Supporting Patients in Self-Management at Jordan Health
1. Supporting Patients in Self-Management:
Existing Practices in Family Medicine
at Jordan Health
Gabriela Pauli
Anthony L. Jordan Health Center
Rochester, NY
2. Introduction
• Chronic conditions are ubiquitous
• Patients’ everyday behaviors affect their health
conditions patients “self-manage” their conditions
• No protocol for providing self-management support within
delivery of care model
• Not all staff receives training in self-management support
• Objective:
• How familiar are Jordan providers with self-management
support models?
• Confident in their knowledge & abilities? How often do
providers employ these techniques?
3. Background
• Identified existing Self-management models
• Literature review for efficacy of models
• Brainstorm with faculty advisor, site supervisor– which models
already taught at Jordan?
• Selected 8 models:
• 5 A’s Behavioral Change Model (Assess, Advise, Agree, Assist, Arrange)
• Motivational Interviewing
• Teach-back
• Ask-tell-ask
• Patient Activation
• Action-planning forms
• Goal Setting
• Goal Setting with Confidence-Scaling
4. Methodology
• Web-based survey emailed to all Family Medicine providers,
nurses (74 staff members)
• 23 participants recruited (31% response rate)
• Measured:
• Have you received any training in providing SM support?
• Trained in specific model?
• How confident do you feel in your skills utilizing that model?
• In what proportion of visits do you use model?
• Open-ended:
• What works?
• What are the barriers?
5. Results
59%
41%
Staff members with
SM training (N=22)
Some
training
No
training
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
LPN or RN MD/DO, NP, or PA
Percent of Respondents with SM training,
by provider type
7. Results
• Salient themes to open-ended questions
• What did staff members identify that works?
• Patients identifying their own goals
• Creating action-plans
• Patients willing, ready to change behaviors (Patient activation!)
• What are the barriers?
• Not enough time (stated by over ½ of participants)
• Many patients lack resources, such as finances, support at
home, housing security to make these health behavior
changes
8. Discussion
• For nearly all models, staff members’ confidence level
was higher than percentage of visits they employ SM
model
• Look for SM literature specific to underserved populations
or patient demographics similar to those at Jordan
9. Recommendations
• For providers: pick 1-2 SM models you prefer and bring to
attention of Practice Transformation
• For Practice Transformation: select 1-2 SM models and
strengthen training for all staff who work with patients
• Establish clear protocol for incorporating SM model into
delivery of care
• i.e. Patient’s action-planning forms as part of EHR
• Require longitudinal reporting on SM model for each patient
• Work with policy-makers, insurers to make SM practices
reimbursable
10. Conclusion
• The chronic conditions our patients face cannot be
managed with medications alone
• Providing Self-management support must become part of
our care delivery model
11. Acknowledgements
• Dr. Laurie Donohue, Site Supervisor
• Dr Colleen Fogarty, Faculty Advisor
• Practice Managers Joyce Land, Sarah Fisher, and Cindy
McGonigle
• Staff and Patients
Editor's Notes
MI is a goal-oriented, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence.
-Patient Activation: Does patient believe their active role to be important in their health? Do they know what behaviors affect their health? (Know the nature, causes of their condition? Does patient even believe they can change them? Is the patient taking action? Staying the Course under Stress?
-
First, we can see that in three of the models where Jordan has done some teaching– 5A’s, Motivational interviewing, and Teach-back, around 50% of respondents said hey had received training. So, that’s good feedback.
Next, we can see that for certain techniques, providers’ confidence levels were very high: Teach-back, Ask-tell-ask. This is promising because it shows that when certain models strengthen providers'’ perceived interaction with patients.
% of visits where technique employed: LOW! Ranges from 25-60%
Lastly… Goal-setting. Many people report they’ve trained in it, but when asked about action-planning and goals-setting with confidence scaling (which are really just more detailed, specific techniques for goal setting, roviders are not trained. Also, people trained in these two more specific forms of goal-setting felt more confident in their abiliities.
