1. Hanke Timmermans & Anne-Berit Harmsen CBO h.timmermans@cbo.nl & a.harmsen@cbo.nl National Action Programme Self-management

2. National Action Programme Self-management Financed by:Ministry of Health, Welfare and Sport Steering group (content):NPCF & patientorganisations Executed by:CBO (a TNO company), duration 2008 - 2012 In co-operation with: - patientorganisations - health care providers - policy makers - expert knowledge organisations - scientists - selfmanagement core group

3. Definition Self-management is the ability to manage one or more chronic conditions (symptoms, treatment, physical and psychosocial consequences and life style changes) and integrate them in day-to-day life with the aim of achieving optimal quality of life

4. Central question: What is needed to empower patients to be actively involved in their own care?  for patients  for health care professionals  prerequisite conditions  prerequisite setting

5. Programme step by step 1.Self-management Framework & Intervention box 2.7 chronic condition working groups: Diabetes, Rheumatic diseases, COPD, Cancer, Depression, Muscular diseases, Heart failure 3.Special interest issues Co-morbidity, health literacy, shared decision making Lifestyle (i.e. diet and exercise) E-health, education, finance of integrated care 4.Pilots in primary care en hospital care

6. Experience based aspects of self- management Living with a chronic condition requires chronic optimism

7. Survey of the Federation of Patients and Consumer Organisations in the Netherlands (NPCF) ‘Are you actively involved in your care?’ 2053 participants 35 % ‘always’, 37% ‘most of the time’, 27% % less involved than they would like to be -Lack insufficient information -Lack of co-operation health care professionals -Feel incompetent -Too costly -……

8. Discussion In your most recent face-to-face contact with a health care professional… … did you feel empowered? If so, how? What happened? What did they do to empower you? If not, how? What happened? What should they have done?

9. Self- management Framework

10. Self-management Framework Basis: Literature Expert opinion Chronic condition working parties Discussions with professionals and patients

11. Focus: interaction Partnership Communication Mutual trust and respect

12. Ring 1: patient competencies Knowledge and skills i.e.: understanding your condition Self-efficacy i.e.: setting goals and making action plans Personal growth potential i.e.: set up and maintain personal (care) networks

13. Ring 1: professional competencies State of the art knowledge and teaching skills i.e.: tailor information to patients needs Coaching skills i.e.: motivational interviewing Guide to aid and support systems i.e.: referral to self management courses

14. Ring 2: self-management domains Experience-based knowledge Shared care Living with the condition Patient-professional relationship Organisition of care and support

15. Outer circle: setting and conditions Care delivery processes ICT Quality of care Research and development Education Finances Rules and regulations Society

16. Roadmap to self-management support Aims to: Inspire and motivate Understand necessary conditions Stimulate teamplanning Evaluate and improve teamplans Phases: preliminary work, integration in care practice, evaluation Self-management support is cyclic…

17. Team visionCompetencies Personal Care Plan Allocation of tasks Selection SM tools and interventions ImproveEvaluate After visit During visit Before visit

18. Self-management: the movie

19. www.zelfmanagement.com (in dutch) If you are interested in our video/ presentation/ framework? Email: zelfmanagement@cbo.nlzelfmanagement@cbo.nl More information can be found @