1. Teaching Chronic Disease Self-Management in Residency Education Maureen Gecht-Silver MPH, OTR/L Dana M Bright LSW Conference on Practice Improvement November 10, 2007

2. Objectives After participating in this seminar participants will be able to… Identify key elements and approaches to developing a self-management learning laboratory (SMLL) Discuss methods of teaching residents to promote patient self-management of chronic illness Apply self-management teaching strategies in their own settings

3. Background Residents struggle to manage patients with chronic illness  Lack skills, feel frustration, limited hope for patient progress Growing support for teaching patient self management  Future of Family Medicine project  IOM “Crossing the Quality Chasm”  Lorig “Chronic Disease Self Management Program”  Wagner “Chronic Care Model”  Bodenheimer “Improving Primary Care” UIC Family Medicine was awarded a grant to teach residents self-management skills during community medicine

4. Development of the SMLL Adaptation of Chronic Disease Self- Management Program (CDSMP) Collaborated with a Community Partner Conducted Program in a Community Laboratory Setting

5. 2007 SMLL Programs 2 Groups 6 PGY2 Residents 21 Patients

6. Goals of the Self-Management Learning Lab (SMLL) Teach residents to teach patients self- management skills action planning problem-solving methods for interactive education Conduct program in a manner that benefits participants

7. Structure Three 2-hour sessions Key Components of each session Feedback/Problem-Solving Education Session Break with Healthy Snack Action Planning Wrap-up

8. Materials Easel with writing pad or erasable board Markers Parking Stickers Posters Participant folder and pen Book Pedometer Refreshments

9. Benefits to Residents Learn to teach health promotion and self- management to patients with chronic illness See skills modeled by health educator Practice skills with supervision Conduct group versus individual patient education

10. Benefits to Patients Learn new skills Pride associated with training future doctors Limited time commitment Opportunity for additional education (follow- up group)

11. Preparing Residents to Conduct the Self-Management Learning Lab Half-Day Training Session Weekly practice with feedback before each group session—face-to-face and email Written guides for each session (“Road Map”) Written Instructions for phone coaching

12. DEMONSTRATION

13. Participant Observations Pedometers are an effective self-management tool SMLL helped weight loss Heightened awareness of healthy behaviors (e.g., drinking more water, eating less sugar) Action planning positively impacted daily life Expanded awareness of helpful exercises Interest in monthly follow-up meetings

14. Residents’ Confidence (N=5)

15. Resident Perceptions of the SMLL  Learning how to work with an action plan and have a patient make an action plan…  I liked the training--it helped us prepare for the sessions  I liked that the patients asked their own questions and that we had to respond on the spot.  I learned how to teach patients about their chronic condition so that they can help themselves rather than having to make so many visit to the clinic.  I like that multiple problems were addressed at the same time in a group setting.

16. Resident Perceived Impacts of SMLL  Using action planning and self-management education offers more than just medicines and helps patients make positive decisions about their health.  I have new tools to motivate patients to persist with health behavior changes for different types of problems.  I’m able to help patients who smoke and patients with weight issues make small changes through my discussions about action planning.  I learned about the importance of coaching both during and after patient encounters in the clinic.

17. Keys to Successful Collaboration with Community Partner Institutional buy-in, support Shared goals and philosophy Consistent communication Both SMLL leaders trained in CDSMP Program

18. Partner Responsibilities: Logistics Coordination Marketing: print, email, outreach Recruitment of participants: Self-management presentation to prospective participants Phone calls and invitations targeted to past program participants Confirmation letters Workshop logistics: meeting space, refreshments, parking

19. DISCUSSION

20. Self-Management Learning Lab Follow-up Group 1.5 hour sessions Once per month Average of 6 attendees Topics selected by participants for this year East meets West Doctor Patient Communication Aging Process “What to Expect” Strategies to empower participants

21. Useful Resources Lorig K, Holman HR, Sobel D, Laurent D, González V, Minor M: Living a Healthy Life with Chronic Conditions (2nd Edition). Boulder CO: Bull Publishing, 2006. Bodenheimer T and Grumbach K: Improving Primary Care. New York: Lange Medical Books, McGraw Hill, 2007. Stanford Patient Education Resource Center http://patienteducation.stanford.edu/ http://patienteducation.stanford.edu/ Using Action Plans to Help Primary Care Patients Adopt Healthy Behaviors: A Descriptive Study http://www.jabfm.org/cgi/reprint/19/3/224

22. Contact Information Maureen Gecht-Silver UIC Department of Family Medicine mgecht@uic.edu 312-996-0136 Dana Bright Rush University Medical Center Dana_M_Bright@rush.edu 312-942-7900