Transcript Document

Chronic Disease Self-Management
A Patient-Centered Option for
Managing the Healthcare Challenge
Presentation prepared by:
John Irwin,
Healthcare & Community Informatics Consultant,
Stanford Licensed Chronic Disease Self-management Program Master Trainer
Today you will hear…

An introduction to chronic disease selfmanagement

A closer look at one evidence-based selfmanagement program
Impacts of Chronic Disease

Chronic disease will increase 300% by 2049

Chronic disease results in pain, debilitation,
disability, dependence, lost physical function,
and less mobility

Chronic diseases include: heart disease,
cancer, stroke, arthritis, asthma, lung disease,
cancer, diabetes, hypertension, osteoporosis,
multiple sclerosis, Parkinson’s disease…
Sources: NGA study; Stanford University Patient Education Center ,
http://www.stanford.edu/group/perc/
Financial Reality - Rising costs…

Chronic disease costs: 75-95% of health care
expenditures!

By 2030: Anticipated increase in healthcare
costs tied to chronic disease, 25% to 54%
Sources : Partnership for Solutions: Better Lives for People with Chronic Conditions, WA
State ; Health Affairs, 2005; 24 (1) 80-92; Center for Healthy Aging (NCOA)
People With Chronic Disease Report…

Significantly reduced productivity

Living with less income

Accomplishing less

Spending more time in bed sick

Having poor mental health
Sources: Stanford University (Lorig, K.); Center on an Aging Society,
National Institute on Aging
Self-Management Definition
“Involves [the person with the chronic disease]
engaging in activities that protect and promote
health, monitoring and managing of symptoms and
signs of illness, managing the impacts of illness on
functioning, emotions and interpersonal
relationships and adhering to treatment regimes.”
Source: Center for Advancement in Health (1996). Indexed bibliography on Selfmanagement for People with Chronic Disease. Washington DC.. Page 1
Self-Management Benefits Patients…
Builds confidence (self-efficacy) to perform 3 tasks
- Disease management
- Role Management
- Emotional Management
Focuses on improved health status and appropriate
health care utilization
Self-Management Differs
From Patient Education
Self-Management
- Manage life with disease
- Increase skills & self-confidence
- Problem solve and make decisions
Patient Education
- Change behaviors
- Increase knowledge
- Use specific tools (e.g., Care Plans, Action Plans)
Self-Management Also
Encompasses
 The patient and health professional working together.
 Often involves the family.
 An holistic approach to care (i.e., medical and psycho-
social components of a condition).
 Pro-active and adaptive strategies that aim to empower
the individual.
Patients Increasingly Want
to Retain Independence
More people with chronic disease believe…
They have a “right” to take part.
 They are capable of taking part, with the right
supports.
 Patient assertiveness is necessary…and needed.

Source: California Healthcare Foundation
Chronic Disease SelfManagement Assumptions

Patients with different chronic diseases have
similar self-management problems and
disease-related tasks.

Patients can learn to take day-to-day
responsibility for their diseases.

Confident, knowledgeable patients practicing
self-management will experience improved
health status and use fewer health resources.
Source: Lorig and Holeman 2003
Self-Management Framework

Patients accept responsibility to manage or comanage their own disease conditions.

Patients become active participants in a system
of coordinated health care, intervention and
communication.

Patients are encouraged to solve their own
problems with information, but not orders, from
professionals.
Sources: Stanford University Patient Education Center; Center for Healthy Aging (NCOA)
Self-Management Skills
Problem-solving
 Decision-making
 Resource Utilization
 Formation of a patientprovider partnership
 Action-planning
 Self-tailoring

Source: Lorig and Holeman 2003
Chronic Disease Self-Management Means…

Taking care of your illness (using medicines,
exercise, diet, technology, physician partnership)

Carrying out normal activities (employment,
chores, social life)

Managing emotional changes (anger, uncertainty
about the future, changed expectations and
goals, and depression)
It means having a combination of …
SKILLS, SUPPORT, PRACTICE and CONFIDENCE
Chronic Disease SelfManagement Program (CDSMP)
…the Stanford Model

Developed by Stanford University’s patient education
program

Structured w/~15 participants in a six-week series
of workshops
Participative instruction with peer support
 Designed to enhance medical treatment
 Outcome-driven: impacts show potential for reduced
or avoided costs
 Evidence-based: a tested model (intervention) that
has demonstrated results

Stanford’s CDSMP
is Evidence-based

Found to truly benefit targeted populations.

Demonstrated it does not cause harm.

Demonstrated it does not waste resources.
Reference: http://www.aoa.gov/evidence/evidence.asp; www.healthyagingprograms.org
The Stanford CDSMP Model
Why these techniques work…






Peer educators
Constant modeling
Active problem-solving
Formal brainstorming
Goal-setting
Action planning
Source: National Council on Aging, http://www.ctb.1si.ukans.edu,
www.healthyagingprograms.org
CDSMP Content
Content/Week
Overview of self-management and chronic health conditions
Making an action plan
Relaxation / Cognitive symptom management
Feedback / Problem solving
Anger / Fear / Frustration
Fitness / Exercise
Better breathing
Fatigue
Nutrition
Advance directives
Communication
Medications
Making treatment decisions
Depression
Informing the healthcare team
Working with your healthcare professional
Future plans
1
2
3
4
5
6
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
P
Participant’s Learn How to
Manage the Symptom Cycle
Disease
Fatigue
Tense Muscles
VICIOUS
CYCLE
Depression
Stress/Anxiety
Anger/Frustration/Fear
Participant’s Learn and Practice
Action Planning
Something YOU want to do
Reasonable
Behavior-specific
Answer the questions:
What?
How much?
When?
How often?
 Confidence level of 7 or more




The Stanford Model: Content…
“meets the test of common sense”






Techniques to deal with frustration, fatigue, pain,
and isolation.
Exercises/activities for maintaining and improving
strength, flexibility, and endurance.
Medication management.
Approaches for improving communication with
friends, family and health professionals.
Nutrition information.
Treatment evaluation information.
The Stanford Model: Impact
All studies looked at behavior, health status and utilization.
Findings included:



Improved self-efficacy
Reduced use of doctors, hospital emergency
rooms
Improvements in health status - identified by
BOTH the participant and the health provider
Sources: Stanford University Patient Education Center; Society of Behavioral Medicine
publication (2003)
Impact (continued)…
Improved quality of life
 Specific improvements in healthful behaviors
 Improvement in overall health status
 Decreased hospital stays: .49 days, per patient,
over a two year time period
 Decreased physician/emergency room use: 2.5
fewer visits to the emergency room and to
physicians, per patient, over a two year time
period

Source: Stanford University Patient Education Center; Center for Healthy
Specific health-related impacts…
Increased physical activity
 Cognitive symptom management
 Improved communication with physicians
 Better self-reported general health
 Improved attitude
 Less health distress
 Less fatigue
 Reduced disability
 Fewer social/role limitations

Sources: Stanford University Patent Education Center; published articles 1997-2003 (Lorig, K)
Creating an effective chronic disease
self-management system locally -
Key Ingredients






Infrastructure
Community networks
Partnerships
Financial support
Sustained marketing
On-going recruitment
Source: “Challenges and Successes in Implementing the Chronic Disease
Self-Management Program”, National Council On Aging,
http://www.healthyagingprograms.org/resources/CDSMPFinalReport.pdf
Reasons to support this approach…

Disease and demographic challenges will be
unrelenting - “We need to start yesterday…”

Limited availability of reliable, evidence-based
(proven) approaches to chronic disease selfmanagement

Better utilization of current resources
necessary; more efficient use of physician time
desired
Sources: Society of Behavioral Medicine publication (Lorig K., Holman, H.)
Summary
Chronic Disease Self-Management is:



Managing the work of dealing with a chronic disease
and/or multiple disease conditions.
Managing the work of dealing with daily activities in light
of debilitation and disability.
Managing emotional changes resulting from or
exacerbated by the disease conditions.
Once a chronic disease is present,
one cannot NOT manage, the only
question is “how.”
(Bateson 1980, Lorig, 2003)
For further information…
Contact:
John Irwin
Health & Community Informatics Consulting
(541) 664-2456
[email protected]
www.callineb.com
Or
Sharon Johnson
Oregon State University
(541) 776-7371 x210
[email protected]
Additional information & results of studies:
http://patienteducation.stanford.edu/