Action Planning in Chronic Disease Self Management - PowerPoint

							Chronic Disease
Self-Management


     Does It work?
     Sharon Johnson M.S.
     Associate Professor Health and Human Sciences
     Oregon State University Extension Service

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Question Number 1.
                 Diabetes, arthritis,
Do               osteoarthritis,
                 osteoporosis,
you              osteopenia, cancer,
                 heart disease,
have….           hypertension,
                 fybromyalgia,
                 depression, stroke,
                 asthma, lung disease,
                 multiple sclerosis,
                 Parkinson‟s disease

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Question Number 2.

                 Scared?
How              Frustrated?
do               Fatigued? Angry?
                 Depressed?
you              Anxious? Sad?
                 Confused?
feel?            Uncertain?
                 Isolated?
                 Fearful?
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Question Number 3.

What
are
you
going
to
do
about
it?
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Here‟s an idea.

                  Close your eyes….




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Close your eyes…get comfortable….

  Imagine you‟re holding a big, bright yellow lemon.
  Picture it in your mind. You can feel the texture of
  the lemon rind in your hand. Now lift the lemon to
  your nose. You can smell its strong citrus
  aroma…now bring the lemon to your mouth and
  take a big bite out of that lemon. …it‟s juicy….that
  juice squirts through your mouth…you can taste the
  tart lemon juice filling your mouth…the juice
  dribbles down your chin…suck the juice of that
  lemon.

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There‟s a demographic tidal wave
and it‟s headed our way…

   Increased life
    expectancy

   More older
    adults

   More chronic
    disease
    Sources: Pew Internet and American Life
    Project, Centers for Disease Control (CDC),
    Merck Institute, Gerontological Society of
    America (GSA)
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“Chronic diseases are live wolves
                                           they travel in packs…”

     People with chronic
     diseases 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


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Chronic Disease Self-Management
Stanford University Model


   Stanford University‟s           Designed to enhance
    patient education program        medical treatment
    (“Living Well”)
                                    Outcome-driven: impacts
   Highly structured six-week       show potential for
    series of workshops
                                     reduced or avoided costs
   Participative instruction
    with certified leader peer      Evidence-based: a tested
    support                          model (intervention) that
                                     has demonstrated results



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What happens….


   You accept responsibility to
    manage or co-manage your
    own disease conditions

   You become an active
    participant in a system of
    coordinated health care,
    intervention and
    communication

   You are encouraged to
    solve your own problems
    with information (but not
    orders) from professionals

    Sources: Stanford University Patient
    Education Center; Center for Healthy
    Aging (NCOA)
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Why these techniques work…

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

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




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What‟s the content of these classes?

   Distraction and cognitive
    symptom management

   Breathing techniques

   Nutrition and fitness

   Fatigue management

   Relaxation approaches

   Communication strategies;
    working with your health care
    professional


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The Stanford Model: Impact
All studies look at behavior, health status and utilization.


   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)                     14
Impact…with details
   Improved quality of life   Example: (initial findings)
                                 Decreased hospital stays:
                                  .49 days, per patient, over
   Specific improvements         a two year time period
    in healthful behaviors
                                  Decreased
                                   physician/emergency room
   Improvement in overall         use: 2.5 fewer visits to the
                                   emergency room and to
    health status                  physicians, per patient,
                                   over a two year time period

                                   Source: Stanford University
                                   Patient Education Center; Center
                                   for Healthy Aging

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Southern Oregon impacts…

   Increased physical        Improved attitude
    activity                  Less health
   Cognitive symptom          distress
    management
                              Less fatigue
   Improved
    communication             Reduced disability
    with physicians           Fewer social/role
   Better self-reported       limitations
    general health
                               Sources: Stanford University Patent
                               Education Center; published articles   16
                               1997-2003) (Lorig, K)
Impact…
                     …Southern Oregon stories

   Steve: These distraction             Sept 2008 Telephone Survey
    techniques are remarkable.               (random sample of eleven individuals who
                                             had completed the series five months earlier)
    Counting backward by 3‟s from
    100….I‟m usually pain free by 79.”
                                            All respondents indicated
                                             they were still using
   Timothy: Marveling at the                specific approaches
    changes in his wife…
    Timothy’s wife: “I didn‟t want to
    let my class down.”                     „Relaxation techniques‟,
                                             „Action planning” and
   Char: “I lost ten pounds; my blood       „Communication skills‟ most
    sugar is down. I even made new           frequently referenced
    friends in the class. I plan to be
    trained as a program leader….”
                                            “Attitude improvement”
                                             cited in 40% of
                                             respondents

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

    Patients can learn to take day-to-day
     responsibilities for their diseases

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

   Better utilization of current
    resources necessary; more
    efficient use of physician
    time desired
    Sources: Society of Behavioral
    Medicine publication (Lorig K., Holman,
    H.)
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Summary:
Chronic Disease Self-Management means:
 Managing the work of dealing with a chronic
   disease and/or multiple disease conditions

   Staying involved in 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)
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For more information
Sharon Johnson M.S.
Associate Professor
Oregon State University
Southern Oregon Research and Extension
569 Hanley Road
Central Point, OR 97502
541-776-7371 x210
s.johnson@oregonstate.edu
www.sohealthyoregon.org 541-864-9611
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