1. SeMaS: a tool for personalized counselling and support of self-management in primary care
Nathalie Eikelenboom, MSc
September 2014

2. SeMaS: Self-Management screening
Self-management: one size does not fit all1
SeMaS: assessment of patients’ competences/barriers for self-management
27 items, 10 minutes fill-in time
Tailored self-management support by trained practice nurse
1 Trappenburg et al, Self-management: One size does not fit all. Patient Educ Couns (2013)

3. Self-Management definition
‘the care taken by individuals towards their own health and well being: it comprises the actions they take to lead a healthy lifestyle; to meet their social, emotional and psychological needs; to care for their long-term condition; and to prevent further illness or accidents’

4. Effect-study and process evaluation
Development of SeMaS
Literaturestudy
Panels
Validation
Effect-study and process evaluation

5. SeMaS study outline
Control arm: 8 practices
Intervention arm: 7 practices
Training SeMaS en practice visit
Baseline measurement +/- 400 patients
Baseline measurement +/- 350 patients
T=0: follow-up consult with practice nurse ; care as usual
T=0: follow-up consult with practice nurse with tailored self-management support
SeMaS profile with feedback
Stratified cluster randomization of 15 DOH general practices
T=1 week: questionnaire consult
T=1 week: questionnaire consult
Eikelenboom et al., Implementation of personalized self-management support using the self-management screening questionnaire SeMaS; a study protocol for a cluster randomized trial . Trials (2013)

6. SeMaS profile Locus of control Internal Self-efficacy High
More competent
Locus of control
Internal
Self-efficacy
High
depri
Social support
Low
Self-monitoring
Somewhat willing
Functioning in groups
Difficult
Coping
Problem solving
Computer skills
Average
Anxiety
Sometimes
Meneer de Vries: Met deze persoon zal het lastig zijn om met ZM aan de slag te gaan: angstig en depressief. Dit zijn belangrijke barrieres voor ZM. Ook weinig sociale steun. Dus eerst werken aan depressie en angst, en dan opnieuw bekijken. Beleid volgens gebruik praktijk. Later wel aan de slag: LOC, EE en COP zijn goed.
Burden of disease
Average
Depression
High
© Koninklijke Philips Electronics N.V. 2012

7. SeMaS categories

8. Qualitative analysis Level1 Barriers/incentives innovation
Advantages in practice, feasibility, credibility, accessibility, attractiveness
patient
Knowledge, skills, attitude, compliance
professional
Awareness, knowledge, attitude, motivation to change, behavioural routines
social context
Opinion of colleagues, culture of the network, collaboration, leadership
organizational context
Organization of care processes, staff, capacities,
resources, structures
economic and political context
Financial arrangements, regulations, policies
1 Grol & Wensing, What drives change? Barriers to and incentives for achieving evidence-based practice. Med J Aust (2004)

9. Qualitative analysis Level1 Facilitator Barrier Innovation
Provides a structure to discuss characteristics
Difficult wording of items
Patient
Increased insight in individual characteristics
Random selection of patients, not based on current level of self-management
Professional
Provides input for individual care plan
Attitude towards self-management
1 Grol & Wensing, What drives change? Barriers to and incentives for achieving evidence-based practice. Med J Aust (2004)

10. Qualitative analysis Level Facilitator Barrier Social context
Support from colleagues
Interest of GPs is variable
Organizational context
Sufficient capacity for innovation
Limited time planned for consult
Financial and political context
Practice and care group policy on self-management
Self-monitoring tools for patients not reimbursed

11. Quotes
Innovation “there was a clear line to self-management in my consult” “some patients said they found the questions difficult”
Patient “patients recognized themselves in the profiles” “there is a group that is happy that things can be organized differently. There will also be a middle group, and a group that does not want to, or is not able to self-manage”

12. Quotes
Professional “SeMaS is usefull when creating an individual care plan with the patient” “we have to stimulate people, but I notice that it doesn’t work anymore nowadays”
Social context “the GP’s differed in how involved they were in the SeMaS project” “I discussed the SeMaS with my colleague practice nurse”

13. Quotes
Organizational context “it was sometimes difficult to plan the SeMaS in the consult, besides the usual subjects and measurements that have to be done”
Financial and political context “making people aware of their own responsibility for their health is part of the policy in our practice” “sometimes the financial agreements with health insurers are not translated to the workplace”

14. Questionnaire consult
Intervention group: was SeMaS discussed?
Which subjects were discussed?
Did you receive information, advice or referral to self-management interventions?

16. Take home message
SeMaS is the first step in providing personalized self-management support.
© Health and Social Care Alliance Scotland

17. Co-creation team SeMaS
Contact:
Nathalie Eikelenboom