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Chronic Disease Self-Management
A Patient-Centered Option for Managing the Healthcare Challenge
Presentation prepared by:
John Irwin,
Healthcare & Community Informatics Consultant,
Stanford Licensed Chronic Disease Self-management Program Master Trainer
Today you will hear…
An introduction to chronic disease self-management
A closer look at one evidence-based self-management program
Impacts of Chronic Disease
Chronic disease will increase 300% by 2049
Chronic disease results in pain, debilitation, disability, dependence, lost physical function, and less mobility Chronic diseases include: heart disease, cancer, stroke, arthritis, asthma, lung disease, cancer, diabetes, hypertension, osteoporosis, multiple sclerosis, Parkinson’s disease…
Sources: NGA study; Stanford University Patient Education Center , http://www.stanford.edu/group/perc/
Financial Reality - Rising costs…
Chronic disease costs: 75-95% of health care expenditures!
By 2030: Anticipated increase in healthcare costs tied to chronic disease, 25% to 54%
Sources : Partnership for Solutions: Better Lives for People with Chronic Conditions, WA
State ; Health Affairs, 2005; 24 (1) 80-92; Center for Healthy Aging (NCOA)
People With Chronic Disease Report…
Significantly reduced productivity Living with less income Accomplishing less Spending more time in bed sick Having poor mental health
Sources: Stanford University (Lorig, K.); Center on an Aging Society, National Institute on Aging
Self-Management Definition
“Involves [the person with the chronic disease] engaging in activities that protect and promote
health, monitoring and managing of symptoms and signs of illness, managing the impacts of illness on
functioning, emotions and interpersonal relationships and adhering to treatment regimes.”
Source: Center for Advancement in Health (1996). Indexed bibliography on Self-management for People with Chronic Disease. Washington DC.. Page 1
Self-Management Benefits Patients…
Builds confidence (self-efficacy) to perform 3 tasks
- Disease management
- Role Management
- Emotional Management
Focuses on improved health status and appropriate health care utilization
Self-Management Differs From Patient Education
Self-Management
- Manage life with disease
- Increase skills & self-confidence
- Problem solve and make decisions
Patient Education
- Change behaviors
- Increase knowledge
- Use specific tools (e.g., Care Plans, Action Plans)
Self-Management Also Encompasses
The patient and health professional working together. Often involves the family. An holistic approach to care (i.e., medical and psycho-
social components of a condition). Pro-active and adaptive strategies that aim to empower
the individual.
Patients Increasingly Want to Retain Independence
More people with chronic disease believe…
They have a “right” to take part. They are capable of taking part, with the right supports. Patient assertiveness is necessary…and needed.
Source: California Healthcare Foundation
Chronic Disease Self-Management Assumptions
Patients with different chronic diseases have similar self-management problems and disease-related tasks.
Patients can learn to take day-to-day responsibility for their diseases.
Confident, knowledgeable patients practicing self-management will experience improved health status and use fewer health resources.
Source: Lorig and Holeman 2003
Self-Management Framework
Patients accept responsibility to manage or co- manage their own disease conditions.
Patients become active participants in a system of coordinated health care, intervention and communication.
Patients are encouraged to solve their own problems with information, but not orders, from professionals.
Sources: Stanford University Patient Education Center; Center for Healthy Aging (NCOA)
Self-Management Skills
Problem-solving Decision-making Resource Utilization Formation of a patient- provider partnership Action-planning Self-tailoring
Source: Lorig and Holeman 2003
Chronic Disease Self-Management Means…
Taking care of your illness (using medicines, exercise, diet, technology, physician partnership)
Carrying out normal activities (employment, chores, social life)
Managing emotional changes (anger, uncertainty about the future, changed expectations and goals, and depression)
It means having a combination of … SKILLS, SUPPORT, PRACTICE and CONFIDENCE
Chronic Disease Self-Management Program (CDSMP)
…the Stanford Model
Developed by Stanford University’s patient education program Structured w/~15 participants in a six-week series of workshops Participative instruction with peer support Designed to enhance medical treatment Outcome-driven: impacts show potential for reduced or avoided costs Evidence-based: a tested model (intervention) that has demonstrated results
Stanford’s CDSMP is Evidence-based
Found to truly benefit targeted populations.
Demonstrated it does not cause harm.
Demonstrated it does not waste resources. Reference: http://www.aoa.gov/evidence/evidence.asp; www.healthyagingprograms.org
The Stanford CDSMP Model Why these techniques work…
Peer educators Constant modeling Active problem-solving Formal brainstorming Goal-setting Action planning
Source: National Council on Aging, http://www.ctb.1si.ukans.edu, www.healthyagingprograms.org
CDSMP Content
Content/Week 1 2 3 4 5 6
Overview of self-management and chronic health conditions
Making an action plan Relaxation / Cognitive symptom management Feedback / Problem solving Anger / Fear / Frustration
Fitness / Exercise
Better breathing
Fatigue
Nutrition
Advance directives
Communication
Medications
Making treatment decisions
Depression
Informing the healthcare team Working with your healthcare professional Future plans
Participant’s Learn How to Manage the Symptom Cycle
Disease
Fatigue
Depression
Tense Muscles
Stress/Anxiety
Anger/Frustration/Fear
VICIOUSCYCLE
Participant’s Learn and Practice Action Planning
Something YOU want to do Reasonable Behavior-specific Answer the questions: What? How much? When? How often? Confidence level of 7 or more
The Stanford Model: Content… “meets the test of common sense”
Techniques to deal with frustration, fatigue, pain, and isolation.
Exercises/activities for maintaining and improving strength, flexibility, and endurance.
Medication management. Approaches for improving communication with
friends, family and health professionals. Nutrition information. Treatment evaluation information.
The Stanford Model: Impact
All studies looked at behavior, health status and utilization.
Findings included:
Improved self-efficacy Reduced use of doctors, hospital emergency
rooms Improvements in health status - identified by
BOTH the participant and the health provider
Sources: Stanford University Patient Education Center; Society of Behavioral Medicine publication (2003)
Impact (continued)…
Improved quality of life Specific improvements in healthful behaviors Improvement in overall health status Decreased hospital stays: .49 days, per patient, over a two year time period Decreased physician/emergency room use: 2.5 fewer visits to the emergency room and to physicians, per patient, over a two year time period
Source: Stanford University Patient Education Center; Center for Healthy
Specific health-related impacts…
Increased physical activity Cognitive symptom management Improved communication with physicians Better self-reported general health Improved attitude Less health distress Less fatigue Reduced disability Fewer social/role limitations Sources: Stanford University Patent Education Center; published articles 1997-2003 (Lorig, K)
Creating an effective chronic disease self-management system locally -
Key Ingredients
Infrastructure Community networks Partnerships Financial support Sustained marketing On-going recruitment
Source: “Challenges and Successes in Implementing the Chronic Disease Self-Management Program”, National Council On Aging, http://www.healthyagingprograms.org/resources/CDSMPFinalReport.pdf
Reasons to support this approach…
Disease and demographic challenges will be unrelenting - “We need to start yesterday…”
Limited availability of reliable, evidence-based (proven) approaches to chronic disease self-management
Better utilization of current resources necessary; more efficient use of physician time desired
Sources: Society of Behavioral Medicine publication (Lorig K., Holman, H.)
Summary
Chronic Disease Self-Management is:
Managing the work of dealing with a chronic disease and/or multiple disease conditions.
Managing the work of dealing with daily activities in light of debilitation and disability.
Managing emotional changes resulting from or exacerbated by the disease conditions.
Once a chronic disease is present, one cannot NOT manage, the only
question is “how.”
(Bateson 1980, Lorig, 2003)
For further information…
Contact:
John IrwinHealth & Community Informatics Consulting
(541) [email protected]
www.callineb.com
Or
Sharon JohnsonOregon State University(541) 776-7371 x210
[email protected] information & results of studies:
http://patienteducation.stanford.edu/
