Self-Management Education and Support by miu18724

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									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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