Chronic Disease Interventions

Taffy Fulton, MPH

Aging in Style

Stanford Chronic Disease Self-Management Program

Taffy Fulton, MPHProgram Coordinator

Living Well

CDSMP in the Brazos Valley

• Area Agency on Aging (AAA)

• Partner with SRPH

• Want to reach everyone, including people in rural areas

Brazos Valley Populations

• 265,000 people in 2000.

• 37,500 people are 60+ years of age or 15 % of total population.

• Nearly 30% of Brazos Valley’s older adults live with incomes at or below 200% of the poverty level; approximately 17% have incomes below the poverty level.

Brazos Valley Seniors with On-going Health Concerns

• 59% of older adults have high blood pressure

• 55 % have high cholesterol

• 56 % have arthritis

• 16 % have diabetes

• 66.5 % are overweight

• 29.5 % are obese

Ongoing Health Concerns in the Brazos Valley

Chronic Disease Self-Management Program

• More chronic diseases now than in past

• Physicians claimed they did not have

enough time to work with their patients

• Fits well with the chronic care model

CDSMP Assumptions

• People with chronic conditions have similar concerns and problems

• People with chronic conditions must deal not only with their disease(s), but also with the impact these have on their lives and emotions

• Lay people with chronic conditions, when given a detailed leaders manual, can teach the CDSMP as effectively, if not more effectively, than health professionals

• The process or way the CDSMP is taught is as important, if not more important, than the subject matter that is taught

Who developed Living Well?

• Dr. Kate Lorig

– Professor at Stanford School of Medicine

– Arthritis nurse

– Wanted some type of treatment plan for her patients

– Developed Arthritis Self-Help Program

– Adapted program to any chronic illness

Living Well is Evidence-Based

What does evidence-based mean?

It means IT WORKS!!

Workshop Overview

• 1 session weekly for 6 weeks

• 2 ½ hour each session

• Taught by lay leaders (everyday people) or health care professionals

Workshop Overview

• Dealing with:

– Fatigue,

– Frustration, and

– Pain

Workshop Overview

Managing medicines

Workshop Overview

How to talk to your doctor,

family, and friends

Workshop Overview

How to evaluate new treatments

Workshop Overview

Daily living activities

Set a Goal

• Set one goal at a time

• Be realistic

• Start off slowly with any change

For what audience is this appropriate?

Audience

• People with diabetes• People living with

HIV/AIDS (PLWHA)• People with cancer• People with

connective tissue disorders, including lupus

• People with neurological disorders

Audience

• People with High Blood Pressure

• People with heart disease including high cholesterol

• People with arthritis• People with hepatitis• Care givers for people

with chronic diseases

Recruitment

Recruitment

• Community settings

• Senior centers

• Retirement centers

• Churches

• Libraries

• Hospitals & Clinics

• Resource centers

• Pharmacies

• Allied healthcare facilities

• Service Organizations

Program Goals

• Have classes in each county

• Recruit volunteers to teach

• Sustainability

– Host sites

– Class leaders

Evaluation and Follow-Up

• Responsibilities of AAA

• Group to develop evaluation

• In progress

http://patienteducation.stanford.edu/programs/cdsmp.html

Living Well: Navasota, Texas

Living Well in Navasota, Texas

Living Well: Navasota, Texas

The Chronic Care Model

Computer Kiosk

• Touch screen computer

• Self-guided

• Diabetes information

• Diabetes control goal setting

Grant from Dell computer

Diabetes and You

A Computer Self-management Project

Center for Community Health Development

Texas A&M Health Science Center

With support from the Center for Disease Control and Prevention, the Prevention Resource Center and the Dell Foundation

Goals

Goals

• Information dissemination

• Behavior change

• Determine whether or not people will use a kiosk like this

Audience

Audience

• Low literate/education

• Low socioeconomic status

• Rural areas

• People wanting information

• Curiosity

• Resource centers

• Healthcare facilities

Development

• Basic outline

• Power Point

• Narrative script and revision and revision and revision….

• Computer programming

• Filming

• Evaluation

Evaluation

• Basic demographics

• Diabetes information

• Surveys

• Focus groups

• Page hits and amount of time spent on each page

Evaluation

A Message from

your doctor

What is diabetes?

Diabetes Care

Diabetes Prevention Videos Things to Do

Everyday

Risk Factor for Diabetes

Hispanic/Latino, African American, American Indian, or Asian American.

Activity

Find someone to talk to. This could even be your pet

WorkingKeep a snack handy

Adjust your activity, eating, testing and medicine times if you need to

Traveling

• Take extra medicine

• “I have diabetes” ID

• Carry snacks

• Don’t forget to be active.

1st Steps to a Healthier Life

Change one thing at a time

Set reasonable goals

How much activity should I get?

Healthy Eating