Self-Managing Chronic Conditions Cindy Corbett, PhD RN Susan E. Fleming, MN, RN.
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Transcript of Self-Managing Chronic Conditions Cindy Corbett, PhD RN Susan E. Fleming, MN, RN.
Self-ManagingChronic Conditions
Cindy Corbett, PhD RNSusan E. Fleming, MN, RN
Cindy Corbett, PhD, RN
Susan E. Fleming, MN, RN
Learning Objectives
o Identify the impact of non-communicable disease on morbidity & mortality
o Describe the role patients have in managing non-communicable disease
o Examine evidenced-based strategies health care providers can use to provide self-management support to patients
Chronic Disease, Condition, Illness: Non-communicable Disease
Characterized by:o Durationo Prognosiso Patterno Sequalae
Projected foregone national income from heart disease, stroke, diabetes
WHO, 2005
Chronic Conditionsleading cause of death globally
Highly impacts low-income countriesFrom poverty to chronic diseases
WHO, 2005
Global Burden: Disability Adjusted Life Year (DALY)
Reducing the burden of chronic disease
Self-Managing: What is it?
• Complex concept• Patients often under-prepared
for self-management• Ethical responsibility for
providers?
Chronic Care Model
Interactions to promote the patient as the expert in managing chronic
conditions
• Emphasize patient’s central role• Involve family members• Build a relationship• Explore patient’s values, preferences,
cultural & personal beliefs• Share information
• Collaboratively set goals• Use skill building & problem
solving strategies to help patient’s identify & overcome barriers
• Follow-up on action plans• Connect patients with community
resources
Interactions to promote the patient as the expert in managing chronic
conditions
The 5 A’s
• Assess: evaluate behavior change status or progress
• Advise: provide personally relevant behavioral recommendations
• Agree: set specific collaborative, feasible goals
• Assist: anticipate barriers, problem-solve solutions, complete action plans
• Arrange: schedule follow-up contacts and resources
©World Health Organization, 2004
1. List specific goals.
2. List barriers and strategies.
3. Specify follow-up plan.
4. Share plan
1. List specific goals.
2. List barriers and strategies.
3. Specify follow-up plan.
4. Share plan
Investigate Resources
Local, national, and international resources aimed at promoting health behaviors
Peer support groups
Group health care visits
Chronic Disease Self-Management Program
Helps people learn to manage chronic diseases and conditions
Participatory workshop
Leader manual available in many languages
Information at: http://patienteducation.stanford.edu/programs/cdsmp.html
CDSMP Research Findings
• Evidence-based
• Beneficial effects– Physical outcomes– Emotional outcomes– Health-related quality of life– Healthcare savings
Motivational Interviewing (MI)
• Directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence
• Brief MI can be implemented in most health care settings
• Training in the technique is needed
Principles of MI
Express empathy
Develop discrepancy
Roll with resistance
Support self-efficacy
Goal of MI
• Identify pt’s stage/attitude toward change
• Have pt articulate pros & cons of change
• Empathize and empower the client to take steps toward change
Summaryo Globally, chronic diseases are responsible
for the majority of morbidity & mortality
o Self-management can prevent and control chronic disease, and patients themselves are central to doing both
o Health care providers have a responsibility to support patients in self-management
o Evidence-based practices, including the 5A’s, the CDSMP and MI, were presented as strategies for providing self-management support
