Self-Management Education and Support University of Victoria Sherry Lynch and Jennifer Ramsay Chronic Care Model Health System Community Resources Health Care Organization and Policies Self- Clinical Delivery Decision Management System Support Information Support Design Systems Informed, Productive Prepared, Activated Interactions Proactive Patient Practice Team Functional and Clinical Outcomes Definition of Self-Management The tasks that individuals must undertake to live well with one or more chronic conditions. These tasks include having the confidence to deal with medical management, role management and emotional management of their conditions. The US Institute of Medicine 2004 Community Self-Management Programs in BC Chronic Disease Self-Management Program Punjabi /Chinese Chronic Disease Self-Management Programs Chronic Pain Self-Management Program Diabetes Self-Management Program Active Choices Program Matter of Balance Program Youth Self-Management Pilot What do people learn in self-management programs? Information From the program From other participants Practical Skills Getting started skills (e.g., exercise) Problem-solving skills Communication skills Working with health care professionals Dealing with anger/fear/frustration Practical Skills (cont’d) • Dealing with depression • Dealing with fatigue • Dealing with shortness of breath • Evaluating treatment options Cognitive Techniques • Self-talk • Relaxation techniques Self-efficacy Enhancing Strategies Self-efficacy: Health Outcomes Mastery Learning Modeling Reinterpreting Symptoms Persuasion Self-Management Skills Problem solving Decision making Resource utilization Patient-provider relationships Taking action (Same as skills per Mapping Project) CDSMP Implementation in BC 2000-09 Leader-training workshops 179 New Leaders 1950 Number of courses delivered 984 Number of course participants 10,626 Percentage of English-speaking British Columbians with chronic health conditions that have access to self-management education programs within a year. Goal: 75% by 2010 Access = the program is offered at least once a year within a 50 km radius. Evaluation Results in BC 1989 - 2009 Ten Studies • Self-efficacy (10) • Pain (7) • Health (7) • Depression (5) • Stress (5) • Disability (6) Department of Health & Human Services Centers for Disease Control and Prevention Atlanta, GA Meta-Analysis on Evidence of the Arthritis Self-Management Program and the Chronic Disease Self-Management Program Expert Panel Julie Barlow, PhD Basia Belza, PhD Coventry, UK University of Washington, WA Joshua Chodosh, MD Kris Ernst, RN Los Angeles, CA Atlanta, GA Victoria Fung, MPH Lori Gerhard Los Angeles, CA Washington, DC Jean Goeppinger, PhD Kate Lorig, DrPH Chapel Hill, NC Palo Alto, CA Patrick McGowan, PhD Marcia Ory, PhD University of Victoria, BC College Station, TX Daniel Solomon, MD Edward H. Wagner, MD Boston, MA Seattle, WA Nancy Whitelaw, PhD Teresa Brady, PhD Washington, DC CDC, Atlanta GA RE – AIM Framework 1. Reach 2. Effectiveness 3. Adoption 4. Implementation 5. Maintenance www.re-aim.org 1. Proportion and representativeness of the target population willing to participate. 2. Impact of the program in terms of outcomes and quality of life. 3. Proportion and representativeness of organizations and staff agreeing to deliver the program. 4. Degree to which interventions are delivered consistently as planned across staff, patients, program components, and time. 5. Extent to which behaviour change is maintained over the longer term and, at the setting level, the extent to which the program is maintained by the organization. Marketing Brochures, Posters Media Presentations Health Professionals Toll-free line: 1-866-902-3767 Web site: www.coag.uvic.ca/cdsmp Maintain List Chronic Care Model Health System Community Resources Health Care Organization and Policies Self- Clinical Delivery Decision Management System Support Information Support Design Systems Informed, Productive Prepared, Activated Interactions Proactive Patient Practice Team Functional and Clinical Outcomes The Flinders Model 5 Minute Empowerment Stages of Change Motivational Interviewing The 5 A’s Approach Health Care Professionals Delivering Self-Management Support 1. Assess 2. Advise 3. Agree 4. Assist 5. Arrange SMS Strategies Establish a Rapport Setting the Agenda Health Risk Appraisals Readiness For Change Ask - Tell - Ask Closing the Loop Making Action Plans Problem-Solving Process Follow-up “Patients as Partners” • We want “Informed Activated Patients” and “Prepared, Proactive Practice Teams” • The mechanism to achieve this is through: 1. Community self-management programs 2. Health care professionals using self- management support strategies.
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