Transcript Self-management education

PARTNERSHIP IN SELF-MANAGEMENT
SUPPORT IN IRAN
OUTLINES
A short review about some facts about chronic
conditions
 Concepts & definitions (self-management, selfcare, self-management education, selfmanagement support, patient education)
 The importance of self-management support in
Chronic Care Models
 How to disseminate a self management program
 Participation of other sectors

THE DEFINITION OF CHRONIC DISEASE
The pattern of disease is changing from nonchronic disease to chronic disease.
 Chronic disease is any impairment or deviation
from normal that has one or more of the following
characteristics:
 is permanent
 leaves residual disability
 is caused by no reversible pathological alteration
 requires a long period of supervision, observation
or care

SOME FACTS ABOUT CHRONIC DISEASES
The prevalence and incidence of chronic disease
is increasing
 a range of conditions: cardiovascular diseases,
stroke, cancer, diabetes, arthritis, and chronic
respiratory diseases etc
 Increasing life expectancy, smoking, unhealthy
diet, inactivity and air pollution
 60 percent of deaths are due to chronic diseases
 Chronic diseases are not a major problem only in
developed countries (affects low and middle
income countries)

BREAKDOWN OF TOTAL
HEALTH CARE SPENDING
78%
Health Care Spending
for People with
Chronic Conditions
22%
Health Care Spending
for People without
Chronic Conditions

Among chronic diseases, about 80% premature
heart diseases, 80% of diabetes type 2 and 40%
cancers are estimated to be preventable
CONSEQUENCES OF CHRONIC CONDITIONS
Effect on the individual
 Effect on the family
 Effect on the community

In spite of the increasing prevalence of chronic
diseases, the healthcare system is still based
primarily on delivering care to patients with
acute disease or acute symptoms of chronic
condition
 The patients are often controlled poorly. (As an
example, in diabetes) blood sugar is poorly
controlled even in developed countries

At the end of the 1970s, it was argued that for
dealing with the prevalence of growing chronic
diseases the traditional “medical model” was not
effective
 The term self-management was first used by
Thomas Creer in an article in relation to asthma
in children (Career et al, 1976)

FOUR FACTORS IN ESCALATION OF SELF
MANAGEMENT
the increasing chronic diseases
 the increasing elderly population
 recent concepts of ageing such as successful
ageing
 a lack of health education programmes
appropriate for those with chronic condition

WHAT IS SELF-MANAGEMENT DEFINITION

“the individual’s ability to manage the
symptoms, treatment, physical and psychosocial
consequences and life style changes inherent in
living with a chronic condition” (Barlow 2001,
p547).
Living
with Chronic Disease
Managing the Condition
• Taking medications
• Changing diet and exercise
• Managing symptoms of pain, fatigue, insomnia,
shortness of breath, etc.
• Interacting with the medical care system
Managing Daily Activities and Roles
• Maintaining roles as spouse, parent, worker, etc.
Managing the Emotions
• Managing anger, fear, depression, isolation, etc.
FIVE CORE ELEMENTS OF SELF-MANAGEMENT
problem solving;
 decision making;
 locating and using resources;
 making of a partnership between the person and
health professional,
 and making an action plan and taking action

A DISTINCTION EXISTS BETWEEN SELFCARE AND SELF-MANAGEMENT
Self-care refers to preventive strategies
undertaken by healthy people, while selfmanagement refers to strategies that are used to
manage conditions
 The outcomes of self-care can prevent disease
through changes in lifestyle and maintain a
satisfactory quality of life
 The outcomes of self-management are sharing in
decision making and gaining control, reducing
the frequency of visits to medical doctors and
improving physical health status and functioning

SELF MANAGEMENT SUPPORT

“the systematic provision of education and
supportive interventions by health care staff to
increase patients’ skills and confidence in
managing their health problems, including
regular assessment of progress and problems,
goal setting, and problem-solving support” (Adam
et al, 2004)

“Well, when I was in East Yorkshire and there
was talk of me going on DAFNE course initially I
did speak to one of my err, supervisors about the
possibility of being off for five days and he was a
bit shocked, quite a big surprise, you know, why
would you need five days off? You know you’re
fine, you’re walking you’re talking, you eat, you
drink” (laughs)
CHRONIC CARE MODEL(CCM)

The model demonstrates that self-management
support is an essential component of good care for
the patients with chronic conditions
CCM
Wagner and colleagues (Wagner, 1998) have
developed CCM as a care framework for people
with chronic diseases to change in health care
systems both in prevention and in management
of chronic condition.
 It is a evidence based, patient-centred and
community-based model and a multidimensional
solution to chronic conditions.

Chronic Care
Model
Health
System
Health Care Organization
Community
Resources
and Policies
Informed,
Activated
Patient
SelfManagement
Support
Productive
Interactions
Delivery
System
Design
Decision
Support
Clinical
Information
Systems
Prepared,
Proactive
Practice Team
Functional and Clinical Outcomes
THE INNOVATIVE CARE FOR
CONDITIONS (ICCC)
CHRONIC
In 2002, WHO produced an expanded version of
the model—the Innovative Care for Chronic
Conditions (ICCC)
 It includes three components at the micro level
(patient / family, community partners and health
care teams), meso level(health care organization
and community) and macro level(policy)

OTHER MODELS
In Canada and the USA the Chronic Care Model
has been expanded including ‘health promotion’
 There are various models in chronic care in
different countries such as Germany; Denmark;
Italy; Netherlands
 NHS and Social Care Model (SCM)
 It has been accepted in January 2005 as a
framework for chronic care in the UK
 It includes three elements linked together: (1)
infrastructure, (2) delivery system & (3)
better outcome

The NHS and Social Care Long-term
Conditions Model
Delivery
Delivery
System
System
Infrastructure
Infrastructure
Community
Community
Resources
Resources
Health and social
Health and social
system environment
system environment
Disease
Disease
Management
Management
Supported
Supported
Self care
Self care
Promoting Better
Promoting Better
Health
Health
Creating
Creating
Case Management
Case Management
Supporting
Supporting
Decision support
Decision support
tools and clinical
tools and clinical
information system
information system
(NPfIT)
(NPfIT)
Better
Better
outcomes
outcomes
Empowered and
Empowered and
informed patients
informed patients
Prepared and
Prepared and
proactive health and
proactive health and
social care teams
social care teams
Self-management support provides selfmanagement education as one of the steps to
support patients with chronic disease
 Self-management education provides skills to
help individuals gain self-confidence in order to
lead active and meaningful lives
 Structured self-management education (SSME)
programmes
 Criteria for such programmes are: “a curriculum,
trained educators, quality assurance of the
delivery of the programme and audit of the
outcomes of the programmes”

SELF-MANAGEMNET SUPPORT
SELF-MANAGEMENT
EDUCATION
SSME
SSME
The programmes include a blend of educational
(e.g. knowledge) and/or psychological (e.g. selfefficacy, mastery) components.
 The teaching method is a mixture of didactic and
interactive, and a group format with more
sessions.

COMPARISON OF PATIENT EDUCATION
AND SELF-MANAGEMENT EDUCATION
Patient education
What is taught?
Information and technical
skills about the disease
How are problems formulated?
problems framed in terms of
inadequate control of the
disease
Relation of education to the
disease?
Education is disease specific
and teaches information and
technical skills related to the
disease
What is the goal?
Compliance with the behaviour
change taught to the patient to
improve clinical outcomes
Who is the educator?
A health professional
Self-management
education
Skills for how to act on
problems
The patient identifies
problems he/she
experiences that may or
may not be related to the
disease
Education provides
problem-solving skills that
are relevant to the
consequences of chronic
conditions in general
Increased self-efficacy to
improve clinical outcomes
A health professional, peer
leader or other patients,
often in group settings.
CHRONIC DISEASE SELF-MANAGEMENT
PROGRAM (CDSMP)
A six-week training course delivered by peer
educators who have a chronic condition
 Developed in the US by Kate Lorig
 Research has shown that the CDSMP can create
substantial improvement in self-efficacy, selfmanagement skills, and health behaviours

SSME
Generic (CDSMP, EPP)
 Specific ( ASMP, X-PERT, DAFNEA,
DESMOND)

Highly participative
Brainstorming
AN EXPERIENCE RELATED TO OTHER
COUNTRY
In the UK, 17.5 million live with a chronic
condition
 a considerable economic burden £12 billion in
year
 Labour Government acknowledged the EPP as an
integral policy for health care system
 in 1999, for the first time in White Paper “Saving
Lives: Our Healthier Nation”, the Department of
Health announced its plan of an Expert Patients
Program” which will help more people with
chronic illness to take control over the
management of their condition”

Then, in late 1999 an “Expert Patients Task
Force”, who worked on the idea, published their
report, the expert patient: a new approach to
chronic disease management for the 21st century,
in September 2001
 Following, in accordance with the “the Expert
Patient” recommendations, the introduction of
the EPP into the NHS began with a pilot stage in
36 NHS Primary Care Trusts (PCTs) in 2002 that
reached to 300 PCTs in 2004.

During the 3-year pilot phase each PCT was
given support to run courses. More than 12,000
people had participated in the programmes in
over 800 courses.
 Following the success of these pilots, the NHS
Improvement Plan, published in June 2004 in
order made a commitment to be mainstreamed
the EPP within all NHS areas.
 In 2005, the Government’s manifesto pledged to
treble investment in the Expert Patients
Programme to facilitate an increase in the
delivery of 100,000 courses by 2012


In 2007, the Expert Patients Programme
Community Interest Company (EPP CIC) was
formed to continue the development and delivery
of self-management programmes in the
community
CDSMP in
the US
Labour
Government
acknowledged
Plan of an
Expert
Patients
Program
Pilot
Dissemination
THE BENEFITS OF SELF MANAGEMENT
Cost effective: an average saving of £452.per
patient per year
 Reduces burden on professional time
 a direct relationship between supporting self
management and improved clinical outcomes
 For every £1 invested in self management some
£6.50 of social value is created
 Provides the skills and confidence for
patients
 Improved interactions are reported by clinicians
and patients

CONCLUSION
Improving the quality and productivity of health
services to patients with chronic conditions
 Emphasizing self-management support as an
important and determinant factor
 Determining the location of self-management
support in chronic care model in Iran
 Developing various national generic / specific
self-management education programs
 Delivering the programs by using other parts
(NGOs, non profit organizations) across the
country
 Evaluating and amending the programs
regularly

THANK YOU FOR YOUR ATTENTION
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