Transcript Helping Patients Manage Their Diabetes

HELPING PATIENTS MANAGE
THEIR DIABETES AT
NEIGHBORCARE HEALTH
PRESNTER: NCH DIABETES EDUCATION AND EMPOWERMENT COORDINATOR JULIE MYERS
MN RN. SEATTLE, WASHINGTON 2014, [email protected]
Adapted from: “Helping People Manage Their Chronic Conditions.” Thomas Bodenheimer,
Kate MacGregor, Claire Sharifi http://www.chcf.org/publications/2005/06/helpingpatients-manage-their-chronic-conditions.
Collaborative Decision Making
5 Strategies
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3.
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5.
Establishing an agenda
Ask, tell, ask
Closing the loop
Assessing readiness to change
Goal setting
Why Self-Management Support
There is strong evidence that shows that
self-management support improves
health-related behaviors and clinical
outcomes
Self-Management Support:Two
Interrelated Activities
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Providing information about patients’ diabetes
(helping patients become informed)
Working in partnership with patients to make
medical decisions
In collaborative interactions…..
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Information and skills are taught based on the
patient’s agenda
One’s confidence in the ability to change, together
with knowledge, creates behavior change
The goal is increased confidence in the ability to
change, rather than compliance with the coach’s
advice
Decisions are made as a patient-coach partnership
1. Collaborative Decision Making:
Establishing an Agenda
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An agenda for the visit is negotiated between the
patient and the coach, but the patient has the last
word
If the coach wishes to discuss an issue with the
patient, the patient’s permission should be sought
2. Information Giving: Ask Tell Ask
Adult learning takes place primarily through
“self-directed learning”
 The information is chosen by the learner and
doesn’t necessarily follow a step-by-step or
linear format
 Ask, Tell, Ask provides information to the
patient in a manner directed by the patient
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Ask, Tell, Ask Example
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Coach: “What do you know about HbA1c?”
After receiving an answer the coach then tells the
patient the information and asks them what
information is new and what additional information
is desired
This allows the coach to see what information the
patient was able to retain and if their
understanding is accurate
It also encourages a collaborative interaction
3. Information Giving: Closing the Loop

Assess the patient’s understanding by closing the
loop
Closing the loop example:
Coach: There are three things that prevent diabetes
complications: improving your diet, exercising more,
and taking medications. If you were to talk to a
friend or family member what things would you tell
them you can do to prevent diabetes complications?
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4. Assessing Readiness to Change
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Motivational Interviewing Model:
readiness=importance x confidence
The collaborative model stresses the importance of
internal motivation
The coach and patient develop a non-judgmental, nonauthoritarian relationship that resembles a partnership
The coach refrains from giving advice and evokes the
experiences, beliefs and ideas that motivate the patient
The patient’s autonomy is demonstrated throughout the
entire process
MI In Practice
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Assess the patient’s readiness by estimating the level
of importance and confidence
Use interviewing techniques to help the patient
increase his or her willingness to change
If the patient is motivated make an action plan then
move on to goal setting
5. Goal Setting
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Goal setting is accomplished by coaches and
patients formalizing an action plan
Goal setting is the process and action plans are the
result of the process
Actions are concrete and highly specific
Developing an action plan that the patient can
succeed at is very important for ensuring selfefficacy (i.e. a person’s level of self-confidence that
they can carry out a behavior necessary to reach a
desired goal