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

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)

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’

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

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)

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

SeMaS categories

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)

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)

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

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”

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”

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”

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

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

Co-creation team SeMaS Contact: Nathalie Eikelenboom nathalie.eikelenboom@radboudumc.nl n.eikelenboom@doh-huisarts.nl