitude
 Less health distress
 Less fatigue
 Reduced disability
 Fewer social/role limitations
Sources: Stanford University Patent Education Center; published articles 1997-2003 (Lorig, K)
       Creating an effective chronic disease
        self-management system locally -
                    Key Ingredients

                   Infrastructure
                   Community networks
                   Partnerships
                   Financial support
                   Sustained marketing
                   On-going recruitment

Source: “Challenges and Successes in Implementing the Chronic Disease
Self-Management Program”, National Council On Aging,
http://www.healthyagingprograms.org/resources/CDSMPFinalReport.pdf
    Reasons to support this approach…

   Disease and demographic challenges will be
    unrelenting - “We need to start yesterday…”

   Limited availability of reliable, evidence-based
    (proven) approaches to chronic disease self-
    management

   Better utilization of current resources
    necessary; more efficient use of physician time
    desired
Sources: Society of Behavioral Medicine publication (Lorig K., Holman, H.)
                      Summary

Chronic Disease Self-Management is:

   Managing the work of dealing with a chronic disease
    and/or multiple disease conditions.
   Managing the work of dealing with daily activities in light
    of debilitation and disability.
   Managing emotional changes resulting from or
    exacerbated by the disease conditions.
Once a chronic disease is present,
one cannot NOT manage, the only
       question is “how.”

                 (Bateson 1980, Lorig, 2003)
For further information…
                 Contact:
               John Irwin
Health & Community Informatics Consulting
             (541) 664-2456
            jirwin@mind.net
           www.callineb.com
                     Or
             Sharon Johnson
          Oregon State University
           (541) 776-7371 x210
       s.johnson@oregonstate.edu
 Additional information & results of studies:
   http://patienteducation.stanford.edu/

				
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