Self management

1. Self-Management
Done by:
Vandana Mehta
Submitted to:
E.R.Garima
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2. Outline
Definition
Purpose
Effectiveness
Self management in respiratory cases
Advantages
Problems
Strategies
Study
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3. Defining Self-Management
Self-management involves a controlling
behavior and a controlled behavior
Controlling behavior what the person does now.
Managing antecedents and consequences.
Controlled behavior refers to the behavior the
person wants to manage in the future.
Learning new behaviors.
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4. Defining Self-Management
Self-management: Although the term
"self" implies "alone", the self-
management component always
includes a partnership with a health
care professional.
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5. Purpose
To ensuring individuals are actively engaged
in self-management.
to complement pharmacological care and
enhance outcomes.
Delivery of pulmonary rehabilitation, that
assists patient self-management and
provision of self-management education and
support to increase self-efficacy and help
patients to better manage their condition
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6. Effectiveness
Effective self-management
encompasses the ability to monitor
one’s condition and to affect the
cognitive, behavioral, and emotional
responses necessary to maintain a
satisfactory quality of life.
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7. considerations
Age
Culture and Health Beliefs
Health Literacy
Access to Care
Psychosocial Factors
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8. Advantages
client related:
quality of life
ability to attend school/ go to work
self-confidence
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9. Advantages
health related :
related to depression
blood pressure
hemoglobin levels
pain
and use of medication
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10. Advantages
health service related :
planned and emergency visits to
emergency departments or general
practitioners
cost of health care.
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11. Self management in
respiratory
COPD and other chronic is highly prevalent and a significant
cause of morbidity and mortality, impacting on quality of life and
healthcare expenditure. Health promotion is therefore an
important consideration. By applying specific strategies,
respiratory therapists can play a major role in the promotion of
self-management
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12. Our role :
Training
Training to deliver and support self-management is
crucial, but insufficient as a sole intervention . Even
well-designed theoretically-based training for
professionals, for example including generic
consultation skills as well as specific knowledge
about disease self-management, may not enable the
professional to implement their learning in routine
practice if the organization does not nurture and
support
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13. Problems
Behavioral deficits refers to the failure to
perform the desirable behavior.
Behavioral excess refers to the consistent
performance of the undesirable behavior.
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14. Self-Management Strategies
Basically, self-management involves
the individual:
identifying and defining the target
behavior.
using behavior modification procedure(s)
to develop alternative behavior(s).
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15. Self-Management Strategies
Four steps are involved:
1. Goal setting.
2. Self-monitoring.
3. Antecedent manipulations..
4. Data collection
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16. Self-Management Strategies
1.Goal setting.
• Set goals that are:
achievable.
especially true early in change program.
Goal achievement=conditioned reinforcer.
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17. Self-Management Strategies
2.Self-monitoring.
Observing one’s own behavior.
Often combined with goal setting.
Produces reactivity effects.
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18. Equipment •
Intel Health-Guide (home based monitoring system).
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19. Equipment
• Peripherals:
Sphygmomanometer
Pulse oximeter
Scales
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20. Monitoring System
Web-based central monitoring system (Intel Health
Management Suite)
•On-line interface that allows nurses to securely monitor their
patient’s condition
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21. Self-Management Strategies
3.Antecedent manipulations.
Involved in all self-management interventions.
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22. Interventions
Telephone consultation by the staff
•Home visit by a member of the Health Choices nursing team
(clinical or technical)
•Liaison with patient’s GP/Specialist if indicated
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23. Self-Management Strategies
Data collection
A written document that:
Activity status
Level of improvement
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24. self-management plan
The self-management plan includes all the
necessary information for your patients to understand
their condition and tools to manage it.
The plan covers everything from breathing
techniques and what questions to ask your doctor to
exercise and goal setting.
( patient is his on therapist )
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25. Study
Self-management reduces both short- and long-term
hospitalization in COPD
M-A. Gadoury, K. Schwartzman, M. Rouleau, F. Maltais, M.
Julien, A. Beaupré, P. Renzi, R. Bégin, D. Nault, J. Bourbeau
DOI: 10.1183/09031936.05.00093204 Published 1 November
2005
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26. Study
Abstract
The aim of the present study was to assess the long-term
impact on hospitalization of a self-management programme for
chronic obstructive pulmonary disease (COPD) patients.
A multicentre, randomized clinical trial was carried out involving
191 COPD patients from seven hospitals. Patients who had one
or more hospitalizations in the year preceding study enrolment
were assigned to a self-management programmed “Living Well
with COPDTM” or to standard care. Hospitalizations from all
causes were the primary outcome and were documented from
the provincial hospitalization database; emergency visits were
recorded from the provincial health insurance database.
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27. Study
Most patients were elderly, not highly educated, had advanced
COPD (reflected by a mean forced expiratory volume in one
second of 1 L), and almost half reported a dyspnoea score of
5/5 (modified Medical Research Council). At 2 years, there was
a statistically significant and clinically relevant reduction in all-
cause hospitalisations of 26.9% and in all-cause emergency
visits of 21.1% in the intervention group as compared to the
standard-care group. After adjustment for the self-management
intervention effect, the predictive factors for reduced
hospitalisations included younger age, sex (female), higher
education, increased health status and exercise capacity.
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28. In conclusion, in this study, patients with chronic
obstructive pulmonary disease who received
educational intervention with supervision and support
based on disease-specific self-management
maintained a significant reduction in hospitalisations
after a 2-year period.
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29. Self management for patients with
chronic obstructive pulmonary disease
Marlies Zwerink1, Marjolein Brusse-Keizer1, Paul DLPM van der Valk1,
Gerhard A Zielhuis2, Evelyn M Monninkhof3, Job van der Palen1,4,
Peter A Frith5,6, Tanja Effing5,6,*
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30. Abstract
Self management interventions help patients with chronic
obstructive pulmonary disease (COPD) acquire and practise the
skills they need to carry out disease-specific medical regimens,
guide changes in health behaviour and provide emotional
support to enable patients to control their disease. Since the first
update of this review in 2007, several studies have been
published. The results of the second update are reported here.
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31. Methods
We searched the Cochrane Airways Group Specialised
Register of trials (current to August 2011). Controlled trials
(randomised and non-randomised) published after 1994,
assessing the efficacy of self management interventions for
individuals with COPD, were included. Interventions with fewer
than two contact moments between study participants and
healthcare providers were excluded.
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32. Results
Analysis of the studies revealed that self management training
improved health-related quality of life in patients with COPD compared
with usual care. Also, the number of patients with at least one hospital
admission related to lung disease and other causes was reduced
among those who participated in a self management intervention.
These patients also experienced less shortness of breath. We found
trials that compared different types of self management interventions
versus each other. We had hoped that these trials would help us
identify the most effective components of self management. However,
all interventions were different, and we were unable to draw out the key
themes.
The studies assessed in this review were diverse. Self management
programmes differed in content and duration. Also, types of participants
differed across studies. Therefore, no clear recommendations on the
most effective content of self management training can be made at this
time. 32

33. Conclusion
Self management interventions in patients with COPD are associated
with improved health-related quality of life as measured by the SGRQ, a
reduction in respiratory-related and all cause hospital admissions, and
improvement in dyspnoea as measured by the (m)MRC. No statistically
significant differences were found in other outcome parameters.
However, heterogeneity among interventions, study populations, follow-
up time and outcome measures makes it difficult to formulate clear
recommendations regarding the most effective form and content of self
management in COPD.
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34. The (cost)-effectiveness of self-treatment
of exacerbations on the severity of exacerbations in
COPD patients: the COPE-II study
doi:10.1136/thx.2008.112243
Thorax published online 6 Sep 2009;
and Job van der Palen
Tanja W Effing, Huib A M Kerstjens, Paul D L P M
van der Valk, Gerhard A Zielhuis
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35. ABSTRACT
COPD is a chronic disease with high prevalence and quickly increasing
incidence rates. We
evaluated the effect of self-treatment of COPD exacerbations on the
severity of exacerbations
during one year. In addition, a cost-effectiveness analysis was
performed.
Patients were randomly allocated to four two-hour self-management
sessions, with or
During follow up all participants kept a daily symptom diary. These
provided the
data to calculate the frequency of exacerbations, the number of
exacerbation days and mean
daily severity scores.
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36. Data were analysed of 142 randomised patients (self-treatment: n=70;
control: n=72).
The frequency of exacerbations was identical in both study groups
(mean 3.5 (SD 2.7)).
31(interquartile range (IQR): 8.9-67.5); control: 40 (IQR: 13.3-88.2);
p=0.064), the difference
was significant in the group of patients with a high number of
exacerbation days per year
(>137 (= 90th percentile of the whole study population); p=0.028). The
mean severity score of
differences were found in
health related quality of life. Cost-effectiveness analyses showed that
applying self-treatment
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37. saved €154per patient, with a trend towards a lower probability for
hospitalisations
(number/patient/year: self-treatment: 0.20 versus control: 0.33
(p=0.388)) and a significant
reduction of health care contacts (number/patient/year: self-treatment:
5.37 versus control:
6.51 (p=0.043)).
We conclude that self-treatment of exacerbations incorporated in a
self-management
programme leads to less exacerbation days and lower costs.
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38. Any questions ?
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39. Thank you
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