Model of Patient self-management and healthcare provider support

1. Durhane Wong-Rieger, PhD President Institute for Optimizing Health Outcomes

5. 22/11/2006 Integrating Patients in Chronic Disease Management Acute versus Chronic Disease ACUTE DISEASE CHRONIC DISEASE BEGINNING Rapid Gradual CAUSE Usually one Many DURATION Short Indefinite DIAGNOSIS Commonly accurate Often uncertain, especially early DIAGNOSTIC TESTS Often decisive Often of limited value TREATMENT Cure common Cure rare ROLE OF PROFESSIONAL Select and conduct therapy Teacher and partner ROLE OF PATIENT Follow orders Partner with health professionals, responsible for daily management

6. HCP and Patient Self-Management 22/11/2006 Integrating Patients in Chronic Disease Management Patient Knowledge (Risks, Benefits, Alternatives, Resources) Patient Skills (Problem-solving & Decision Making) Patient Directs (Low Risk) “ Patient Self-Reliance” Patient seeks other information; choice on beliefs, values, fears HCP: challenges, supports Guidance: Internet,alternatives Rely on self, faith, others Patient distrustful of system HCP Directs (Acute) “ Doctor Knows Best” Patient relies on HCP to make choice Patient does not question; complies with prescribed treatment Guidance: Healthcare professional Rely totally on professional judgment Patient trusts, relies totally Patient Self-Manages (Chronic) “ Patient Informed Choice” Patient seeks information; makes plans, responsible for choice HCP listens, informs, supports Guidance: Patient peers, caregivers Rely on family and peer support Patient feels empowered HCP Navigates (High Risk) “ HCP Guidance” HCP defines options, “care maps”; Patient seeks guidance, support HCP clarifies & recommends Guidance: Healthcare professionals Rely on professional guidance Patient feels supported

8. Patient Self-Management Tools 22/11/2006 Integrating Patients in Chronic Disease Management Patient Role Technology Collaborative Patient Role Med Tech: Chronic Disease management aids; decision support aids Med Tech: Patient education materials online Lo Tech: Patient education materials on paper Subordinate Patient Role Hi Tech: Sensor-based surveillance Med Tech: Video camera surveillance Lo Tech: Personal supervision and monitoring Autonomous Patient Role Hi Tech: Advanced Assistive Technologies Med Tech: Online support groups, provider and health plan comparison engines Lo Tech: Self-help books on paper Structured Patient Role Hi Tech: Interactive Telemedicine consultation Med Tech: Monitoring and messaging system with multiple peripherals Med Tech: Home and portable testing peripheral From: California Healthcare Foundation: Patient Self-Management Tools: An Overview, June 2005