Self-management support involves transforming the patient-caregiver relationship into a collaborative partnership. It also includes techniques and tools that help patients choose healthy behaviors to manage long-term conditions. The Chronic Care Model shows that supporting self-management through active follow-up, care coordination, and training patients can improve clinical outcomes and healthcare use. Research demonstrates that approaches focusing on self-efficacy, behavior change, and readiness to change work best to improve patient outcomes over simply providing information alone. Examples show that self-monitoring, goal setting, telephone support, and education can reduce hospitalizations and healthcare costs while improving self-care behaviors and health status.
Quality assurance is one of the important topic for our Nursing field this is important for M.Sc. Nursing Final Year students for the subject of management that will also help to all nurses either in the filed of clinical as well as education
THE EXPENSE OF QUALITY IS AN INTERACTIVE PROCESS BETWEEN CUSTOMER & PROVIDER. QUALITY ASSURANCE USUALLY FOCUSES ON MATERIAL, GOOD WORK & SERVICE PROVIDED EFFECTIVELY. ANY LACK IN SERVICE PROVIDED CAUSES DECREASE IN QUALITY
This presentation will be useful for those who seeks information regarding time management in various fields like management,administration,education, and especially in nursing fields
This course deals with the basic concepts, principles and dimensions of quality health care, patient safety, quality standards for Health Provider Organizations and implementing a quality improvement program in the health care system. It provides students with an introduction to quality improvement science in a health care setting. The course challenges students to think in an interdisciplinary manner when problem solving for quality improvement and will provide students with models and tools for leading quality improvement initiatives in a variety of organizational settings.
The health care system and the nursing profession is expanding globally , there fore it is important for nurses to know the trends, issues and challenges in new millennium.
Quality assurance is one of the important topic for our Nursing field this is important for M.Sc. Nursing Final Year students for the subject of management that will also help to all nurses either in the filed of clinical as well as education
THE EXPENSE OF QUALITY IS AN INTERACTIVE PROCESS BETWEEN CUSTOMER & PROVIDER. QUALITY ASSURANCE USUALLY FOCUSES ON MATERIAL, GOOD WORK & SERVICE PROVIDED EFFECTIVELY. ANY LACK IN SERVICE PROVIDED CAUSES DECREASE IN QUALITY
This presentation will be useful for those who seeks information regarding time management in various fields like management,administration,education, and especially in nursing fields
This course deals with the basic concepts, principles and dimensions of quality health care, patient safety, quality standards for Health Provider Organizations and implementing a quality improvement program in the health care system. It provides students with an introduction to quality improvement science in a health care setting. The course challenges students to think in an interdisciplinary manner when problem solving for quality improvement and will provide students with models and tools for leading quality improvement initiatives in a variety of organizational settings.
The health care system and the nursing profession is expanding globally , there fore it is important for nurses to know the trends, issues and challenges in new millennium.
Person-centred care and patient activationNuffield Trust
Richard Owen, NHS England, and Dr Natalie Armstrong of the University of Leicester present on evaluating Person Centred Care through Patient Activation Measure (PAM).
Most traditional projects capture the majority of their lessons learned at the end of the project. The intent behind capturing these lessons is to allow the organization to apply them to future projects with a similar business or technical domain, or to projects that have similar team dynamics.
This approach, frankly, is too little, too late. We need to apply the benefits of learning as we go—on our current project, and as soon as possible.
Agile projects schedule continuous improvement activities into the plan as part of the methodology. The agile approach to lessons learned is deliberate and frequent, and it helps ensure that the team regularly considers adaptation and improvement to the point where it becomes habitual and part of their normal way of working.
We will look at the T&T and K&S that are part of this “Learn” step:
Retrospectives
Knowledge Sharing
Process Tailoring
Principles of Systems Thinking (Complex, Adaptive, Chaos)
Process Analysis
Continuous Improvement Processes
Self Assessment
Farla Medical, one of the UK's largest supliers of medical technologies, commodities and consumables shared best practices from the UK. Including in infection prevention and control, tooling HRH and improving heath service delivery efficiencies.
Person Centered Care through Integrating a Palliative Approach: Lessons from ...BCCPA
Aging adults are entering residential care facilities with more advanced disease than in the past and their length of stay is shorter. Most health care providers in these facilities do not receive targeted education and training in palliative care, nor are they confident to have crucial conversations about goals of care and end of life challenges with residents and their families. Due to limited capacity to manage predictable symptoms related to end of life and insufficient planning, many residents are transferred to hospital in crisis and die in the Emergency Department or acute care wards.
This presentation will showcase some of the initiatives by identifying common themes, unique features of each and strategies for success. Opportunity will be given for delegates to ask questions and brainstorm how lessons learned from these initiatives could inform the care provided at their own facility.
Presented by:
- Jane Webley, RN LLB Regional lead, End of Life, Vancouver Coastal Health (EPAIRS and the Daisy project)
- Dr Christine Jones, Island Health (SSC project: Improving end of life outcomes in residential care facilities: A palliative approach to care)
- Kathleen Yue, RN, BSN, MN, CHPCN (c) Education Coordinator, BC Center for Palliative Care
Engagement Is Everything, How To Apply Psychology to Improve Digital Experien...Mad*Pow
Why are some digital experiences utterly engaging—addicting, even—and others can’t hold people’s attention for more than a few minutes (we’re looking at you, employer-mandated health risk assessments)? In a world where there are hundreds of thousands of apps in the health and wellness category alone, an engaging experience is a must to win space on someone’s smartphone. In this webinar, we’ll dive into the behavior science behind motivation to uncover some of the qualities of truly engaging digital experiences.
We begin with an understanding of what it means to be engaged, and how to decide what level of engagement is needed for a particular experience. Then, we dive into a robust and well-researched theory of motivation, self-determination theory, to understand what makes certain experiences stick. It’s all about identifying and pushing the “levers of motivation” by designing for the fundamental psychological needs that make people tick. Behavior Change Design Director Amy Bucher, Ph.D., will walk through industry-best examples of engaging digital experiences ranging from video games to educational tools to health interventions. She’ll offer a list of best practices for each of the key levers of motivation: autonomy, competence, and relatedness. Learn how to super-charge your digital products with psychology.
Unit I. Introduction to Nursing Research.pptxshakirRahman10
Introduction to Nursing Research:
Objectives:
Define nursing research
Describe ways of knowing in nursing (tradition, authority, borrowing, trial and error, intuition, and research )
Identify role of a nurse in research as ADN, BS, MS, PhD, and DNP
Explain Evidence Based Practice through research.
Definitions:
Research: It is a systematic, formal, rigorous, and precise process used to gain solutions to problems or discover and interpret new facts and relationships.
Nursing Research: is systemic inquiry designed to develop knowledge about issues of importance to nurses, including nursing practice, nursing education, and nursing administration.
Research-based Practice: using research findings to inform the decisions, actions, and interaction of nurses with clients.
Importance of research in nursing:
Emphasizing on the development and utilization of nursing knowledge, which is essential for continued improvement in patient care.
Nurses' need to document the effectiveness of their practices not only to the profession, but also to the clients, administrators, and other professionals. - (Thus research findings help them to eliminate nursing actions that do not achieve desired outcomes or to identify the practices that alter health care outcomes and contain costs).
Nurses' need for understanding the varied dimensions of their profession, (theoretical, ethical, practical dimensions, etc.)
4. Research enables nurses to describe:
The characteristics of a particular nursing situation about which little is known.
Explain phenomena that must be considered in planning nursing care.
Predict the probable outcomes of certain nursing decisions.
Control the occurrence of undesired outcomes.
Initiate activities to promote desired client behavior.
Roles of nurses in nursing research:
It is every nurse's responsibility to engage in one or more roles along the research participation:
Indirect participation:
This is a minimum nurse involvement in a research responsibility. It is done when a nurse read a research report to keep up-to-date on relevant findings that may affect their practice. This level is called "research utilization".
Research Utilization: "Is the use of the research findings in a practice setting"
2. Direct participation: in which nurses are nursing research producers. They are actively participating in designing and implementing research studies.
3. Between these two dimensions of research participation, there are a variety of roles for nurses to play, from these roles:
Attending research presentations at professional conferences.
Evaluating completed research for its possible use in practice.
Discussing the implications and relevance of research findings with clients.
Giving clients information and advice about participation in studies.
Assisting in the collection of research information.
PRIME Centre Wales
Long Term Conditions Consensus Meeting
Tuesday 10th November 2015, St Mary's Priory, Abergavenny, NP7 5ND
http://www.primecentre.wales/ltc-consensus-meeting.php
Similar to The theory and evidence behind self management (20)
These are the charts and figures from our briefing on what the UK leaving the EU might mean for funding of the NHS in England. We outline the current state of finances for NHS providers in 2015/16, what this implies for the total Department of Health budget, and the scale of the financial challenge facing the health service for the near future.
This slidepack contains figures and charts from analysis that is an update to the April 2015 Health Foundation report, 'Hospital finances and productivity: in critical condition?'
The analysis shows that the productivity of acute hospitals in England has continued to deteriorate. Overall, the productivity of acute hospitals increased by only 0.3% between 2009/10 and 2014/15 – an average rate of 0.1% per year. Between 2009/10 and 2014/15 as a whole, activity growth and input growth have converged leading to the very low level of annual average productivity growth.
A perfect storm: an impossible climate for NHS providers' finances? (Slidepac...The Health Foundation
This is a slidepack of figures from our report on the financial performance of the NHS in England. The main focus is on the finances of NHS providers and the financial position of the commissioners of care (NHS England and clinical commissioning groups).
The report examines commissioners’ budgets and how spending has changed by type of provider, as well as the specific issues facing NHS providers. It also includes the findings of a statistical analysis that set out to identify factors that are most strongly associated with an acute or specialist provider’s deficit.
A connected community working together to improve health and care quality across the UK. Presentation by Penny Pereira, Deputy Director of Improvement at the Health Foundation.
Q is an initiative, led by the Health Foundation and supported and co-funded by NHS England, connecting people skilled in improvement across the UK.
Q will make it easier for people from all parts of the health care system with expertise in improvement to share ideas, enhance their skills, and make changes that benefit patients.
NHS finances: the challenge all political parties need to face - updated tabl...The Health Foundation
View the full set of charts and tables from our 2015 briefing 'NHS finances: the challenge all political parties need to face' - some of the data was updated in May 2015 and this slidepack reflects those updates.
Do people support raising taxes to maintain the NHS? Do they think care has got better, worse, or stayed the same?
Our pack of infographics pulls out the take-home messages from recent polls on what the public really want from the NHS, ahead of the 2015 general election.
With the NHS as the main area of public interest in the run-up to the 2015 general election, the Health Foundation and Ipsos MORI have conducted just under 1,800 interviews with adults across Great Britain to understand what the public thinks about the issues that are shaping debate on the NHS.
These are the charts from a Health Foundation report where we examine the financial performance of NHS providers, focusing on hospitals.
We identify areas of cost pressure using their financial accounts up to 2013/14 and quarterly reporting data up to December 2014 (Q3 2014/15). We also examine trends in efficiency and productivity from 2009/10 to 2013/14.
www.health.org.uk
NHS finances: the challenge all policital parties need to face - charts and t...The Health Foundation
The NHS is one of the key issues of public concern in the run up to the 2015 general election and levels of concern have increased.
We have analysed the funding issues facing the NHS. This slidepack includes all the charts and tables from our research.
Find out more at wwww.health.org.uk/fundingbriefing
This presentation was given by our Chief Executive, Dr Jennifer Dixon, to the International Improvement Science and Research Symposium at the 2014 International Forum on Quality and Safety in Healthcare.
The four health systems of the United Kingdom: how do they compare?The Health Foundation
This slide set shows the top level messages and findings from a report published by the Health Foundation and the Nuffield Trust, assessing the performance of the NHS on the quality of patient care in all four UK countries since devolution.
This presentation, by Professor Eugene Nelson from the Dartmouth Institute, looks at measuring what matters to patients and some specific case studies and examples.
To view a video of the presentation with sound/narrative, go to:
http://www.health.org.uk/multimedia/slideshow/measuring-what-matters-to-patients-concepts-and-cases/
Hard data and soft intelligence: how can we know if care is safeThe Health Foundation
This presentation was given at the Health Foundation's 'What matters in measurement' event in January 2014.
To view a video of the presentation with sound/narrative, go to:
http://www.health.org.uk/multimedia/slideshow/hard-data-soft-intelligence/
In this presentation, Jonathan Riddell Bamber looks at a new proposed framework to help answer the question 'how safe is care today?'
The framework is from a report by Charles Vincent, Susan Burnett and Jane Carthey of Imperial College London, commissioned by the Health Foundation.
The framework highlights five dimensions which the authors believe should be included in any safety and monitoring approach in order to give a comprehensive and rounded picture of an organisation’s safety.
The Health Foundation is exploring how to develop and adapt the framework discussed in this presentation.we are seeking the thoughts and insights of a wide range of stakeholders – including those with a specialist role in patient safety, those involved in direct care delivery, patients and carers and the public in general.
If you would like to share your thoughts, please complete our response form at https://www.surveymonkey.com/s/safetymeasurement or email measurement@health.org.uk by 1 July 2013.
The form includes the following questions:
Does the framework in this report reflect your experience of healthcare?
Are there other dimensions of safety and how would this framework relate to them?
Would using this framework make it easier for you to know whether care is safe?
Please tell us how you could use this framework.
What do you think needs to be done to help you use the framework in practice?
How could the intelligence from the framework be used to improve care?
We will share what we learn widely to help those involved in patient safety work. We will also use the responses to help develop our thinking about how to improve patient safety.
What we know about how to improve quality and safety in hospitals - Mary Dixo...The Health Foundation
Professor Mary Dixon-Woods looks at improving the quality and safety of care in hospitals, and suggests that we need to take a three-pronged approach: ensuring we are collecting the right data and interpreting it intelligently, looking at the systems we work in and finally how culture and behaviour impact on quality of care.
To watch this presentation with accompanying audio/narration, go to:
http://www.health.org.uk/multimedia/slideshow/what-we-know-about-how-to-improve-quality-and-safety-in-hospitals/
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
1. The theory and evidence
behind self management
Natalie Grazin
Assistant Director
The Health Foundation
2. Why support self-management?
Life with a long term condition: the person’s perspective
Interactions with the service: planned or unplanned
Problem solving:
Time limited
consultation/s
Care planning: A system of
providing
regular scheduled appointments,
motivational
providing proactive structured
support
support
Care pathways:
providing
specific
interventions
NB : People may also be accessing a wide variety of other support e.g. from within their
communities
3. What is self-management
support?
“Self management support can be viewed in
two ways: as a portfolio of techniques and
tools that help patients choose healthy
behaviours; and a fundamental
transformation of the patient-caregiver
relationship into a collaborative
partnership.”
Bodenheimer T, MacGregor K, Shafiri C (2005). Helping Patients Manage
Their Chronic Conditions. California: California Healthcare Foundation.
3
4. The Chronic Care Model
The problems:
• Lack of care coordination
• Lack of active follow-up
• Patients inadequately trained to
manage their illnesses
„Overcoming these deficiencies
will require nothing less than a
transformation of health care,
from a system that is essentially
reactive - responding mainly
when a person is sick - to one
that is proactive and focused on
keeping a person as healthy as
possible.‟
4
5. The Chronic Care Model
„Overcoming these deficiencies
will require nothing less than a
transformation of health care,
from a system that is essentially
reactive - responding mainly
when a person is sick - to one
that is proactive and focused on
keeping a person as healthy as
possible.‟
Understanding
have role;
confident and
capable in role Supporting
people on
their
journey of
Developed by the MacColl Institute
ACP-ASIM Journals and Books
activation
5
6. The evidence
Evidence for supporting self management grows every year.
• Research is up to date
• Internationally, studies are consistently positive
• Research has used a range of methodologies.
• Studies are from small to large scale.
It shows that supporting self-management can improve:
• self confidence / self efficacy
• self management behaviours
• quality of life
• clinical outcomes
• patterns of healthcare use
6
7. Active support works best
Research shows that more
active support focused on
self-efficacy (confidence)
and behaviour works best
to improve outcomes.
Information and
knowledge alone are not
enough.
7
8. Active support works best
Approaches that focus on
whether people are
ready to change work
well.
Source: Prof Judy Hibbard, University of Oregon
8
9. Examples of improvement
• Self monitoring and agenda setting reduce hospitalisations, A&E
visits, unscheduled visits to the doctor and days off work or school for
people with asthma (Gibson et al 2004).
• Goal setting for older women with heart conditions reduces days in
hospital and overall healthcare costs (Wheeler et al 2003).
• Telephone support may improve self care behaviour, glycaemic
control, and symptoms among vulnerable people with diabetes (Piette
et al 2000).
• Motivational interviewing improve self efficacy, patient activation,
lifestyle change and perceived health status (Linden et al 2010).
• Individual education and group sessions improve symptoms for
people with high blood pressure (Boulware et al 2001).
9
10. More information
Visit our self management support
resource centre on the Health Foundation‟s
website:
www.health.org.uk/sms
10
Editor's Notes
SLIDE 2: Why support self-management The greatest challenge for the NHS is no longer curing infectious diseases or treating acute conditions. The greatest challenge now is enabling the nearly1 in 3 people who have a long-term condition – whether coronary heart disease or diabetes; asthma or COPD; chronic pain or rheumatoid arthritis; Parkinson’s disease or as a survivor of cancer treatment – to live healthier and longer lives without bankrupting the NHS. If that is the challenge, what is the reality? The reality is that People who live with a long-term condition spend very few hours in contact with health service. Some of those hours are for routine tests and appointments; many are for crisis interventions. Treating their long-term condition demands a different sort of health service, one in which the primary function is to support people to self-manage.This picture in this slide was drawn by people living with a long-term condition supported by some clinicians. It really does capture that reality nicely. There is a growing appreciation in health services of this reality and of the central importance both to improving outcomes and to improving quality of people with a long-term condition being actively engaged in their care.
SLIDE 3: What Is Supported Self-Management? Supporting self-management is very different from telling patients what to do. Being a good ‘self-manager’ is very different to following the doctor’s orders. To be effective at managing their own health, a patient must have a central role in determining their care, one that fosters a sense of responsibility for their own health. A health services that supports people to manage their condition ensures that they have the confidence and the skills to do so. Supporting self management involves providing encouragement and information to help people understand their condition, monitor symptoms and take appropriate action. This may include: involving people in decision makingpromoting healthily lifestyles providing education about conditions and self caremotivating people to look after themselvessetting goals and checking whether these are achieved over timeproactively following up goalsproviding opportunities to share and learn from other peopleThere are all sorts of things that nudge our behaviour. Will power may help. But for most of us most of the time, it really isn’t enough. A little bit of audience participation: raise your hand if you have you ever determined to go to a gym regularly or to shed a few pounds? Now keep your hand raised if you were still using the gym regularly six months later That’s why gyms charge you an annual fee. They know that those new year’s resolutions will soon wane, so they want your money up front. Weightwatchers understands it too. That’s why their model is built around peer support. And it works in the digital age too: [Natalie can you insert the name of the web site you use – and which I failed to use!] not only provide you with information and tools to help you understand what you can do and to measure your progress, but have also adopted a facebook approach, allowing you to share your progress with an online community that can support and encourage you.
SLIDE 6: The evidence There is strong evidence from over 600 studies and across a range of conditions – from arthritis to diabetes, COPD to hypertension; coronary heart disease to rheumatoid arthritis. The research is up to date. Most studies have been published in the past 15 years. Internationally, studies are consistently positive: from the UK, North America, Europe, Australasia and Asia are available. The findings are similarly positive across all countries. The research has used a range of methodologies, including systematic reviews, randomised trials and observational and comparative studies. Studies sizes have ranged from tens of people to several thousand. The evidence shows that when people are supported to look after themselves, they feel better, enjoy life more and have fewer visits to GPs, fewer admissions to hospital and, when they are admitted, shorter lengths of stay, costing health services less: Studies have shown a wide range of improvements: people living with arthritis reported a 12% reduction in pain; their disability decreased by 7%people living with diabetes had a significantly reduction [0.9%] in HbA1c, improvements in their quality of life as well as their diet and exercisepeople with hypertension saw a 20% reduction in systolic blood pressurethe confidence of people with asthma to manage symptoms improved, they had a more appropriate use medication and reduced hospital admission reduced hospital admission COPD, asthma, CHD –the number of sick days for people with rheumatoid and osteo-arthritis was cut in half
How do we support people to manage their condition more effectively? Again, the evidence is clear. We know what does not work: Providing information is helpful, but it is not sufficient: without the confidence and skills to use information, the information will not lead to better health outcomes. Telling a person that they need to lose weight, why they need to lose weight and that they can achieve it through exercise and eating less fat and more fruit rarely changes their behaviourSelf management courses alone are of limited effectiveness if isolated from mainstream services. The gainsin confidence are insufficient when faced with the medical model of care and the infrastructure that supports it. We also know what does work: methods that improve people’s activation and self-efficacy are the most effective ways of improving self-management, healthy behaviours and outcomes for people living with a long-term condition. collaborative interactions have the greatest impact on changing people’s behaviour and supporting them to take on responsibility for their healthcareshared agenda setting, collaborative goal setting and health service follow-up on goals lead to better quality of life, more appropriate patterns health service utilisation and better clinical outcomes.
SLIDE 7: Active support works best How do we support people to manage their condition more effectively? Again, the evidence is clear. We know what does not work: Providing information is helpful, but it is not sufficient: without the confidence and skills to use information, the information will not lead to better health outcomes. Telling a person that they need to lose weight, why they need to lose weight and that they can achieve it through exercise and eating less fat and more fruit rarely changes their behaviourSelf management courses alone are of limited effectiveness if isolated from mainstream services. The gains in confidence are insufficient when faced with the medical model of care and the infrastructure that supports it. We also know what does work: [Click mouse/pointer/return key to move slide to first builD] methods that improve people’s activation and self-efficacy are the most effective ways of improving self-management, healthy behaviours and outcomes for people living with a long-term condition. collaborative interactions have the greatest impact on changing people’s behaviour and supporting them to take on responsibility for their healthcareshared agenda setting, collaborative goal setting and health service follow-up on goals lead to better quality of life, more appropriate patterns health service utilisation and better clinical outcomes. [Click mouse/pointer/return key to move slide to second build.] Supporting people to become activated self-managers enables them: to begin the journey of taking a role in their healthto build their knowledge and their confidenceto take actionand to maintain their changed behavirours
SLIDE 8: Examples of improvement following active support So, the evidence shows that methods that improve people’s self-efficacy are most effective. There are many examples from the evidence. Here are a few: A Cochrane review of 36 trials found that self monitoring and agenda setting reduced hospitalisations, A&E visits, unscheduled visits to the doctor and days off work or school for people with asthma A US trial found that personalised goal setting for older women with heart conditions reduced days in hospital and overall healthcare costs A trial found that telephone support may improve self care behaviour, glycaemic control, and symptoms among vulnerable people with diabetes US researchers found that motivational interviewing helped improve self efficacy, patient activation, lifestyle change and perceived health statu A large meta analysis found that individual education and group sessions improved symptoms for people with high blood pressure