1. Self-Managing Chronic Conditions Cindy Corbett, PhD RN Susan E. Fleming, MN, RN

2. Cindy Corbett, PhD, RN Susan E. Fleming, MN, RN

3. 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

4. Chronic Disease, Condition, Illness: Non-communicable Disease Characterized by: o Duration o Prognosis o Pattern o Sequalae

5. Projected foregone national income from heart disease, stroke, diabetes Brazil Canada China India Nigeria Pakistan Russian Federation United Kingdom United Republic of Tanzania Estimated income loss In 2005 2.70.518.318.70.41.211.11.60.1 Estimated income loss In 2015 9.31.5131.854.0 1. 5 6.766.46.40.5 Accumulated loss In 2005 value 49.28.5557.7236.6 7. 6 30.7303.232.82.5 WHO, 2005

6. Chronic Conditions leading cause of death globally

7. Highly impacts low-income countries From poverty to chronic diseases Material deprivation and psychosocial stress Constrained choices and higher levels of risk behavior Increased risk of diseaseDisease OnsetReduced access to care Reduced opportunity to prevent complications WHO, 2005

8. Global Burden: Disability Adjusted Life Year (DALY)

9. Reducing the burden of chronic disease

10. Self-Managing: What is it? Complex concept Patients often under-prepared for self-management Ethical responsibility for providers?

11. Chronic Care Model

12. 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

13. 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

14. 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

15. Assess: Beliefs, Behaviors & Knowledge Advise: Provide specific information about health risks and benefits of change. Agree: Collaboratively set goals based on patient’s interest and confidence in their ability to change behaviors(s) Assist: Identify personal barriers, strategies, problem- solving techniques, and social environmental support Arrange: Specify plan for follow-up (e.g., visits, phone calls, mailed reminders) ©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

16. Investigate Resources  Local, national, and international resources aimed at promoting health behaviors  Peer support groups  Group health care visits

17. 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/progr ams/cdsmp.html http://patienteducation.stanford.edu/progr ams/cdsmp.html

18. CDSMP Research Findings Evidence-based Beneficial effects – Physical outcomes – Emotional outcomes – Health-related quality of life – Healthcare savings

19. 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

20. Principles of MI  Express empathy  Develop discrepancy  Roll with resistance  Support self-efficacy

21. 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

22. Summary o 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

23. Cindy Corbett, PhD, RN corbett@wsu.edu Susan E. Fleming, MN, RN sefleming@wsu.edu Contact Information