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Diabetes Patient-Centered Care: Everyone Has a Role to Play
- 1. April 2015
- 6. Health Coaching improves Health service utilization Self- efficacy Adherence to treatment Behaviour changes Health outcomes Health Coaching: The Evidence Lindner H, Menzies D, Kelly J, et al Kreindler S. King DK, Estabrooks PA, Strycker LA, et al Kirsi Kivela, Satu Elo, Helvi Kyngas, Maria Kaariainen
- 7. Health Coaches and Regions
- 8. Building Blocks Training Approach UK Health Trainers Stanford Chronic Disease Self- Management 3 Minute Empowerment “Changing Minds” - Canadian Mental Health Assoc. Mental Health First Aid - Mental Health Commission of Canada Mindfulness - Dr. Bill Cook Behaviour Change Strategies - Dr. M. Vallis Mental Fitness – Government of New Brunswick
- 9. Target Population • Adults in the 6 regions – Self-management of diabetes and other chronic diseases – Prevention of diabetes and other chronic diseases
- 10. Client Experience Self-referral One-on-oneClient focused Meetings in person, by telephone or by Skype Flexible times and location Average of 8 meetings
- 11. Health Coach Roles Health Coaching for Patients –Bennett, Coleman, Parry & Bodenheimer http://www.aafp.org/fpm/20100900/p24 Five Roles of a Health Coach Self Management Support Bridge Between Clinician & Patient Navigation of the Health Care System Emotional Support Continuity
- 13. Group Coaching Workshops • “Taking S.M.A.R.T Steps to Reach Your Wellness Goals” • “Ignite Your Motivation”
- 14. Evaluation Demographics Have worked one-on-one with a Health Coach Over 500 people Gender split: Average client age: 81% Females 19% Males 53 years 71% Of clients live with at least one chronic disease Of those clients: 43% 41% 25% Have diabetes Have high blood pressure Have arthritis
- 15. Participant Results • 83% fully or partially met wellness goals
- 17. Self-efficacy Scale 1. I will be able to achieve most of the goals I have set for myself. 2. When facing difficulties, I am certain that I will accomplish them. 3. In general, I think that I can obtain outcomes that are important to me. 4. I believe I can succeed at most any endeavour to which I set my mind. 5. I will be able to successfully overcome many challenges. 6. I am confident that I can perform effectively on many different tasks. 7. Compared to other people, I can do most tasks very well. 8. Even when things are tough, I can perform quite well.
- 18. Testimonial
- 19. Thank you! Julie Atkinson, Manager (506) 451-1624 Julie.atkinson@diabetes.ca livewellbienvivre.com Facebook: livewellbienvivre Twitter: @livevivre
Notes de l'éditeur
- Jake Introduce ourselves Partnership between 3 organizations – Funded by Medavie and Dept of health, managed by CDA – focus on wellness – healthy eating, active living and mental fitness
- Jake Introduce ourselves Partnership between 3 organizations – Funded by Medavie and Dept of health, managed by CDA – focus on wellness – healthy eating, active living and mental fitness
- November 2010 – Office of the Chief Med Officer of Health released a report on Diabetes in NB – 27% of total hospital care days were attributed to NBers with Diabetes, and these patients stayed 3.3 times longer in hospital; along with more visits to family MD and specialists June 2011 Comp. Diabetes Strategy launched with 3 areas of focus – the prevention, detection and management of diabetes. Initiative under Management – 1. provide pilot funding to partner with community based organizations to provide structured education in stress mgmt, diet and physical activity to NBers. The Medavie Health Foundation will support initiatives and develop partnerships that encourage healthy living and diabetes self management, particularly with at-risk populations. Our focus is education and awareness as well as initiatives that aim to develop a culture of wellness and encourage individuals to live healthy, active lifestyles.
- Jake Introduce ourselves Partnership between 3 organizations – Funded by Medavie and Dept of health, managed by CDA – focus on wellness – healthy eating, active living and mental fitness
- The Chronic Care Model was developed out of a comprehensive approach to shape and guide quality improvement chronic care health services delivery. It is sometimes called the Wagner Model and is currently being used nationally and internationally. Clinicians and researchers recognized that those projects that had the greatest ongoing success worked across a number of strategies. Health care service delivery is a complex interconnected system, and successful change required that interventions worked across the system towards a common goal. The model incorporates the basic components necessary working together to optimize the patient and primary care provider relationship: Within the Health Care System, there are 4 basic parts: Information systems Decision support Delivery system design Self Management – personal skill development The Health Care System is part of the Community. The Community has 3 basic roles: To build Healthy public policy To create supportive environments To strengthen community action These work together like parts of an engine. When appropriately tuned and maintained, the system can run most efficiently. In this presentation we are specifically talking about self mgmt, but it must always be remembered that this has the greatest impact within a comprehensive strategy that considers all the components. NB Organizational logistics and challenges Governance – whose job is it? Official Languages Act (French and English) Rurality Poverty Illiteracy Opportunities Relatively small province Leverage what works Phenomenal providers Technologically ‘committed
- Evidence of the effectiveness of health coaching not only in terms of patient self-efficacy, adherence to treatment and behaviour changes but also health service utilization and health outcomes Education, coupled with health coaching, has been found to be significantly more effective in achieving lasting behaviour change Health coaching was particularly effective in changing chronically ill patients’ lifestyle behavior and improving their self-efficacy, physical and mental health status
- Chose communities with champions, wellness initaitives that we could leverage Differences in communities – EN/FR, Urban, Rural, includes some FN communities differences in area. – Moncton – uptake vs. AP --- Group Coaching Mental Health Recruitment Criteria: Education Community development Key Attributes
- Project evolution: Non-clinical role – information on 4 pillars and scope of practice. Registered Dietitian, Exercise physiologist (ymca), HIC – mental fitness and resiliancy, NBATC Off to community – Nov/Dec community engagement, cataloging of resources
- Client focused – starting where the client is. Not looking at standards of what they ‘should’ be – ie/ A1C, vegetables, or activity Non-judgemental – aren’t going to say well 8.4 a1c isn’t good enough or you must lose more weight etc. One-on-one Location – they work from home for administrative tasks and use community spaces. Free of charge Self – referral – MarCom important, building connections with stakeholders, Diabetes Educators, etc
- Client focused – starting where the client is. Not looking at standards of what they ‘should’ be – ie/ A1C, vegetables, or activity Non-judgemental – aren’t going to say well 8.4 a1c isn’t good enough or you must lose more weight etc. One-on-one Location – they work from home for administrative tasks and use community spaces. Free of charge Self – referral – MarCom important, building connections with stakeholders, Diabetes Educators, etc Initial Meeting: Privacy and Confidentiality forms, pre-health assessment questionnaire Meeting 2-5: Weekly goals and check-in, building self-efficacy Meeting 6-8: Intermittent support, Building independance Final meeting –sustainability planning, post questionnaire
- Health Coach provides self management support and develops a collaborative and personalized plan focusing on improving health and wellness Builds on the individual’s capacity to achieve short and long term health goals Coaches guide, motivate and provide customized resources to help achieve client’s goals; they do not diagnose, prescribe, give advice or “fix” Coaches are the bridge that move clients from the skills learned in programs to sustainable behavior change
- Based on the UK Model The Health Coach becomes an expert in their community resources and are developing a toolbox of regional community resources and credible wellness information. They will leverage existing wellness intiatives and resources and connect their clients when appropriate. When signposting a client you are likely not to have undertaken any significant work on the specific query you are signposting, whereas with referral it is likely that you will have started to work with the client on the query but for some reason can no longer continue. With signposting you may or may not continuing working with the client Some clients may come to the Health Coach and simply require signposting to one of these sources, while others will spend time working with the health coach to develop an action plan, goals and working to overcome barriers. Credible Resources – eat tracker, Dietitians of Canada, Community – walking clubs, fitness classes, introduce them to activities, gyms, Primary Health Care – keep track of Care Team, prep for a meeting with an RD, foot care, encourage seeing Mental health help, etc.
- In the Acadian Peninsula – rural, francophone area made up for several small communities – we were not getting client uptake Engaged with stakeholders in the area and determined that group sessions are typically well attended for other wellness initatives Decided to trail Group Coaching – Mid October 2013 Developed a session on SMART GOALS for the health coach to facilitate – well attended – 18 people and had 4 sign up on the spot. Jan 2014 – started in all regions in 2014 we reached: “Taking S.M.A.R.T Steps to Reach Your Wellness Goals”: Participants will leave workshop with a customized action plan and insights on how to overcome obstacles and maintain their goal in the long term. “Ignite Your Motivation”: Participants examine their motivation, skills, and support systems to enable them to reach and maintain their wellness goals. 2 Modules: Insert title Insert title One-on-one follow-up is offered
- Scale 1-5 Biggest change #1 – I will be able to achieve most of the goals I set for myself 3.3-4.1 I will be able to successfully overcome challenges Overall self-efficacy