SELFMANAGEMENT SUPPORT: THE BASICS AND BEYOND :

1
SELF-MANAGEMENT SUPPORT THE BASICS AND BEYOND

• Steven ColeJudith Schaefer

2
OBJECTIVES

• By the end of the session participants will be
  able to
• 1. Describe the 5As of Self-Management Support
  (SMS)
• 2. Develop a concrete patient-centered Personal
  Action Plan (PAP), using framework of 5As
• 3. Describe strategies to negotiate PAP with
  complex patients
• 4. Use strategies to negotiate PAP with complex
  patients
• 5. Describe strategies for other components of
  the care model (e.g. DSD) to facilitate increased
  patient self-management

3
What Is Self-Management?

• The individuals ability to manage the symptoms,
  treatment, physical and social consequences and
  lifestyle changes inherent in living with a
  chronic condition.
• Barlow et al, Patient education Counseling 2002
  48177
• Reference the work of Kate Lorig, Stanford.
  Evidence SMS improves health while reducing
  utilization, costs Randomized trial. Medical
  Care. 37 (1)5-14, 1999

4
SELF-MANAGEMENT SUPPORT Empower and prepare
patients to manage their health and health care.

• Emphasize the patients central role.
• Use effective self-management support strategies
  that include assessment, advice (education),
  agreement (goal-setting, action planning), assist
  (problem-solving) and arrange (follow-up).
• Organize internal and community resources to
  provide ongoing self-management support to
  patients.

5
5 As and Self-Management
ASSESS Beliefs, Behavior Knowledge
ADVISE Provide specific Information
about health risks and benefits of change
ARRANGE Specify plan for follow-up (e.g.,
visits, phone calls, mailed reminders
Personal Action Plan 1. List specific goals
in behavioral terms 2. List barriers and
strategies to address barriers 3. Specify
Follow-up Plan 4. Share plan with practice team
and patients social support
ASSIST Identify personal barriers, strategies,
problem-solvingtechniques and social/environmenta
l support
AGREE Collaboratively set goals based on
patients conviction and confidence in their
ability to change or adhere
Glasgow RE, et al (2002) Ann Beh Med 24(2)80-87
6
Patients Central Role

• Diabetes is a serious illness, but there is a
  lot you can do to keep yourself healthy and
  minimize its effects. Were here to help.

7
PATIENT-ACTION PLAN (ultra-brief)

• 1.What would you like to do for your health from
  this point today to our next appointment?
• concrete
• patient-centered
• very specific
• 2. How confident are you on a 1 to 10 scale that
  you will be able to carry out this goal?
• must be gt7 or
• review barriers (develop solutions) or
• revise goal
• 3. Lets arrange a way to check on how you are
  doing?
• notes on a calendar
• involving someone else
• frequent visit to the clinic

8
PAP IN ACTION

• Demonstration of ultra-brief PAP
• Practice ultra-brief PAP with partner

9
BEYOND THE BASICSPAP WITH COMPLEX PATIENTS

• Emphasis on agreement- beyond the basics
• 6th A -- address emotions
• Negotiation and motivation
• roll with resistance
• link the patients own stated goals (eg be able
  to travel, play with grandchildren) to short-term
  objectives which can help meet goals

10
Address Emotions

• Rapport is central to all care
• Addressing patient or family emotion assists
  rapport development

11
You could say

• reflection
• I can see this is upsetting or
• Sounds like this is very difficult
• legitimation
• I can certainly understand why this is so
  difficult. or
• Everyone finds this difficult
• support
• I want to help you with this or
• Its important to me that you get the help you
  need
• partnership
• You and I together or
• Our team will work with you to
• respect
• I am very impressed by or
• Youve done a great job with.

12
Negotiation in action

• Review skills checklist
• Demonstrate PAP in complex case
• Practice, with partner, PAP in complex case

13
Beyond the BasicsIntegration of SMS with other
Components of the Care Model

• Team presentations
• Discussion

14
The CCM and Self-Management Support
Organization of Healthcare Incentives, Fee
waivers Peer mentor programs CDSMP, Pt. Advisory
Councils
Clinical Information Systems Behavioral
Change in Practice Reports, Goal
Reminders, Patient Summaries
Community Exercise Programs, Sr. Centers,
Walking Clubs, Street Safety
Self-Management Support
D S D Group Visits, Patient summaries, Teach back
Decision Support Pt.Guidelines, Open Medical
Record. Patient-driven CME
Prepared, Proactive, Practice Team
Informed, Activated Patient
Productive Interactions
Functional and Clinical Outcomes
E. Wagner, MD, W.A.MacColl Institute, Group
Health Cooperative of Puget Sound
15
Opportunities for SMS

• Before the Encounter
• During the Encounter
• After the Encounter

16
Opportunities for SMS

• Before the Encounter
• Pre-visit contact (phone, mail or e-mail)
• Waiting room assessment
• Patient education material
• Posters
• Pamphlets on Talking to your provider
• Community outreach

17
Opportunities for SMS

• During the Encounter
• Review assessments
• Feedback on achievements vs. goals
• Identifies priorities for visit
• 5As Counseling
• Targeted patient educ. materials
• Referral for more SMS

18
Opportunities for SMS

• After the Encounter
• Referrals (Health Education, etc)
• Further 5A counseling
• Phone calls follow-up
• Mailed patient education
• Peer support
• Newsletters
• Follow-up visits
• e-mail/internet sites