1. Self Management Support
Dr. Patrick Doorley, HSE
25/10/2012

2. Self management long term conditions
What individual or carers can do to manage their condition and their general health and well being.
Managing
Symptoms
Medication
Treatment
Emotional impact
Adapting to impact on activities of daily living
Watching for changes, coping if symptoms worsen, knowing when to seek help
Healthy lifestyle e.g. diet exercise, not smoking
Knowing when to seek professional support
Requires support from health services- e.g. information, improving individual’s confidence and skills.

3. Traditional paternalistic practise styles
Create dependency
Discourage self-care
Ignore preferences
Undermine confidence
Do not encourage healthy behaviours.

5. Common adjustment problems

6. The goal of self management support is to enable people to perform three major functions.
Medical management of their condition
Carrying out normal roles and responsibilities
Managing the emotional impact and the adjustment problems associated with having a long term condition (Lorig & Holman 2003).
Helps people to maintain independence and avoid hospital admissions.

7. Structured self management programmes
Aim - support people to self-manage
Disease specific focus on educating people in medical and technical aspects. E.g. Dafne Desmond
Peer led, community programmes aim to help people to manage illness and cope with social and emotional aspects
Stanford model best known (called Expert Patient programme in Uk,Quality of Life programme in Donegal).

9. Evidence on disease specific programmes
Studies on programmes for chronic lung disease, diabetes asthma heart failure and arthritis found evidence of reduced hospital admissions improved clinical outcomes increased quality of life and wellbeing.
In relation to diabetes better control, improved self-management skills, increased self empowerment and food related quality outcomes.

10. Evidence on peer led community programmes e.g. Stanford model
Systematic review of evidence by Centres for Disease Control (2011) of two programmes from RCTs
Generic Chronic Disease Self Management Programme, a six week series of peer led classes
Arthritis Self Management Programme designed for people with arthritis.

11. CDC Findings CDSMP showed improvements in:
general self efficacy - pain management and other symptoms
psychological health status-anxiety, depression
physical health- fatigue
health behaviour-exercise.
They also suggested that the ASMP and the CDSMP
contribute to improvements in psychological health status,
self efficacy and some health behaviours over 12 months.
Similar findings from HSE Quality of Life Programme
(Donegal) and Arthritis Ireland programme.

12. Overview of Evidence Systematic reviews by Coulter and Ellis (2006),
Battersby(2010), and De Silva(2011), which report on
a broad variety of interventions indicate that:
Information only has limited effectiveness
Self management associated with improvements in knowledge, coping behaviour, adherence, self efficacy and symptom management.
Some evidence of reduction in health service utilisation and enhanced quality of life.
Improvements in health status tend to diminish over time, quality of life effects more likely to be sustained.

13. Summary of most effective forms of self management support
Structured use of targeted information resources within clinical care
Structured self-management education and support for people with specific conditions integrated with routine care planning processes and care pathways
Generic self-management education programmes (peer led, community based)
Interactive web-based self-management education programmes
Medication aids, information and other assistive aids and devices
Support groups and networks
Home-based self-monitoring (anti-coagulation blood pressure and diabetes)
Telephone support/telecare.

14. Conclusions
Peer led self management programmes improve self efficacy and quality of life
Condition specific programmes improve clinical outcomes
Both should be available to everyone who could benefit
Self-management is a hugely under-utilised resource in the health service.

19. Working together to make it better

20. Core elements of self management support
Partnerships in care
Information
Education
Social support-emotional, peer and network support
Technology
Formal care planning processes, with clear referral pathways.

21. HSE A-Z of diseases conditions
Quality assured information on 850 topics written in everyday language.
Original text drafted by medical editors, approved by subject matter experts for NHS.
Edited by senior clinicians with a view to ensuring that content is consistent with clinical practice in Ireland.
Links to other websites e.g. NGOs
Aimed at empowering public and patients on health and illness.
To be launched before year end.

22. HSE Progress
Clinical programmes developing evidence based guidelines,clinical pathways for long term illnesses
A –Z diseases conditions
Framework for self-management will be finalised soon
Agreement to implementation of action plan will need to be negotiated within HSE

23. Thank-you for your time and attention
Dr. Patrick Doorley
National Director
HSE