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Federal Vision and Progress
CDC’s CDSME Agenda
Teresa J. Brady, PhD
Senior Behavioral Scientist
CDC Arthritis Program
Agenda
Building demand for CDSME
Expanding the CDSME science
base
Exploring financing opportunities
Building Demand for CDSME
Raising Awareness of SME
Marketing to Physical Therapists (PTs)
as referral partners
Marketing Toolkits
Raising Awareness of SME as a CD Management Strategy
Goal:
If feasible, develop and implement a self
management education awareness campaign
that:
appeals to people with a variety of chronic
conditions
is not marketing a specific intervention
program
Project Overview Phase 1: Exploring the feasibility
Phase 2: Developing campaign strategy and
materials
Upcoming
Phase 3: Pilot-testing campaign
Phase 4: Campaign Implementation
Simplified Path to Becoming a Chronic Disease Self Manager
•Symptoms
•Chronic Condition
Recognition
“I have a role (or
better figure out how) to
manage this”
A-Ha Moment
•Self Study
•Asking Questions
•Trial and Error
The Learning Process
•Monitoring
•Adapting
•Problem-solving
Active Self Managing
(The World According to Terry)
Accelerating the Learning Process
A-Ha
#2
Seeking
Resources
“gotta
learn
how”
“maybe
a class”
• Physician
• Word of mouth
• Direct to consumer
•Symptoms
•Chronic Condition
Recognition
“I have a role ( or
better figure out how) to
manage this”
A-Ha Moment
•Self Study
•Asking Questions
•Trial and Error
The Learning Process
•Monitoring
•Adapting
•Problem-solving
Active Self Managing
Self Management
Education/Training
How to learn ?
Accelerating the Learning Process
A-Ha
#2
Seeking Resour
ces
“gotta
learn
how”
“maybe
a class”
• Physician
• Word of mouth
• Direct to consumer
•Symptoms
•Chronic Condition
Recognition
“I have a role ( or
better figure out how) to
manage this”
A-Ha Moment
•Self Study
•Asking Questions
•Trial and Error
The Learning Process
•Monitoring
•Adapting
•Problem-solving
Active Self Managing
Self Management
Education/Training
Intervention
- specific
Marketing
How to learn ?
Project Development Phase 1—Exploring Feasibility
Environmental Scan
Literature review
Review of selected intervention-specific
marketing materials
13 key informant interviews
Focus groups Round 1: Exploratory
Focus groups Round 2: New Concepts
Phase 2: Refining concepts/materials
Phase 1—Exploring Feasibility Conclusions Awareness of SME is low
Term unfamiliar, but understood in context
of concepts
General chronic disease message can
appeal to broad range of consumers
Commonalities in message characteristics
and language
Website is preferred response mechanism
(.gov or .org)
CDC is trusted source
Phase 2: Refining Concepts/Materials Most popular executions
Raising Awareness of SME as a CD Management Strategy
Next Steps
Refining executions
Building/testing website
Pilot testing in several mid-size markets
Paid media
Earned media
Partnership placement
Campaign Specifics
Long-term Goal: increase enrollment in SME
programs
Objectives:
Increase awareness of SME as a chronic
disease management strategy
Drive consumers to website for more information
Increase receptivity to intervention specific
marketing
Timeline: pilot test in 2016
Other Learnings (that may inform your marketing)
Preferred language
“ongoing health problem/issue/condition”
“Chronic”, “illness”, “disease” all perceived
negatively (and inconsistently)
But identify themselves as having chronic
disease or illness
Education/workshop/program over class
“Helps you learn” over “teaches you”
“Strategies” over “skills”
“Techniques over” “tools”
Other Learnings (that may inform your marketing)
Common Preferences
Positive tone
Personal message
Empowering language
Clear concise message
Related to health
Show benefits
Don’t overpromise
Building Demand for CDSME
Raising awareness of SME
Marketing to Physical Therapists
(PTs) as referral partners
Marketing Toolkits
Background Research
On-line survey (N=841) to explore PTs:
awareness of and attitudes towards
evidence-based PA and SME programs
in the community,
factors that would influence their
decision to recommend these programs
to their patients , and
preferences for learning about these
community resources.
Awareness and Willingness to Recommend Programs
0%
10%
20%
30%
40%
50%
60%
70%
80%
PA Programs CDSMEPrograms
Program Awareness
Before Description After Description
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
PA Programs CDSME Programs
Willingness to Recommend
Very Likely Somewhat Likely
Results Preferred Channels to Learn about Community Programs
2
1
14
18
19
19
21
21
25
31
33
42
51
82
0 10 20 30 40 50 60 70 80 90
Not interested in receiving information about these…
Other
Exhibit halls in at professional conferences
Newsletters
Webinars
Online video or DVD of a typical session
In-person presentations at my practice
Continuing Education courses
Presentations at professional conferences
Opportunity to visit the program facility/view a session
Articles in professional journals
Direct mail
Website information
What would be the best way to get information about evidence-based group programs like these to you? [CHECK ALL THAT
APPLY]
Results Tools to Facilitate Recommendations
84
28 27
17 11 10
1 0
10
20
30
40
50
60
70
80
90
100
Materials togive topeople
(brochures,videos,flyers)
Programposters foryour office
Reminder inthe EMR
Periodicreminders
from programstaff
No reminderneeded
Stickers forpatient charts
Other
Which of the following tools would be helpful to you in making recommendations about evidence-based group programs to your
patients with [arthritis/joint pain and limited mobility]? [CHECK ALL THAT APPLY]
Results Program Characteristics Influencing PT Recommendation
PA Programs SME Programs
Percent Would Greatly Influence
(“5” on a
5-point scale)†
Percent Would Greatly Influence
(“5” on a
5-point scale)†
The programs are evidence-based (i.e., have been
shown to be effective for people with arthritis).
71% 69%
The programs would encourage post-therapy ongoing
physical activity for your patients with arthritis.
74% 75%
The programs are low cost,
o PA: approximately $2-$3 per session, or free.
o SME: $25-40 for 6 week session, or free.
64%
63%
The programs are led by
o PA: certified instructors
o SME: peer instructors
who have trained to lead these specific programs.
77%
47%
The programs are offered by credible and trustworthy
organizations in the community.
76% 69%
The programs are convenient for your patients with
arthritis (i.e., at convenient places and times).
o SME: or can be done online or through self study.
68%
62%
The programs are designed to lend camaraderie and
social support for your patients with arthritis.
49% 45%
The programs are not for profit and do not sell or market
anything to participants.
43% 49%
PA only: The programs cover techniques to exercise
safely.
80%
SME only: The programs help people learn to take an
active role in managing their conditions.
74%
SME only: The programs cover appropriate pain
management and other strategies to increase function
and improve quality of life.
62%
†Please rate how much each of the following pieces of information would influence your decision to recommend evidence-based PA
/SME Programs to your patients with arthritis.
Conclusions Re: PA Programs
PTs have strong awareness of programs in their community
are less familiar with CDC-identified programs
are very likely to recommend these programs
Re: SME Programs
PTs are less familiar with these programs in their community
most are unfamiliar with the CDC-identified programs
Are moderately willing to recommend to their patients
Next Steps
Developing national
strategy to promote PA
programs to PTs
Adding fact sheets (for
PT and for pts) to APTA
website
Will explore promotion
of CDSME in future
Other Learnings (that may inform your marketing)
Factors to emphasize in marketing SME:
(endorsed by 2/3 or more)
Encourage post-therapy PA
Help patients learn to take active role
Offered by credible community
organizations
Evidence-based
Building Demand for CDSME
Raising awareness of SME
Marketing to Physical Therapists (PTs)
as referral partners
Marketing toolkits
Outreach to PCPs
Direct-to-consumers outreach
Marketing Toolkits
Outreach to PCPs
Direct to Consumers--
Ambassador Outreach
Mark your Calendars…
NCOA Webinar
Marketing CDSME: Using the Personal
Touch to Put "Butts in Seats"
Tuesday May 19, 2015
Both guides downloadable from
www.cdc.gov/arthritis
Agenda
Building demand for CDSME
Expanding the CDSME science
base
Exploring financing opportunities
Expanding the Science Base
CDSMP impact on work outcomes
Impact of Implementation factors on
CDSME outcomes
Impact of CDSMP on Work
Conducted at University of North
Carolina-Chapel Hill (2014-2018)
Examining community-delivered
CDSMP, not work-site tailored CDSMP
Outcomes evaluated include
Usual health outcomes
Work-related outcomes:
Absentee-ism, Presentee-ism
Work self-efficacy, Work stressors
Impact of Implementation factors on CDSME Outcomes
Secondary meta-analysis
34 CDSMP/ ASMP studies (N=10,792)
Research Question:
Do implementation factors or fidelity moderate
CDSME outcomes
Impact of Implementation factors on CDSME Outcomes
Factors Analyzed
Setting (urban/rural)
Participant paid
Leader paid
Leader pair with chronic
disease (at least 1 leader)
Leaders received at least
minimum hours of training
Met 6 Lorig-defined
fidelity requirements*
Unable to Analyze
Setting
(community/health care)
How learned about
intervention (media/HCP)
Directed to intervention
(Self/Other)
Leader type (lay/HCP)
Leader status
(volunteer/job)
% of completers (80%)
Impact of Implementation Factors on CDSME Outcomes Findings
CDSMP/ASMP robust
59 analyses conducted; 80% found no
significant differences
Small counter-intuitive findings-- better
outcomes if:
Participant was not paid
Leaders were not paid
Leaders not meet minimum training
Fidelity requirements not met
Impact of Implementation Factors on CDSME Outcomes
What does it all mean?
CDSMP/ASMP can tolerate implementation
variability
Internal motivation may be important
From outcome standpoint, don’t worry about
not being able to pay participants or leaders
Further work needed to identify the
“essential elements” where fidelity is
essential to effectiveness
Agenda
Building demand for CDSME
Expanding the CDSME science
base
Exploring financing opportunities Understanding perceptions of:
State legislators
Employers and their vendors
Understanding State Legislators
2 focus groups to explore state
legislators’ attitudes towards:
Arthritis
Factors influencing their attention to
health issues
Potential actions to increase availability
of arthritis-appropriate evidence-based
community physical activity (PA) and
self management education (SME)
interventions
Focus Group Participants
• 16 legislators, 2 staff
• 56% Democratic
• 55% Female
What we learned…
Factors influencing decision to take action on a health issue:
Perceived seriousness
Life threatening takes priority
Cost and potential cost savings
Beliefs about the role of the state
Hearing from advocates
Reactions to Evidence-based Community Interventions
Reactions to Interventions:
Appealing to address multiple chronic diseases
Personal responsibility plays a role
Some skepticism about effectiveness (and
confusion with clinical treatments)
Limited support for incorporating interventions as a
covered benefit
Medicaid—little support
Medicaid Health Homes—some support
State Employee Benefit Plans—better chance of inclusion
Incorporating interventions as a covered benefit Medicaid—little support
“Would I try to get [these interventions]
included as a Medicaid benefit? Sure,
because it makes sense.
Would I be successful? No.”
“..it may work for like two minutes
and then next year they are going to
cut it because they are not going to
understand the dollars saved.”
Incorporating interventions…
Medicaid Health Homes—some support
“Medicaid health homes have a
chronic disease management
program…it is important to get
providers engaged…so they are
paying attention to whether or not
arthritis is part of the picture.”
Incorporating interventions… State Employee Benefit Plans—more interest
“Productivity is a big
issue. If you can
show impact on that
then maybe you can
get a little traction.”
“We are self
insured, so we set
our own benefits.”
Conclusions Health issue decisions influenced by perceived
seriousness and potential to save state funds.
Life threatening conditions perceived as more
serious than those that threaten quality of life.
Driven by immediate state budget concerns
Eliminate if not see cost savings
Some interest in state employee productivity
angle
Exploring Employer Perceptions
Key Informant Interviews with
Employers
Large, midsize
government, non-government
Health Insurers
Health and Wellness Vendors
Care Management Suppliers
A few learnings so far…
Most mid-size and large employers are
self insured
Health (medical) insurance and “health
and Wellness” benefits are contracted for
separately
Idea of offering “choice” to employees is
appealing
Need standard pricing, financing, referral
A few learning so far…
Employers think about costs in multiple
ways
Health care claims
Workers compensation
Occupational health and safety
Absentee-ism
Disability
A work in progress…stay tuned!
CDC CDSME Agenda
Using market research to build
demand for CDSME
Expanding the science base for
CDSME
Exploring financing opportunities
Contact Info
Teresa J. Brady, PhD
Senior Behavioral Scientist
CDC Arthritis Program
770-488-5856
Tob9 @cdc.gov
770-488-5856