Transcript Self Mgt presentation Janine B April 09

Improving Primary Mental Health Through
Increased Self-Management Support
Dr Janine Bycroft
MBChB, Dip Paeds, Dip Obs, MPH (Hons), FRNZCGP
Why Urgent Changes are Needed
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Epidemiological shift - LTC conditions increasing
especially mental health conditions
Costs $$$$
Co-morbidity & complexity increasing
Often “flying by seat of our pants” – acute on chronic,
Health inequalities
Poor adherence – averages 50%
Changing consumer expectations & unmet health needs
Best care vs usual care – multiple levels for QI
Technological advances
Traditional patient education ≠ behaviour change
Workforce shortages
Reducing the Quality Gap
Cross Cutting Priority Areas
•Self-management
•Health Literacy
•Care Coordination
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What is self-management?
 “People with chronic conditions having greater
control in looking after themselves, with the
support of their families (where desired) and in
partnership with health professionals and
community resources.”
(National Health Committee, 2005)
Six Principles of
Self-Management
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Activities that protect & promote health (Live a
healthier lifestyle)
Monitor signs/symptoms of illness and take
appropriate action to respond
Know and understand your health condition
Be actively involved in decision making
Manage the social / emotional and physical impact
Follow a care plan that is agreed with your health
professionals
(Battersby, 2005)
3 Tasks when living with LTC
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Managing your health condition – things like diet,
exercise, medications, treatments, self-testing and
monitor & respond (early warning signs etc)
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Maintaining your functions and roles in life – being
able to do the things you need and want to do. Work,
family, friends, social life, hobbies, quality of life, etc
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Dealing with the emotional demands of your
condition and life – especially difficult emotions like
grief, fear, frustration, and anger.
Self Management Support
 What we can do as health providers to support
patients to self manage more effectively
 Multilevel changes in healthcare systems to facilitate
patient self-management
 Collaboration between patient and care provider, provider
is a coach as well as clinician and the patient and family
are managers of daily care.
Key Components of SMS
1. Build patient’s selfefficacy (confidence)
2. Improve health
literacy
3. Use behaviour change
techniques
4. Share decision making
5. Collaborative, planned
care with regular F/up
Share responsibility
and decision
making so patients
feel in control and
realise how
important their
actions are
SMS for Improving Mental Health
1. Assessment tools – CHAT, PIH, Flinders Model
2. Funding for Flinders Assessments & Care
Planning
3. Group Self Management Education - generic
4. IT Tools
5. Online initiatives – ProTube
6. Training for health providers
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Assessment Tools
Brief
1.CHAT Tool – lifestyle & mental health
2.PIH Scale - also for F/up
3.PHQ 9
Systematic Assessment
3. Flinders Assessment
Stepped Care
Level 1: Mild Depression/Anxiety
Level 2: Mild- Moderate Depression/Anxiety
Self-help approaches eg scheduling,
Bibliotherapy eg self-help workbooks
Health Navigator NZ
e-health initiatives eg computerised CBT (NICE guidelines)
Regular follow up to monitor progress
+/- medication or CBT
Generic Self Management
Courses
Builds life skills –
improves communication,
problem solving,
Action planning & goal setting
Control & independence
Increases self-efficacy, confidence
and control
“Give a man a fish and you feed him for a
day; teach him to fish and you feed him for
life.”
Flinders Model
Generic assessment process leading to targeted interventions
& care planning
Collaborative
Holistic: bio-psycho-social
Outcomes based
Motivational
Medical and self-management
Patient centred
Tool for Communication / Coordination
Care Planning and Care Plans
Mr ‘Jones’
 Diabetes
 Angina
 Osteoarthritis
 Smoker
 Asthma
 “Main problem? ....
Nurse’s perspective
 “M knew what she should do to manage her asthma (use preventers) her
doctor had told her often and she "had a drawer full of them" but never
used them; instead "puffing on her ventolin" all day.
 The Flinders assessment "set M thinking" and was a real catalyst for
change.
 Three months on, using preventers regularly,
 asthma much better, ventolin use decreased dramatically
 feels "really good" & now back to mowing lawns
 Cut smoking by half and now ready to stop
 She appears to have a good long-standing relationship with her GP yet his
frequently offered advice to use preventers had not been heeded.
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Paradigm Shift
 Self management is not optional, clinicians only present
fraction of time
 Enhancing primary care for improved mental health of
population
 Supporting a paradigm shift (WHO, 2002)
 Cultural change in expectations, roles, norms,
 Nearly all outcomes mediated through patient behaviour
 Working towards seamless, comprehensive, system of care
 WIN-WIN Solution