Chronic Disease Self-Management

1
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
2
Today you will hear

• An introduction to chronic disease
  self-management
• A closer look at one evidence-based
  self-management program

3
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, Parkinsons disease
• Sources NGA study Stanford University Patient
  Education Center , http//www.stanford.edu/group
  /perc/

4
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)

5
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

6
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
7
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

8
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)
9
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.

10
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 necessaryand needed.
• Source California Healthcare Foundation

11
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

12
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)

13
Self-Management Skills

• Problem-solving
• Decision-making
• Resource Utilization
• Formation of a patient- provider partnership
• Action-planning
• Self-tailoring
• Source Lorig and Holeman 2003

14
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

15
Chronic Disease Self-Management Program (CDSMP)
the Stanford Model

• Developed by Stanford Universitys 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

16
Stanfords 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

17
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.healthyagingpro
  grams.org

18
CDSMP Content
19
Participants Learn How to Manage the Symptom
Cycle
Disease
Fatigue
Tense Muscles
VICIOUS CYCLE
Stress/Anxiety
Depression
Anger/Frustration/Fear
20
Participants 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

21
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.

22
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)

23
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

24
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)

25
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.healthyaging
programs.org/resources/CDSMPFinalReport.pdf
26
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.)

27
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.

28
Once a chronic disease is present, one cannot
NOT manage, the only question is how.
(Bateson 1980, Lorig, 2003)
29
For further information
Contact John Irwin Health Community
Informatics Consulting [phone] jirwin_at_mind
.net www.callineb.com Or Sharon Johnson Oregon
State University [phone] x210
s.johnson_at_oregonstate.edu
Additional information results of
studieshttp//patienteducation.stanford.edu/