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42self management
42self management
42self management
42self management
42self management
42self management
42self management
42self management
42self management
42self management
42self management
42self management
42self management
42self management
42self management
42self management
42self management
42self management
42self management
42self management
42self management
42self management
42self management
42self management
42self management
42self management
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42self management

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  • 1. Module 4.2 Self management Evidence and theoretical componentsProduced by The Alfred Workforce Development Team on behalf of DHS Public Health - Diabetes Prevention and Management Initiative June 2005
  • 2. Presentation purposeTarget audience Service providers and project workers on DPMI projectsAim To encourage consumers to self manageObjectives 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. DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 3. 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 DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 4. Is self management effective? Evidence to support self management  Improves quality of life  Supports behavior change  Decreases health care utilisation DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 5. 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 DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 6. Diabetes self management educationin 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 DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 7. Measuring effectiveness of selfmanagement 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 DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 8. Stanford Chronic Disease SelfManagement Program RCT - 952 subjects  Demographic Data  Age 62 years  Male 27%  Education 14 years  No. Diseases 2.2Kate Lorig et al. Evidence suggesting that a chronic disease self management program can improve health status while reducing hospitalizations. Medical Care 37,1 1999 DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 9. Stanford Chronic Disease SelfManagement Program Percent With Common Diseases  Lung Disease 21%  Heart Disease 24%  Diabetes 26%  Arthritis 42% DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 10. Stanford Chronic Disease SelfManagement Program 6-MonthImprovements in Health Outcomes  Self-Rated Health • Disability • Social and Role Activities Limitations • Energy/Fatigue • Distress with Health State DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 11. Stanford Chronic Disease SelfManagement 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-$200http://patienteducation.stanford.edu/bibliog.html DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 12. 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/ DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 13. Peer led self management http://www.latrobe.edu.au/aipc/director/plsmci/about_healthprof.htm DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 14. Peer led self management DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 15. Peer led self management DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 16. Peer led self management DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 17. 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 DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Kate Lorig
  • 18. How self management differs from patient education Self-Management Patient Education Self-Management PatientPurpose To manage life Education To change Purpose: To Manage Life disease with To Change behaviors With Disease Behaviors To Increase Skills/Self- To Increase Confidence Knowledge To increase skills To Problem Solve To Use Specific To increase /self confidence And Make DecisionsTools knowledge Kat e Lor ig To problem solve To use specific and make decisions tools Kate Lorig DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 19. How self management differsfrom patient education Self Patient Management EducationNeeds Patient What patientsAssessment problems need to knowContent Disease, role, Disease knowledge & emotional and behaviors managementLeader Leader is guide Leader is expert Kate Lorig DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 20. Essential elements of self managementinterventions Disease, medication and health management Role management Emotional management Support enhancement of self efficacy Problem solving training Follow up Tracking and ensuring implementationThe Robert Wood Johnson Foundation.The Centre for the Advancement of Health. www.cfah.org DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 21. Handling self management tasksS/M Task Passive ActiveMedical Deferred CollaboratesManagementRole Relinquishes Strives toManagement maintainEmotional Erratic Regular use ofManagement ineffectual coping skillsA. Jerant et al. “Patients perceived barriers to active self-management of chronicdisease” Patient education and counseling. 57,3 June 2005 DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 22. Handling self management tasksS/M skills Passive ActiveProblem Catastrophists SystematicSolving processDecision making Made in haste Carefully weighs fear optionsResource Erratic Regular use ofUtilisation ineffectual coping skillsPartnership Minimal Identifies and selectswith HPs HPs for supportAction Planning Minimal Applied frequentlySelf Tailoring Minimal Frequent DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 23. Promoting self efficacy Promote performance accomplishment Use verbal persuasion Role modelling Identifying feelings and helping work through strategies to deal with feelings DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 24. 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 DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 25. SMART Specific Measurable Achievable Realistic Timely Flinders University DPMI Workforce Development – The Alfred Workforce Development Team June 2005
  • 26. Guidelines for helping with - Problemsolving 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 DPMI Workforce Development – The Alfred Workforce Development Team June 2005

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