Balbezit door de patiënt

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Balbezit door de patiënt
Wat betekent zelfmanagement voor de patiënt?
Per Åke Zillén, nierpatiënt en tandarts

Published in: Health & Medicine, Education
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Balbezit door de patiënt

  1. 1. Self-management
  2. 3. My perspective
  3. 4. <ul><li>My kidney function </li></ul>0 50 years
  4. 5. 1990 2001 100% My kidney function 10% ?
  5. 6. 1990 2001 100% My kidney function 10% ? Stupid me
  6. 7. <ul><li>Two diseases </li></ul><ul><li>A kidney carcinoma </li></ul><ul><li>10% kidney function </li></ul>
  7. 8. <ul><li>Two diseases </li></ul><ul><li>A kidney carcinoma </li></ul><ul><li>Nephrectomy </li></ul><ul><li>10% kidney function </li></ul><ul><li>Dialysis </li></ul>
  8. 9. <ul><li>Acute Chronic </li></ul><ul><li>Duration Short For life </li></ul><ul><li>Goal Well again Not worse </li></ul><ul><li>Attitude Fight it Accept it </li></ul><ul><li>Responsible HC staff Shared </li></ul><ul><li>Treatment HC staff Patient </li></ul><ul><li>Education None Considerable </li></ul><ul><li>Life-style As before Changed </li></ul>
  9. 10. <ul><li>Acute Chronic </li></ul><ul><li>Duration Short For life </li></ul><ul><li>Goal Well again Not worse </li></ul><ul><li>Attitude Fight it Accept it </li></ul><ul><li>Responsible HC staff Shared </li></ul><ul><li>Treatment HC staff Patient </li></ul><ul><li>Education None Considerable </li></ul><ul><li>Life-style As before Changed </li></ul><ul><li>Action Reflection </li></ul>
  10. 11. <ul><li>My trauma </li></ul><ul><li>Healthy individual </li></ul><ul><li>Emergency patient </li></ul>
  11. 12. <ul><li>My trauma </li></ul><ul><li>Healthy individual </li></ul><ul><li>Emergency patient </li></ul><ul><li>Chronically ill patient </li></ul>
  12. 13. <ul><li>My trauma </li></ul><ul><li>Healthy individual </li></ul><ul><li>Emergency patient </li></ul><ul><li>Chronically ill patient </li></ul><ul><li>Pre-dialysis patient </li></ul>
  13. 14. <ul><li>Stages of CKD </li></ul><ul><li>GFR, % </li></ul><ul><li>Normal function > 90 </li></ul><ul><li>Mild reduction 90-60 </li></ul><ul><li>Moderate reduction 60-30 </li></ul><ul><li>Severe reduction 30-15 </li></ul><ul><li>Kidney failure < 15 </li></ul>
  14. 15. Life is wonderful ... considering the alternative
  15. 16. Expectations
  16. 17. <ul><li>In the 60´s </li></ul><ul><li>End stage </li></ul><ul><li>dental disease </li></ul>
  17. 18. <ul><li>Prevention </li></ul><ul><li>Keep clean </li></ul><ul><li>Use fluoride </li></ul><ul><li>Regular check-ups </li></ul>
  18. 19. <ul><li>8 760 hours/year </li></ul>
  19. 20. <ul><li>8 760 hours/year </li></ul><ul><li>- 2 dental office </li></ul>
  20. 21. <ul><li>8 760 hours/year </li></ul><ul><li>- 2 dental office </li></ul><ul><li>8 758 hours/year </li></ul><ul><li>= my responsibility </li></ul><ul><li>= self-management, self-care </li></ul>
  21. 22. <ul><li>Long term change </li></ul><ul><li>My parents </li></ul><ul><li>My generation </li></ul><ul><li>My children </li></ul><ul><li>My grandchildren </li></ul>
  22. 24. <ul><li>Real health care </li></ul><ul><li>Prevention </li></ul><ul><li>Early detection </li></ul><ul><li>Early life-style change </li></ul><ul><li>Early treatment </li></ul><ul><li>Slow or stop progression </li></ul><ul><li>Replacement </li></ul>
  23. 25. Slow or even stop the disease?
  24. 26. <ul><li>What </li></ul><ul><li>can I do </li></ul><ul><li>MYSELF </li></ul><ul><li>? </li></ul>
  25. 27. <ul><li>Treatment plan </li></ul><ul><li>1. Medication </li></ul><ul><li>2. Special diet </li></ul><ul><li>3. Healthy life-style </li></ul>
  26. 28. <ul><li>Blood pressure </li></ul><ul><li>Medication </li></ul>
  27. 29. <ul><li>Blood pressure </li></ul><ul><li>Medication </li></ul><ul><li>Regular physical activity </li></ul><ul><li>Weight control </li></ul><ul><li>Stop smoking </li></ul><ul><li>Less salt, no extra </li></ul><ul><li>Drink less </li></ul><ul><li>Stress management </li></ul><ul><li>Relax and sleep well </li></ul><ul><li>Get a pet </li></ul>
  28. 30. <ul><li>The special diet </li></ul><ul><li>helps minimize the symptoms and slow the progression </li></ul><ul><li>+ </li></ul><ul><li>makes me feel in charge </li></ul><ul><li>keeps my family involved </li></ul>
  29. 31. <ul><li>Health behaviour </li></ul><ul><li>Regular physical activity </li></ul><ul><li>Blood pressure control </li></ul><ul><li>Glucose control </li></ul><ul><li>Weight control </li></ul><ul><li>No smoking </li></ul><ul><li>Healthy diet </li></ul>
  30. 32. <ul><li>My daily to-do-list Patient </li></ul><ul><li>Medication Yes </li></ul><ul><li>Blood pressure Yes </li></ul><ul><li>Blood sugar Yes </li></ul><ul><li>Weight control Yes </li></ul><ul><li>No smoking Yes </li></ul><ul><li>Physical activity Yes </li></ul><ul><li>Special diet Yes </li></ul><ul><li>Mental health Yes </li></ul>
  31. 33. <ul><li>My daily to-do-list </li></ul><ul><li> Patient Doctor </li></ul><ul><li>Medication Yes Yes </li></ul><ul><li>Blood pressure Yes </li></ul><ul><li>Blood sugar Yes </li></ul><ul><li>Weight control Yes </li></ul><ul><li>No smoking Yes </li></ul><ul><li>Physical activity Yes </li></ul><ul><li>Special diet Yes </li></ul><ul><li>Mental health Yes </li></ul>
  32. 34. <ul><li>Outside the clinic </li></ul><ul><li>No doctor </li></ul><ul><li>No nurse </li></ul><ul><li>No dietician </li></ul><ul><li>No physiotherapist </li></ul>
  33. 35. <ul><li>It´s so obvious: </li></ul><ul><li>My health is </li></ul><ul><li>my responsibility </li></ul><ul><li>My illness is </li></ul><ul><li>my problem </li></ul>
  34. 36. <ul><li>My doctor and </li></ul><ul><li>all health care staff </li></ul><ul><li>are my </li></ul><ul><li>medical advisors </li></ul>
  35. 37. <ul><li>To be able to assume </li></ul><ul><li>Responsibility </li></ul><ul><li>We need: </li></ul><ul><li>Good relations </li></ul><ul><li>Partnership </li></ul><ul><li>Education </li></ul>
  36. 39. <ul><li>Relations </li></ul><ul><li>Compliance </li></ul><ul><li>Adherence </li></ul><ul><li>Empowerment </li></ul><ul><li>Self-management </li></ul>
  37. 40. <ul><li>Em- power -ment </li></ul><ul><li>The Doctor </li></ul><ul><li>- Expertise </li></ul><ul><li>- Integrity </li></ul><ul><li>- Decisions </li></ul>
  38. 41. <ul><li>Em- power -ment </li></ul><ul><li>The Doctor The Patient </li></ul><ul><li>- Expertise - Expertise </li></ul><ul><li>- Integrity - Integrity </li></ul><ul><li>- Decisions - Decisions </li></ul>
  39. 42. <ul><li>Em- power -ment </li></ul><ul><li>The Doctor The Patient </li></ul><ul><li>- Expertise - Expertise </li></ul><ul><li>- Integrity - Integrity </li></ul><ul><li>- Decisions - Decisions </li></ul><ul><li>- Mutual respect </li></ul><ul><li>- Mutual empowerment </li></ul><ul><li>- Agreements </li></ul><ul><li>- Partnership </li></ul>
  40. 43. Patient information
  41. 45. <ul><li>Education </li></ul><ul><li>Knowledge </li></ul><ul><li>Learning is more important than teaching </li></ul>
  42. 46. <ul><li>Education </li></ul><ul><li>Knowledge </li></ul><ul><li>Learning more important than teaching </li></ul><ul><li>Motivation </li></ul><ul><li>Enhanced through group discussions </li></ul>
  43. 47. <ul><li>Education </li></ul><ul><li>Knowledge </li></ul><ul><li>Learning more important than teaching </li></ul><ul><li>Motivation </li></ul><ul><li>Enhanced through group discussions </li></ul><ul><li>Healthy behaviour </li></ul><ul><li>A process of change </li></ul>
  44. 48. <ul><li>Change of behaviour </li></ul><ul><li>When we are: </li></ul><ul><li>Ready </li></ul><ul><li>Convinced </li></ul><ul><li>Empowered </li></ul><ul><li>Entrusted </li></ul><ul><li>Supported </li></ul>
  45. 49. 1990 2001 100% My kidney function 10% ?
  46. 50. My medication
  47. 51. My CKD diet Protein down Energy up Balanced+balancing
  48. 52. <ul><li>My healthy </li></ul><ul><li>life-style </li></ul>
  49. 53. <ul><li>The outcome </li></ul>100% 10% 1990 2001 2007 No dialysis Tolerable symptoms
  50. 54. <ul><li>It worked for me </li></ul><ul><li>___________________________________ </li></ul><ul><li>It may work </li></ul><ul><li>for others </li></ul><ul><li>___________________________________ </li></ul><ul><li>Not for all </li></ul>
  51. 55. <ul><li>Gains </li></ul><ul><li>Me: 6 years of health, freedom </li></ul><ul><li>The clinic: 15 min/2 months </li></ul><ul><li>Local gov: Saved €400000 </li></ul><ul><li>My doctor: My HERO </li></ul>
  52. 56. Thank you

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