Integrating Patient SelfManagement into a Group Visit

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Integrating Patient Self-Management into a Group
Visit

• Masset Team
• Shelly Crack Dietician
• Sheena Howard Public Health Nurse
• Vanita Lokanathan Physician
• Susan Lyster Office Manager
• Cindy Talarico Diabetes Outreach RN

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Providers Self-Management Aims for 1st Group
Clinic

• Introduce group visit format
• Introduce self-management support and
  collaborative goal-setting
• Self-management goals for 2/3 patients
• Set Quit date with 50 smokers

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First Group Visit

• 13 patients (and family)
• Introduction to goal-setting
• Physician sharing of own goal using Personal
  Action Plan format
• Invitation to group to share goals within group
  setting

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Personal Action Plan

• 1. Something you WANT to do
• 2. Describe
• How/Where
• What Frequency
• When
• 3. Barriers
• 4. Plans to overcome barriers
• 5. Confidence rating (1-10)
• 6. Follow-Up plan

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Personal Action Plan

• 1. I want to resume daily Chi Kung standing
  meditation because it helps me relax, have more
  energy, feel less frustrated during day, more
  aware of my body.
• 2. Describe
• How/Where At home
• What Frequency 5 days per week, M-F
• When Morning
• 3. Barriers Waking up early enough, especially
  when its dark outside
• 4. Plans to overcome barriers Find and use my
  dawn simulator alarm clock because its easier
  to get up with than an alarm
• 5. Confidence rating (1-10) 9/10
• 6. Follow-Up plan

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Results of Sharing Goal?

• No one else shared goal within group setting at
  initial clinic
• Noticeable impact on group however everyone
  seemed to pay more attention
• Easier to focus on goal-setting in subsequent 11
  visits didnt have to introduce concept
• More specific goals set than on previous attempts
  (see example next slide)
• 8/12 set goals

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FRs Personal Action Plan of January 12th, 2005

• 1. What she wants to do
• Lose weight thru diet control
• 2. How
• Reduce coke (regular) from 3 cans per day to two,
  by cutting out coke at lunchtime, replacing it
  with Diet Sprite or water
• 3. Barriers
• Mood tends to drink more coke when stressed
• 4. Plans to overcome barriers
• Anticipates reduced workload job stress soon
• 5. Confidence
• 7/10
• 6. Follow-up plan
• With doc in clinic in 3 weeks
• 7. Update
• At follow-up visit following through with goal
  2 out of 3 days replaced Coke with half-cans
  and using 1 2/day

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Providers Self-Management Aims for 2nd Group
Clinic

• Encourage group participation and discussion of
  goal-setting
• Support three people to set activity goals
• Support 3 people to set diet goals around healthy
  portions
• Support one smoker to set quit date
• Increase awareness of community resources

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Second Group Visit

• Brief intro only, as many from 1st clinic
• Dietician led round table group sharing by asking
  everyone to share one change that s/he had made
  since being diagnosed with diabetes

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Results

• Many had made similar changes
• Opportunity to reinforce healthy behaviours
• Opening for education, advice, linking behaviour
  to outcome
• Opening for questions to providers, community
  resources to support healthy behaviours
• More group participation with round table
  format/everyone sharing, rather then asking for
  volunteers

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Next Clinic Aims?

• More group discussion of goals
• Round table of What I want to do and first
  steps to get there
• Aim to help patients think of own personal action
  plan in group setting, and facilitate
  goal-setting with provider later, if not within
  group

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Patient Feedback on Group Clinic

• Almost uniformly positive, except for one
  participant who didnt feel enough 11 time
• Positives identified by patients
• Access to multiple providers
• Links to community resources
• Opportunity to interact with others with diabetes
• dont feel so alone
• can lead a normal life even if you have
  diabetes
• helps to see others are dealing with the same
  things
• all in the same boat
• something to learn from everyone

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85 will have a self-management goal documented
annually.