Self management and community resources

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Self management and community resources

• Sarah Dennis and Anna Williams

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Definitions

• Self management support
• Collaboratively helping patients and their
  families to acquire the skills and confidence to
  manage their condition. Provide self management
  tools, referrals to community resources,
  routinely assessing progress.
• Community resources
• Linkages with hospitals providing patient
  education classes or home care agencies to
  provide case managers
• Linkages with community based resources
  exercise programs, self help groups, and senior
  centres.

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Self-management support
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Effective self-management support

• People
• Well trained
• Health professional gt usual care
• Lay /peer led gt usual care
• Health professional v lay/peer led ?
• Education content
• Specific gt general
• Therapeutic patient interventions
• Empowerment
• Motivation to change
• Annual top-up

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Community resources for self management

• Group gt one to one
• Class size not important
• Community gathering places gt home
• Particularly for population groups
• Culturally specific

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Summary

• Beneficial effects
• Improvements in disease outcomes (HbA1c), quality
  of life, health and functional status,
  satisfaction and health service use
• Types of self-management intervention
• Patient education, motivational counseling,
  intensive, specific, group or community based to
  one, empowerment
• Difficult to sustain, increased knowledge does
  not always translate into improved health
  outcomes
• Chronic diseases
• Improved patient outcomes with diabetes,
  hypertension, lipid disorders and to lesser
  extent arthritis
• Evidence less clear for COPD and asthma

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CPHCE Focus Self Management

• Addressing issues of uptake and sustainability of
  self management in general practice and broader
  PHC
• Contributing evidence to the field of self
  management
• Developing and evaluating innovative models of
  CDSM

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Uptake and Sustainability SM in General Practice

• Scoping Paper (Pascoe et al 2006)
• Aims
• effectiveness of Chronic Disease Self Management
  and its interaction with other elements of the
  Chronic Care Model
• highlight important considerations for
  integration of Chronic Disease Self Management
  into the core functions of general practice
• Methods
• Review of the Literature
• Consultation with key informants

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Uptake and Sustainability SM in General Practice

• Scoping Paper Key Findings
• Increased use of non GP staff
• Information systems (registers)
• Decision support tools
• Building external links with community agencies
  by having key contacts with individuals

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Uptake Sustainability CDSM Primary Health Care

• Sharing Health Care Initiative Follow Up study
  (Williams, Harris et al 2006).
• Aim
• Explore the uptake and sustainability of CDSM
  within the routine activities of primary health
  care clinicians
• Methods
• Interviews
• Focus Groups

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Uptake Sustainability CDSM Primary Health Care

• Follow Up study Key Findings
• SM activities congruent with PHC clinician role
  but workforce issues challenge sustainability
• Well received by clients
• Poor linkages with general practice
• Limitations of mainstream program in CALD
  communities
• Reduced sustainability

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Contribution to evidence

• Systematic Review
• Zwar N, Harris M, Griffiths R, Roland M, Dennis
  S, Powell Davies G, et al. A systematic review of
  chronic disease management. UNSW Research Centre
  for Primary Health Care and Equity, Canberra
  Australian Primary Health Care Research Institute
  (APHCRI) 2006
• McDonald J, Harris E, Kurti L, Furler J,
  Apollini L, Tudball J. Action on Health
  Inequalities early intervention and chronic
  condition self management, Sydney HIRC 2004

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Contribution to evidence

• difficulties in making comparisons between
  different types of self-management models in
  order to identify those that are more successful
• little analysis of the impact of self-management
  interventions for disadvantaged populations in
  systematic reviews
• limited generalisability of findings to the
  Australian context and limitations in the
  strength of the evidence for disadvantaged groups

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Developing and evaluating innovative models of
CDSM

• Evaluation of Moving On a chronic disease
  program for people with a chronic illness
• NHMRC Application Chronic disease
  self-management in Chinese and Vietnamese from
  socio-economically disadvantaged backgrounds

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Current Future Activities

• Appropriate, accessible, affordable effective
  mainstream CDSM program
• Culturally appropriate approach to SM for Chinese
  and Vietnamese populations
• Stronger linkages with general practice
• Improved coordination of care and SM activities
  into overall management plans