1. Helping Patients Manage Their Diabetes at Neighborcare Health Presnter: NCH Diabetes Education and Empowerment Coordinator Julie Myers MN RN. Seattle, Washington 2014,
Adapted from: “Helping People Manage Their Chronic Conditions.” Thomas Bodenheimer, Kate MacGregor, Claire Sharifi patients-manage-their-chronic-conditions.

2. Collaborative Decision Making 5 Strategies
Establishing an agenda
Ask, tell, ask
Closing the loop
Assessing readiness to change
Goal setting

3. Why Self-Management Support
There is strong evidence that shows that self-management support improves health-related behaviors and clinical outcomes

4. Self-Management Support:Two Interrelated Activities
Providing information about patients’ diabetes (helping patients become informed)
Working in partnership with patients to make medical decisions

5. In collaborative interactions…..
Information and skills are taught based on the patient’s agenda
One’s confidence in the ability to change, together with knowledge, creates behavior change
The goal is increased confidence in the ability to change, rather than compliance with the coach’s advice
Decisions are made as a patient-coach partnership

6. 1. Collaborative Decision Making: Establishing an Agenda
An agenda for the visit is negotiated between the patient and the coach, but the patient has the last word
If the coach wishes to discuss an issue with the patient, the patient’s permission should be sought

7. 2. Information Giving: Ask Tell Ask
Adult learning takes place primarily through “self-directed learning”
The information is chosen by the learner and doesn’t necessarily follow a step-by-step or linear format
Ask, Tell, Ask provides information to the patient in a manner directed by the patient

8. Ask, Tell, Ask Example Coach: “What do you know about HbA1c?”
After receiving an answer the coach then tells the patient the information and asks them what information is new and what additional information is desired
This allows the coach to see what information the patient was able to retain and if their understanding is accurate
It also encourages a collaborative interaction

9. 3. Information Giving: Closing the Loop
Assess the patient’s understanding by closing the loop
Closing the loop example:
Coach: There are three things that prevent diabetes complications: improving your diet, exercising more, and taking medications. If you were to talk to a friend or family member what things would you tell them you can do to prevent diabetes complications?

10. 4. Assessing Readiness to Change
Motivational Interviewing Model: readiness=importance x confidence
The collaborative model stresses the importance of internal motivation
The coach and patient develop a non-judgmental, non- authoritarian relationship that resembles a partnership
The coach refrains from giving advice and evokes the experiences, beliefs and ideas that motivate the patient
The patient’s autonomy is demonstrated throughout the entire process

11. MI In Practice
Assess the patient’s readiness by estimating the level of importance and confidence
Use interviewing techniques to help the patient increase his or her willingness to change
If the patient is motivated make an action plan then move on to goal setting

12. 5. Goal Setting
Goal setting is accomplished by coaches and patients formalizing an action plan
Goal setting is the process and action plans are the result of the process
Actions are concrete and highly specific
Developing an action plan that the patient can succeed at is very important for ensuring self- efficacy (i.e. a person’s level of self-confidence that they can carry out a behavior necessary to reach a desired goal