42self management

Module 4.2

Self management
Evidence and theoretical
components

Produced by The Alfred Workforce Development Team
on behalf of DHS Public Health -
Diabetes Prevention and Management Initiative
June 2005

Presentation purpose
Target audience

 Service providers and project workers on DPMI projects
Aim

 To encourage consumers to self manage

Objectives
 Provide an overview of the concepts of self management
 Review self management programs and evidence
 Explore the components of self management and integration into
practice.

DPMI Workforce Development – The Alfred Workforce Development Team June 2005

What is self management?

 Self-management is the active participation by
people in their own healthcare.
 Self-management incorporates:
 health promotion and risk reduction
 informed decision making
 following care plans
 medication management
 working with health care providers to attain the best
possible care and to effectively negotiate the often
complex health system.

National Chronic Disease Strategy (Draft) National Health Priority
Action Council www.nhpac.gov.au


Is self management effective?

 Evidence
to support self
management
 Improves quality of life
 Supports behavior change

 Decreases health care

utilisation


References

 Barlow J. et a “Self – management
approaches for people with chronic
conditions: a review” Patient Education
and Counseling 48 (2002) 177-187
 “Patients as effective collaborators in
managing chronic conditions”
www.cfah.org.au
 Adherence to long term therapies
www.who.org go to publications link

Diabetes self management education
in Australia
 Norsworthy document reviewed
 8 articles in which the authors reviewed up to 153
studies of the effectiveness of diabetes
interventions.
 Each of the studies concludes that diabetes self
management education is effective in improving
health outcomes for people living with diabetes.
influence behaviour change and improve knowledge and
skill for diabetes self management
 reductions in secondary complication rates

 reducing reliance on health services.

Ann Nosworthy April 2004 ADEA. www.adea.org.au

Measuring effectiveness of self
management
 Self-management Education Programs in
Chronic Disease-A Systematic Review and
Methodological Critique of the Literature

 Conclusions:
 Self-management education programs resulted in
small to moderate effects for selected chronic
diseases as measured by clinical markers. ( diabetes,
hypertension and asthma)
 Need to adhere to a standard methodology to help clarify
whether self-management education is worthwhile.

Asra Warsi,et al. Arch Intern Med. 2004;164:1641-1649


Stanford Chronic Disease Self
Management Program
 RCT - 952 subjects
 Demographic Data
 Age 62 years
 Male 27%
 Education 14 years
 No. Diseases 2.2

Kate Lorig et al. Evidence suggesting that a chronic disease self management program
can improve health status while reducing hospitalizations. Medical Care 37,1 1999


Management Program
 Percent With Common Diseases
 Lung Disease 21%
 Heart Disease 24%
 Diabetes 26%
 Arthritis 42%


Management Program
 6-MonthImprovements in Health
Outcomes

 Self-Rated Health
• Disability
• Social and Role Activities Limitations
• Energy/Fatigue
• Distress with Health State


Management Program
Improvements in utilisation and costs
 Average 0.8 fewer days in hospital in the past
six months (p=.02)
 Trend toward fewer outpatient and ER visits

(p=.14)
 Estimated cost of intervention $100-$200

http://patienteducation.stanford.edu/bibliog.html


Good Life Club – Coaching
 Six-month outcome data for the Good Life Club
project: An outcomes study of diabetes self-
management
 positive changes in four of eight self rated
symptom measures
 reductions in the reported use of GPs,
 improvements in social functioning
 large increases in all six confidence in self-
management items.

Colette J Browning & Shane A Thomas. Australian Journal of Primary Health
— Vol. 9, Nos. 2 & 3, 2003 www.goodlifeclub.info/

Peer led self management

http://www.latrobe.edu.au/aipc/director/plsmci/about_healthprof.htm

Peer led self management


Key components of self management

 Based on patient perceived
problems
 Builds confidence (self-
efficacy) to perform 3 tasks
 Disease Management
 Role Management
 Emotional Management
 Focus on improved health
status and appropriate
health care utilization

Kate Lorig

How self management differs from
patient education
Self-Management Patient
Education
Self-Management Patient
Purpose To manage life Education To change
Purpose: To Manage Life disease
with To Change behaviors
With Disease Behaviors
To Increase Skills/Self- To Increase
Confidence Knowledge
To increase skills
To Problem Solve To Use Specific
To increase
/self confidence
And Make DecisionsTools knowledge
Kat e Lor ig

To problem solve To use specific
and make decisions tools
Kate Lorig

How self management differs
from patient education
Self Patient
Management Education
Needs Patient What patients
Assessment problems need to know

Content Disease, role, Disease knowledge
& emotional and behaviors
management

Leader Leader is guide Leader is expert

Kate Lorig

Essential elements of self management
interventions
 Disease, medication and health management
 Role management
 Emotional management
 Support enhancement of self efficacy
 Problem solving training
 Follow up
 Tracking and ensuring implementation

The Robert Wood Johnson Foundation.The Centre for the Advancement of
Health. www.cfah.org


Handling self management tasks
S/M Task Passive Active
Medical Deferred Collaborates
Management

Role Relinquishes Strives to
Management maintain

Emotional Erratic Regular use of
Management ineffectual coping skills

A. Jerant et al. “Patients perceived barriers to active self-management of chronic
disease” Patient education and counseling. 57,3 June 2005


Handling self management tasks
S/M skills Passive Active
Problem Catastrophists Systematic
Solving process

Decision making Made in haste Carefully weighs
fear options

Resource Erratic Regular use of
Utilisation ineffectual coping skills

Partnership Minimal Identifies and selects
with HPs HPs for support

Action Planning Minimal Applied frequently

Self Tailoring Minimal Frequent


Promoting self efficacy

 Promote performance accomplishment
 Use verbal persuasion
 Role modelling
 Identifying feelings and helping work
through strategies to deal with feelings


Goal Setting- Getting started

 Choose long term goal
 Goals should be something you want to do

 Identify steps needed to reach long term
goal

 Choose one of those steps to start
working towards goal

SMART

 Specific
 Measurable
 Achievable
 Realistic
 Timely

Flinders University


Guidelines for helping with - Problem
solving

 Identify the problem
 List ideas
 Select one
 Assess the results
 Substitute another idea (if first didn’t
work)
 Accept that the problem may not be
solvable
Kate Lorig

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