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Also known nationally as the Chronic Disease Self-Management Program - Developed by Stanford University - Living Well with Chronic Conditions.

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Presentation on theme: "Also known nationally as the Chronic Disease Self-Management Program - Developed by Stanford University - Living Well with Chronic Conditions."— Presentation transcript:

1 Also known nationally as the Chronic Disease Self-Management Program - Developed by Stanford University - Living Well with Chronic Conditions

2 Introductory Note The Utah Approach to CDSMP and Diabetes Care: In no way is CDSMP to take the place of Diabetes Self-Management Education (DSME) DSME comes first and foremost for a patient with diabetes We would like to view CDSMP as complementary/supportive to the DSME process

3 Utah Arthritis Program Leads the administration of the Chronic Disease Self- Management Program in Utah Funding sources are the Centers for Disease Control and Prevention (CDC) and the Administration on Aging (AoA) Work in partnership with the CDC and AoA to address the burden of arthritis, and other chronic diseases, in Utah Primary objective is to develop partnerships around the state to increase access to and use of evidence-based programs

4 CDC Arthritis Funded States

5 AoA Funded States for CDSMP

6 Our Broad Goal To improve the quality of life for people affected by arthritis and other chronic conditions. I love CDSMP and ADEU!

7 The Chronic Disease Problem Research has shown that an increasing number of U.S. families are experiencing high financial burdens from medical care expenses, as rapidly rising health care costs are passed on to families in the form of higher premiums, deductibles, co-payments, and even reduced benefits. For people with chronic health conditions, such burdens can be a long-term problem that threatens their families' financial well-being. Commonwealth Fund (July 23, 2009)

8 The Chronic Disease Problem Approximately 30% of Utahns have at least one chronic condition (similar number for U.S.) Chronic diseases are the most prevalent and costly healthcare problems in the U.S. More than two-thirds of all deaths are caused by one or more of five chronic conditions: heart disease, cancer, stroke, COPD, and diabetes Sources: BRFSS, 2007; Centers of Disease Control and Prevention (CDC)

9 The Chronic Disease Problem Chronic disease not only affects health and quality of life, but is also a major driver of healthcare costs… Chronic disease accounts for about 75% of the Nation’s aggregate healthcare spending, or about $5,300 per person in the U.S. each year In taxpayer-funded programs, treatment of chronic disease constitutes an even larger proportion of spending: 96 cents per dollar for Medicare 83 cents per dollar for Medicaid Source: Centers of Disease Control and Prevention (CDC)

10 Chronic Disease Rates A ge-adjusted Rates: Utah Data: Utah BRFSS 2009 U.S. Data: National Center for Chronic Disease Prevention and Health Promotion, BRFSS Survey Utah High Cholesterol 25.9% Hypertension 25.4% Arthritis: 24.0% Asthma: 7.9% Diabetes: 6.9% U.S. High Cholesterol 37.6% Hypertension 26.7% Arthritis: 26.1% Asthma: 8.5% Diabetes: 8.5%

11 Prevalence of Arthritis Among Persons With Other Conditions, Utah Source: BRFSS, 2009

12 Stanford’s CDSMP In the past 20 years or so, the Stanford University, Patient Education Research Center has developed, tested, and evaluated self-management programs for people with chronic health problems All programs are designed to help people gain self- confidence in their ability to control their symptoms and how their health problems affect their lives Workshops are highly interactive, focusing on building skills, sharing experiences and support

13 Stanford’s CDSMP Once a program is developed, it is evaluated for effectiveness through a randomized, controlled trial, which is 2-4 years in length It is ONLY after a program has been shown to be safe and effective through these trials that it is released for dissemination This was the procedure for the Chronic Disease Self-Management Program (CDSMP)

14 Chronic Conditions Represented in CDSMP Workshops 52.7% Arthritis 41.0% High Blood Pressure 36.6% Chronic Joint Pain 34.8% Diabetes 33.2% High Cholesterol 27.4% Chronic Pain 23.5% Depression 17.2% Heart Disease 14.3% Asthma 13.2% Lung Disease 12.8% Fibromyalgia 8.0% Cancer 7.6% Kidney Disease Source: Utah Arthritis Program, 2010

15 Chronic Conditions Represented in CDSMP Workshops Source: Utah Arthritis Program, 2011

16 Living Well with Chronic Conditions Stanford Model of CDSMP

17 Program Description –Designed for people who live with any chronic condition –Based on the symptoms of chronic conditions –Participants learn tools that enable them to self-manage their symptoms –Community or healthcare-based settings

18 Living Well with Chronic Conditions Stanford Model of CDSMP Patient Engagement Activities –Participants learn how to identify problems –Participants learn how to act on problems –Participants learn how to generate short-term action plans –Participants learn problem-solving skills related to chronic conditions in general

19 Living Well with Chronic Conditions Stanford Model of CDSMP Program Subject Matter: –Dealing with frustration, fatigue, pain and isolation –Exercise for maintaining and improving strength, flexibility and endurance –Appropriate use of medication and proper nutrition –Communicating effectively with family, friends and health professionals –Evaluating new treatments

20 Living Well with Chronic Conditions Stanford Model of CDSMP Program Structure Series of 6 sessions, 1 session per week, 2 hours per session Held in community settings (including healthcare) Highly scripted curriculum

21 Living Well with Chronic Conditions Stanford Model of CDSMP Program Structure Designed to be lay-led; 2 leaders facilitate each class; at least 1 facilitator also has a chronic condition Workshops offered at no charge (free!) Available in Utah in English, Spanish, Tongan

22 Living Well with Chronic Conditions Stanford Model of CDSMP Week 1 –Difference between acute and chronic conditions –Short term distractions –Introduce action plans Week 2 –Dealing with difficult emotions –Physical activity and exercise Week 3 –Better breathing techniques –Muscle relaxation –Pain and fatigue management Week 4 –Future plans for healthcare –Healthy eating –Communication skills –Problem solving Week 5 –Medication usage –Making informed treatment decisions –Depression management –Positive thinking –Guided imagery Week 6 –Working with your healthcare professional –Planning for the future

23 Living Well with Chronic Conditions Stanford Model of CDSMP Improved Outcomes 6 mo.2 yrs. Self efficacy √√ Self rated health √ √ Disability√ Role activity √ Energy/fatigue√√ Health distress√√ MD/ER visits√√ Hospitalization√ Lorig, et al 1999, 2001

24 Living Well with Chronic Conditions Stanford Model of CDSMP Improved Outcomes Self-efficacy X X XX Self-rated health X X Fatigue X XX Anxiety/Distress X XX Role limitation X X HRQOL X Pain X Exercise X XX Cog. Symp mgmt X XX 1=Lorig 05, 2=Barlow 05, 3=Goeppinger 07, 4=Kennedy 07, 5=Gitlin 08

25 Living Well with Chronic Conditions Stanford Model of CDSMP Action Plans –Something they want to do –Achievable –Confidence Level –Problem Solving –Action Specific –What –How much –When –How often

26 Living Well with Chronic Conditions Stanford Model of CDSMP Workshop Resources Resource book: Living a Healthy Life with Chronic Conditions CD: Time for Healing Weekly action plans and feedback Groups are small: people –Share information, interactive learning activities, problem-solving, decision-making, social support for change

27 Living Well with Chronic Conditions Stanford Model of CDSMP Infrastructure Master Trainers – 11 in state of Utah as of October 2011 (8 English, 2 Spanish) –Attend 4 ½ day training at Stanford University –Teach classes and train leaders Peer Leaders / Instructors –Complete 4-day training taught by 2 Master Trainers in order to teach classes Stanford License –Each organization teaching this program must purchase a license from Stanford Training Material –Resource books and CDs for participants and leaders

28 Living Well with Chronic Conditions Stanford Model of CDSMP What participants are saying.... –“I know I can self-manage a few problems and make life better for me and my husband.” –“It gave me some important coping mechanisms.” –“This class has helped me get my life in order.” –“I recommend this course and handbook to all seniors.” –“We have set goals, accomplished them and will continue to manage our lives better due to this class.” Source: Class participants of Wasatch and Summit County courses

29 Tomando Control de Su Salud Stanford Model of Spanish CDSMP Spanish Program Development Not a translation but an independent development in Spanish Developed to be culturally appropriate Focus groups conducted in Spanish Health care professionals working with persons with chronic conditions

30 Tomando Control de Su Salud Stanford Model of Spanish CDSMP Spanish Program Development Participants incorporate healthy habits into their lives: –Healthy eating habits –Exercise (physical activity) –Cognitive management of symptoms –Better communication with health care providers –Overall perception of better health

31 Tomando Control de Su Salud Stanford Model of Spanish CDSMP Overview/ responsibilities Acute/chronic Using mind/symptoms Action plans English Overview/ Responsibilities Acute/chronic Proactive in management, Importance of food & exercise Healthy food Spanish Week One

32 Tomando Control de Su Salud Stanford Model of Spanish CDSMP Action plan rpt/problem solve Difficult emotions Intro to physical activity/exercise Action plan English Share diaries/problem solve Formula for a healthy menu Action plans Intro to physical activity/exercise Exercise practice Spanish Week Two

33 Tomando Control de Su Salud Stanford Model of Spanish CDSMP Week Three Action plan report/problem solve Better breathing Muscle relaxation Pain/fatigue management Endurance activities Action plan English Action plan rpt/problem solve Prepare a low fat menu Managing symptoms Muscle relaxation Better breathing Action plan Spanish

34 Tomando Control de Su Salud Stanford Model of Spanish CDSMP Week Four Action plan report/problem solve Future plans for health care Healthy eating Communication skills Problem solving Action plan English Action plan rpt/problem solve Reading nutrition labels Finding health care Managing depression Positive thinking Action plan Spanish

35 Tomando Control de Su Salud Stanford Model of Spanish CDSMP Week Five Action plan report/problem solve Medication usage Informed treatment decisions Depression management Positive thinking Guided imagery Action plan English Action plan report/problem solve Communication skills Future plans for healthcare Increasing physical activity intensity Medication usage Working with healthcare professional Action plan Spanish

36 Tomando Control de Su Salud Stanford Model of Spanish CDSMP Week Six Action plan rpt/problem solve Working with health care Professional/health care system Looking back and plan future English Action plan rpt/problem solve Evaluating home remedies Guided imagery Sharing successes/plan future Celebration Spanish

37 Ideas for Linking CDSMP with Diabetes Education The Utah Approach to CDSMP and Diabetes Care: In no way is CDSMP to take the place of Diabetes Self-Management Education (DSME) DSME comes first and foremost for a patient with diabetes That said, we would like to encourage referrals from Diabetes Programs into local CDSMP classes for some of the following reasons….

38 Ideas for Linking CDSMP with Diabetes Education Self-management support option for post- DSME (National DSME Standard #7) Great option for follow up work with patients with diabetes (National DSME Standard #8) Supports and complements self-management efforts of diabetes educators/healthcare providers Continuous quality improvement opportunity??

39 Ideas for Linking CDSMP with Diabetes Education Powerful evidence-based program for patients with co-morbid conditions –CDSMP is successful at addressing mental health issues as well Excellent self-management option for uninsured patients; if you have to turn away uninsured patients, please send them to a free CDSMP workshop Addresses income issues by offering classes at no charge

40 Ideas for Linking CDSMP with Diabetes Education Opportunity to connect to community resources (perhaps as part of a planned care model) Reinforces lifestyle behaviors so that patients continue implementing healthy choices such as regular physical activity and nutrition Other ideas?

41 Living Well with Chronic Conditions Stanford Model of CDSMP General Patient and Provider Benefits An evidence-based program such as Living Well/CDSMP can capture many chronic diseases through this one channel Self-management support option Can improve self-rated health and energy levels Reduced healthcare utilization (ED visits) As the New Jersey program puts it: Feel Better!

42 Living Well with Chronic Conditions Stanford Model of CDSMP Program Partnerships University of Utah Community Clinics Arthritis Foundation, Utah/Idaho Chapter Area Agencies on Aging/Senior Centers: –Weber-Morgan –Davis County –Salt Lake County –Mountainlands (Summit/Wasatch/Utah Counties) –Five County (Southwest Utah) –Tooele County –San Juan County

43 Living Well with Chronic Conditions Stanford Model of CDSMP Program Partnerships Community-based Organizations: –National Tongan American Society –Alliance Community Services (Spanish) Local Health Departments: –Bear River –Central Utah –Davis County –Salt Lake Valley – Southwest – Tri County – Utah County – Weber-Morgan

44 Living Well with Chronic Conditions Stanford Model of CDSMP Program Partnerships Dixie Regional Medical Center in St. George Valley View Medical Center in Cedar City Salt Lake VA Medical Center Valley Mental Health –SL County, Park City, Tooele Utah Partnership for Healthy Weight –Healthy weight project in Magna

45 Living Well with Chronic Conditions Stanford Model of CDSMP Resources –Stanford University’s site on CDSMP –Utah Arthritis Program (class schedules) –Administration on Aging: –National Council on Aging:

46 Living Well with Chronic Conditions Stanford Model of CDSMP Contact Information Utah Arthritis Program: (for class schedules)www.health.utah.gov/arthritis Rebecca Castleton: Christine Weiss:

47 Help Your Clients Quit Tobacco Marci Nelson, B.S., CHES Tobacco Prevention and Control Program Utah Department of Health (801)

48 Objectives  Discuss the risks of tobacco use especially the effects of smoking on diabetes  Present a brief intervention to quit  Discuss procedures for implementation  Supply information on free tobacco cessation services

49 Tobacco Use in Utah: The Problem  More than 200,000 Utahns use tobacco  More than 1,330 die annually from their smoking  Nearly 17,150 children exposed to secondhand smoke in their homes  $663 million each year in smoking-attributable medical and lost productivity costs Source: Tobacco Prevention and Control in Utah Tenth Annual Report - August 2010

50 Tobacco Health Effects   Long-term Heart disease Stroke Lung function Cancers Ulcer Infertility   Short-term Respiratory illness Decreased lung capacity High blood pressure & cholesterol Nervousness Mouth problems Reduced taste & smell Responsible for more than 400,000 premature deaths each year in the U.S.

51 Health Effects of Secondhand Smoke   Stillbirth; miscarriage   Premature Birth   Cleft palates and lips   Sudden Infant Death   Infertility   Tooth Decay   Cancer   Bronchitis; pneumonia   Asthma   Upper Respiratory Tract Disease   Ear Infections   Coughs Secondhand smoke affects loved ones & is a powerful motivator to quit!

52 Effect of Smoking on Diabetes  Tobacco raises blood sugar levels  Tobacco use increases the risk of heart attack or stroke  Increased chance of getting gum disease and may suffer tooth loss  Tobacco use can make foot ulcers, foot infections, and blood vessel disease in the legs worse

53 WHY SHOULD CLINICIANS ADDRESS TOBACCO?   Tobacco users expect to be encouraged to quit by health professionals. 72% of Utahns saw a healthcare provider in the last year   Screening for tobacco use and providing tobacco cessation counseling are positively associated with patient satisfaction (Barzilai et al., 2001).   Advice from a healthcare provider can double the chances of successful quitting.

54 Clinical Practice Guideline for Treating Tobacco Use and Dependence  Update released May 2008  Sponsored by the Agency for Healthcare Research and Quality of the U.S. Public Heath Service with Centers for Disease Control and Prevention Centers for Disease Control and Prevention National Cancer Institute National Cancer Institute National Institute for Drug Addiction National Institute for Drug Addiction National Heart, Lung, & Blood Institute National Heart, Lung, & Blood Institute Robert Wood Johnson Foundation Robert Wood Johnson Foundation

55 Brief Counseling: ASK, ADVISE, REFER ASK about tobacco USE ADVISE tobacco users to QUIT REFER to other resources ASSIST ARRANGE Patient receives assistance, with follow-up counseling arranged, from other resources such as the Utah Tobacco Quit Line

56 Step 1: ASK 1 min Ask EVERY patient about tobacco use status at EVERY visit. Current Current Former Former Never Never This occurs most consistently when there are systems in place, such as question on intake form, chart stickers, or electronic prompts on electronic medical records. Chart stickers are available.

57 Step 2: Advise1 min Step 2: Advise1 min Clinicians should urge all tobacco users to quit. Even brief advice to quit by a clinician results in greater quit rates. Smokers cite a clinician's advice to quit as an important motivator for attempting to stop smoking. Advice should be: clear clear strong strong personalized personalized Specific to the individual 's own situation (e.g. oral health condition, family status, costs of tobacco).

58 Offer a motivational intervention, the “ 5 R's ” Relevance Risks Rewards Roadblocks Repetition What if they are not willing?

59 The “5 R’s” Relevance: Why is quitting important to their own personal situation? Risks: Outline the risks of continued tobacco use. Rewards: Outline the benefits of quitting. Roadblocks: What are the barriers preventing this person from quitting? What are some solutions to these barriers? Repetition: Repeat this discussion frequently, until the person is ready to quit.

60 Step 3: Refer1 min Referral options:  A doctor, nurse, pharmacist, or other clinician, for additional counseling  The Utah Tobacco Quit Line  Utah QuitNet  Text to Quit  Local Services - Ending Nicotine Dependence (youth) - First Step (pregnant women)

61 Utah Tobacco Quit Line  Toll free: QUIT.NOW - Spanish: TTY:  Monday-Sunday, 6:00 am to 11:00 pm  FREE  For adults and youth  Services available in English, Spanish and translation in 140 other languages

62 Utah Tobacco Quit Line Professional counseling sessions by telephone – up to five 40-minute sessions Individualized Quit Plan NRT upon qualification (patch, gum or lozenge) Tailored resources for Utah residents QUIT.NOW

63 Fax Referral System “ Would you like the Utah Tobacco Quit Line to help you quit? ”

64 3 Simple Steps 1.Personalize your forms online at: /utqlprofax.html /utqlprofax.html 2. 2 A’s and R with client. For those ready to quit give them the form to fill out. Verify signature! 3.Fax form in to the Utah Tobacco Quit Line: *The Quit Line will fax you to inform you of services your patient received.

65  Quitting guide  Medication guide  Expert counseling  Personalized quit plan  24 hour community support  Online NRT purchase Lifetime membership!

66  Text messaging service that offers Utahns daily quit tips to help them get through the quitting process Users text READY to to receive two quit tips per day via cell phone for 21 days. Users text READY to to receive two quit tips per day via cell phone for 21 days. Users will be asked to answer simple questions regarding age, gender and zip code.Users will be asked to answer simple questions regarding age, gender and zip code.  New research suggests that motivational text messages more than double the odds that smokers will be able to kick the habit. Source: The Lancet, news release, June 29, 2011

67 Tobacco Dependence: a 2-Part Problem Tobacco Dependence Treatment should address the physiological and the behavioral aspects of dependence. PhysiologicalBehavioral Treatment The addiction to nicotine Medications for cessation The habit of using tobacco Behavior change program

68 Nicotine polacrilex gum Nicorette ( OTC) Generic nicotine gum (OTC) Nicotine lozenge Commit (OTC) Generic nicotine lozenge (OTC) Nicotine transdermal patch Nicoderm CQ (OTC) Nicotrol (OTC) Generic nicotine patches (OTC, Rx) Nicotine nasal spray Nicotrol NS (Rx) Nicotine inhaler Nicotrol (Rx) Bupropion SR (Zyban) Varenicline (Chantix) These are the only medications that are FDA-approved for smoking cessation. Smoking Cessation Medications

69 What About A Relapse?   Viewed as a learning experience   Not a sign of personal or clinician failure   Continue to provide encouragement It takes an average of 7 quit attempts to successfully quit using tobacco!

70 Make a Commitment Address tobacco use with all patients. At a minimum, make a commitment to incorporate brief tobacco interventions as part of routine patient care. Ask, Advise, and Refer. For more information, contact: Tobacco Free Resource Line: or


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