Journey Into Well-Being:

The Path to Positive Self Management of Chronic Disease

OBJECTIVES:

1.To understand the concept of self management in Chronic Disease Management

2. To learn the tasks and skills required to self manage

3. To introduce NYGH ‘s Chronic Disease Self Management Program, Journey Into Well-Being

4. To experience elements of group skill mastery

5. To discover how CDSMP fits into the Community Health Centre

Reflect…..

Knowledge =?= Behavior Change

ACUTE DISEASE

abrupt onset short termsingle causediagnosis certainintervention usually effectiveoutcome cure commonuncertainty minimalknowledge of professional important

Chronic Disease

gradual onsetlong termmany causes, interrelateddelayed diagnosismultiple interventions, side effects, no effectsno cure…..managementuncertain futureknowledge of patient and professional important

Traditional Education Self ManagementEducation

Professional is expert in diseaseProfessional tells patient what to do and sets goalsProfessional solves the problemsGoal is for patient to comply to professional to achieve benefitsBehaviour changed by external motivation

Minimal behavior change occurs.

Patient is the expert in their livesPatient sets goals with professionalPatient identifies problemsPatient learns strategies to solve problemsPatient internally motivated and uses problem solving, goals to achieve benefits that are meaningful

Maximal behaviour change occurs

Self Management Tasks

Medical management of condition(s)

Managing changing life roles

Dealing with difficult emotions

Self Management Skills

Problem solvingDecision makingResource utilizationPatient/ health care provider partnershipTaking action (achieving meaningful goals)

Action Planning

1. Something YOU want to do2. Achievable3. Action specific4. Answers the questions:

What?How much?When?How often?

5. Confidence level of 7/10 or more(Stanford CDSMP)

Benefits of Self Management programs

Increased use of healthy behaviours

relaxation, exercise, healthy eating, stress management

Improved health status

Reduced health care utilization

1:9

Why do self management programs work?

Self Efficacy Theory:When patients have the confidence to do something, they will probably do it (Bandura)

skills masterymodellingreinterpretation of symptomssocial persuasion

INDIVIDUALS AND FAMILIES

Improved clinical, functionaland population health outcomes

HEALTH CAREORGANIZATIONS

Informed,activated

individuals& families

Prepared, proactivepracticeteams

Activated communities &

prepared, proactivecommunity

partners

HealthyPublicPolicy

SupportiveEnvironments

CommunityAction

DeliverySystemDesign

ProviderDecisionSupport

InformationSystems

Ontario’s CDPM Framework

Productive interactions and relationships

PersonalSkills & Self-Management

Support

INDIVIDUALS AND FAMILIES

Improved clinical, functionaland population health outcomes

HEALTH CAREORGANIZATIONS

Informed,activated

individuals& families

Prepared, proactivepracticeteams

Activated communities &

prepared, proactivecommunity

partners

HealthyPublicPolicy

SupportiveEnvironments

CommunityAction

DeliverySystemDesign

ProviderDecisionSupport

InformationSystems

Ontario’s CDPM Framework

Productive interactions and relationships

PersonalSkills & Self-Management

Support

Journey Into Well-beingThe Chronic Disease Self Management Program

Stanford (Lorig) modelLicensed programNo doctor’s referral neededTarget: 50+ with any chronic disease

diabetes, asthma, hypertension, arthritis, osteoporosis, depression

6 weeks, 2 ½ hoursRelaxation, nutrition, exercise, action plans

$25 (Reference book)

2 leaders: 1 Lay leader, 1 Health Care Professional

(4 day training for leaders)Scripted sessions –emphasis on group process, setting and achieving goals, learning from others

CDSMP in the CHC

Need for CDM programmingCommunity – staff relationshipLocationsExisting programsOngoing support

Disease specific informationExercise

Other opportunities