1. Chronic Disease Self Management Program Tomando Control de su Salud Washington State Maureen Lally, MSW WA Aging and Disability Services Administration The Chronic Disease Self-Management Program

2. To underscore the belief that individuals can manage their chronic health conditions. By taking control of their symptoms people can be healthier and happier. My Goal Today

3. What problems do you have because of your health condition?

4. Have You Experienced Fatigue? Depression? Stress? Other symptoms? Even with different chronic conditions, many of the concerns are the same.

5. The Vicious Symptom Cycle Chronic Condition Stress/Anxiety Pain Tense Muscles Fatigue Difficult Emotions Depression Shortness of Breath

6. Symptom Cycle Often fatigue and difficult emotions are common problems experienced by people with chronic conditions. One symptom can lead to a series of other problems which often creates more symptoms Which becomes a vicious symptom cycle

7. No known cure for many chronic conditions Self management or what you can do to manage your chronic condition is very important. It involves the use of various methods or tools to manage the problems you experience.

8. What is Self-Management? “The tasks that individuals must undertake to live with one or more chronic conditions.” “What people do 99.9% of the time.”

9. What Can You Do? Keep informed; ask questions Take part in planning your treatment, communicate your preferences/goals Inform your health care team about problems/changes you experience Try new things and give activities at least a 2 week trial before deciding what works best for you Set goals and work towards them

10. You Can Break The Symptom Cycle Explore a variety of ways to: Regain control of your life to do the things that matter Have energy to do more and get relief from fatigue, pain, and other symptoms Meet new people, share what you know, and learn new ways to improve your life Feel better by… Participating in the 6 week workshop “Living Well with Chronic Conditions”

11. Program Overview Six, weekly, 2.5 hour sessions Small group setting (10-15 people) Practical, interactive curriculum Led by pair of lay leaders, at least one of whom is a peer with a chronic condition Convenient locations Action oriented discussion and problem solving Supportive atmosphere Low cost

12. Program Principles Regardless of the chronic condition,  People have similar challenges.  Deal not only with their condition, also with the impact of that condition on their lives.  Lay Leaders can teach the workshop as effectively if not more effectively, than health professionals.

13. Patient Education compared to Self Management Support Patient Education Information and skills are taught Usually disease-specific Assumes that knowledge creates behavior change Goal is compliance Health care professionals are the teachers Self Management Support  Skills to solve patient identified problems are taught  Methods are applied across conditions/needs  Assumes that confidence yields better outcomes  Goal is increased self- efficacy  Teachers can be professionals or peers

14. Target Populations Adults 55 and older across the state  Eight tribes-Nooksack, Lummi, Swinomish Quinault, Quileute, Makah, Puyallup & Samish  Hispanic elders  African American elders  Asian communities  Senior housing communities  Rural and urban communities

15. The Self-Management Toolbox Physical activity Medications Managing fatigue Action Planning Better breathing Understanding emotions Problem-solving Using your mind Managing pain Communication Healthy eating Working with health professionals

16. Action Planning Something you want to do Achievable Action-specific Answers the questions: What? When? How much? and How often? Rated on a Confidence level of 7+ (out of 10)

17. Problem Solving 1.Identify the problem 2. List ideas 3. Select one 4. Assess the results 5. Substitute another idea 6. Use other resources

18. Evidence-Base Program Outcomes Research indicates participants spend Fewer days in the hospital Fewer outpatient and ER visits Participants report Improvement in self-reported health and health distress Improvement in social life/activities Improved energy/less fatigue Lorig, Ritter, et al. 2001: Sobel, Lorig & Hobbs, 2002

19. Testimony “I learned how to cope with things in my life that I couldn’t handle before” “This class kept me on track” “I was tired. My pain was my boss. It was telling me what I could and couldn’t do. This workshop put ME back in charge.” “I learned we’re all in the same boat, but the boat isn’t sinking.”

20. Contact Information Maureen Lally  Aging and Disability Services Administration 360-725-2449 lallym@dshs.wa.gov Living Well in Washington  http://livingwell.doh.wa.gov http://livingwell.doh.wa.gov Stanford Patient Education Resource Center  http://patienteducation.stanford.edu http://patienteducation.stanford.edu