Evidence and theoretical components Module 4.2 Self management Evidence and theoretical components

Presentation purpose Target audience Service providers and project workers on DPMI projects Aim To encourage consumers to self manage Objectives Provide an overview of the concepts of self management Review self management programs and evidence Explore the components of self management and integration into practice.

What is self management? Self-management is the active participation by people in their own healthcare. Self-management incorporates: health promotion and risk reduction informed decision making following care plans medication management working with health care providers to attain the best possible care and to effectively negotiate the often complex health system. National Chronic Disease Strategy (Draft) National Health Priority Action Council www.nhpac.gov.au

Is self management effective? Evidence to support self management Improves quality of life Supports behavior change Decreases health care utilisation

References Barlow J. et a “Self – management approaches for people with chronic conditions: a review” Patient Education and Counseling 48 (2002) 177-187 “Patients as effective collaborators in managing chronic conditions” www.cfah.org.au Adherence to long term therapies www.who.org go to publications link

Diabetes self management education in Australia Norsworthy document reviewed 8 articles in which the authors reviewed up to 153 studies of the effectiveness of diabetes interventions. Each of the studies concludes that diabetes self management education is effective in improving health outcomes for people living with diabetes. influence behaviour change and improve knowledge and skill for diabetes self management reductions in secondary complication rates reducing reliance on health services. Ann Nosworthy April 2004 ADEA. www.adea.org.au

Measuring effectiveness of self management Self-management Education Programs in Chronic Disease-A Systematic Review and Methodological Critique of the Literature Conclusions: Self-management education programs resulted in small to moderate effects for selected chronic diseases as measured by clinical markers. ( diabetes, hypertension and asthma) Need to adhere to a standard methodology to help clarify whether self-management education is worthwhile. Asra Warsi,et al. Arch Intern Med. 2004;164:1641-1649

Stanford Chronic Disease Self Management Program RCT - 952 subjects Demographic Data Age 62 years Male 27% Education 14 years No. Diseases 2.2 Kate Lorig et al. Evidence suggesting that a chronic disease self management program can improve health status while reducing hospitalizations. Medical Care 37,1 1999

Stanford Chronic Disease Self Management Program Percent With Common Diseases Lung Disease 21% Heart Disease 24% Diabetes 26% Arthritis 42%

Stanford Chronic Disease Self Management Program 6-Month Improvements in Health Outcomes Self-Rated Health Disability Social and Role Activities Limitations Energy/Fatigue Distress with Health State

Stanford Chronic Disease Self Management Program Improvements in utilisation and costs Average 0.8 fewer days in hospital in the past six months (p=.02) Trend toward fewer outpatient and ER visits (p=.14) Estimated cost of intervention $100-$200 http://patienteducation.stanford.edu/bibliog.html

Good Life Club – Coaching Six-month outcome data for the Good Life Club project: An outcomes study of diabetes self-management positive changes in four of eight self rated symptom measures reductions in the reported use of GPs, improvements in social functioning large increases in all six confidence in self-management items. Colette J Browning & Shane A Thomas. Australian Journal of Primary Health — Vol. 9, Nos. 2 & 3, 2003 www.goodlifeclub.info/

Peer led self management http://www.latrobe.edu.au/aipc/director/plsmci/about_healthprof.htm

Peer led self management

Peer led self management

Peer led self management

Key components of self management Based on patient perceived problems Builds confidence (self-efficacy) to perform 3 tasks Disease Management Role Management Emotional Management Focus on improved health status and appropriate health care utilization Kate Lorig

How self management differs from patient education Purpose To manage life with disease To change behaviors To increase skills /self confidence To increase knowledge To problem solve and make decisions To use specific tools Kate Lorig

How self management differs from patient education Needs Assessment Patient problems What patients need to know Content Disease, role, & emotional management Disease knowledge and behaviors Leader Leader is guide Leader is expert Kate Lorig

Essential elements of self management interventions Disease, medication and health management Role management Emotional management Support enhancement of self efficacy Problem solving training Follow up Tracking and ensuring implementation The Robert Wood Johnson Foundation.The Centre for the Advancement of Health. www.cfah.org

Handling self management tasks S/M Task Passive Active Medical Deferred Collaborates Management Role Relinquishes Strives to Management maintain Emotional Erratic Regular use of Management ineffectual coping skills A. Jerant et al. “Patients perceived barriers to active self-management of chronic disease” Patient education and counseling. 57,3 June 2005

Handling self management tasks S/M skills Passive Active Problem Catastrophists Systematic Solving process Decision making Made in haste Carefully weighs fear options Resource Erratic Regular use of Utilisation ineffectual coping skills Partnership Minimal Identifies and selects with HPs HPs for support Action Planning Minimal Applied frequently Self Tailoring Minimal Frequent

Promoting self efficacy Promote performance accomplishment Use verbal persuasion Role modelling Identifying feelings and helping work through strategies to deal with feelings

Goal Setting- Getting started Choose long term goal Goals should be something you want to do Identify steps needed to reach long term goal Choose one of those steps to start working towards goal

SMART Specific Measurable Achievable Realistic Timely Flinders University

Guidelines for helping with - Problem solving Identify the problem List ideas Select one Assess the results Substitute another idea (if first didn’t work) Accept that the problem may not be solvable Kate Lorig