1. Paul Kerston, Positive Living BC Kathy Reims, MD STOP HIV/AIDS Collaborative Learning Session Learning Session 2 May 25, 2011 Supporting Patients on their Journey

2. Session Overview Self-Management Support (SMS) Important SMS themes from a patient perspective SMS implementation ideas Time for dialogue Key resources attached

3. The continuous healing relationship really does matter.

4. If you are thinking about what to say next, you are not really listening.

5. Explain the rationale for recommendations

6. Don’t let the technology and science obscure the personal

7. Thoughts about team-based care

8. Patients have a life, not just a disease

9. What changes can we make that will result in improvement? Emphasize the patient's central role Use effective self-management support strategies that include: assessment, goal setting, action planning, problem-solving and follow-up Organize resources to provide support

10. Trusting Relationships Continuity Interpersonal skill building Strong systems support

11. Listening Takes practice Motivational Interviewing training Role play Office culture

12. Explain, then respect the patient choice Information, but more than that Evidence for shared-decision making Respect for patient role and autonomy Brief Action Planning – patient drives the goal

13. Keep it personal Eye contact Think through computer use – involve the patient See what you are asking through the lens of the person Document progress over time and follow up

14. Teams Protocols Prompts and reminders Outreach Case management assistance when needed Decide what is always in the provider domain Expanded multidisciplinary teams

15. See the person, not the disease Social history Prompts about key life events Ask questions about impact of care and illness Leverage strengths Emphasize wellness Tap into personal networks and community supports

17. SMS Resources: Core Training Schaefer J, Miller D, Goldstein M, Simmons L. Partnering in Self-Management Support: A Toolkit for Clinicians. Cambridge, MA: Institute for Healthcare Improvement; 2009. Available at: www.IHI.orgwww.IHI.org Physician Tip Sheet for Self-Management Support. Chicago, IL: American Medical Association; 2008. AMA.org Prochaska, JO; Norcross, JC; DiClemente, CC. Changing for good: the revolutionary program that explains the six stages of change and teaches you how to free yourself from bad habits. New York: W. Morrow; 1994. ISBN 0688112633.ISBN 0688112633

18. SMS Resources: Advanced Training Cole S. Ultra-Brief Personal Action Planning. Rochester, NY: Stony Brook University Medical Center; 2008. California HealthCare foundation Website: http://www.chcf.org/publications/2005/06/helping- patients-manage-their-chronic-conditions http://www.chcf.org/publications/2005/06/helping- patients-manage-their-chronic-conditions Weiss, Barry D., Mays, Mary Z., Martz, William, Castro, Kelley Merriam, DeWalt, Darren A., Pignone, Michael P., Mockbee, Joy, Hale, Frank A. Quick Assessment of Literacy in Primary Care: The Newest Vital Sign Ann Fam Med 2005 3: 514-522

19. SMS Resources: Advanced Training The Newest Vital Sign: A New Health Literacy Assessment Tool for Health Care Providers http://www.pfizerhealthliteracy.com/physicians- providers/newest-vital-sign.htmlhttp://www.pfizerhealthliteracy.com/physicians- providers/newest-vital-sign.html The Macarthur Initiative on Depression and Primary Care http://www.depression- primarycare.org/clinicians/toolkits/materials/forms/phq9/ http://www.depression- primarycare.org/clinicians/toolkits/materials/forms/phq9 Motivational Interviewing http://www.motivationalinterview.org/http://www.motivationalinterview.org/ Motivational Interviewing in Health Care: Helping Patients Change Behavior (Applications of Motivational Interviewing) Stephen P Rollnick PhD, William R. Miller Phd, Christopher C. Butler MD, Guilford Press, New York, 2008.

20. Time for dialogue