1. Evidence and theoretical components
Module 4.2
Self management
Evidence and theoretical components

2. Presentation purpose Target audience
Service providers and project workers on DPMI projects
Aim
To encourage consumers to self manage
Objectives
Provide an overview of the concepts of self management
Review self management programs and evidence
Explore the components of self management and integration into practice.

3. What is self management?
Self-management is the active participation by people in their own healthcare.
Self-management incorporates:
health promotion and risk reduction
informed decision making
following care plans
medication management
working with health care providers to attain the best possible care and to effectively negotiate the often complex health system.
National Chronic Disease Strategy (Draft) National Health Priority Action Council

4. Is self management effective?
Evidence to support self management
Improves quality of life
Supports behavior change
Decreases health care utilisation

5. References
Barlow J. et a “Self – management approaches for people with chronic conditions: a review” Patient Education and Counseling 48 (2002)
“Patients as effective collaborators in managing chronic conditions”
Adherence to long term therapies go to publications link

6. Diabetes self management education in Australia
Norsworthy document reviewed
8 articles in which the authors reviewed up to 153 studies of the effectiveness of diabetes interventions.
Each of the studies concludes that diabetes self management education is effective in improving health outcomes for people living with diabetes.
influence behaviour change and improve knowledge and skill for diabetes self management
reductions in secondary complication rates
reducing reliance on health services.
Ann Nosworthy April 2004 ADEA.

7. Measuring effectiveness of self management
Self-management Education Programs in Chronic Disease-A Systematic Review and Methodological Critique of the Literature
Conclusions:
Self-management education programs resulted in small to moderate effects for selected chronic diseases as measured by clinical markers. ( diabetes, hypertension and asthma)
Need to adhere to a standard methodology to help clarify whether self-management education is worthwhile.
Asra Warsi,et al. Arch Intern Med. 2004;164:

8. Stanford Chronic Disease Self Management Program
RCT subjects
Demographic Data
Age 62 years
Male 27%
Education 14 years
No. Diseases 2.2
Kate Lorig et al. Evidence suggesting that a chronic disease self management program can improve health status while reducing hospitalizations. Medical Care 37,1 1999

9. Stanford Chronic Disease Self Management Program
Percent With Common Diseases
Lung Disease 21%
Heart Disease 24%
Diabetes 26%
Arthritis 42%

10. Stanford Chronic Disease Self Management Program
6-Month Improvements in Health Outcomes
Self-Rated Health
Disability
Social and Role Activities Limitations
Energy/Fatigue
Distress with Health State

11. Stanford Chronic Disease Self Management Program
Improvements in utilisation and costs
Average 0.8 fewer days in hospital in the past six months (p=.02)
Trend toward fewer outpatient and ER visits (p=.14)
Estimated cost of intervention $100-$200

12. Good Life Club – Coaching
Six-month outcome data for the Good Life Club project: An outcomes study of diabetes self-management
positive changes in four of eight self rated symptom measures
reductions in the reported use of GPs,
improvements in social functioning
large increases in all six confidence in self-management items.
Colette J Browning & Shane A Thomas. Australian Journal of Primary Health — Vol. 9, Nos. 2 & 3,

13. Peer led self management

14. Peer led self management

15. Peer led self management

16. Peer led self management

17. Key components of self management
Based on patient perceived problems
Builds confidence (self-efficacy) to perform 3 tasks
Disease Management
Role Management
Emotional Management
Focus on improved health status and appropriate health care utilization
Kate Lorig

18. How self management differs from patient education
Purpose
To manage life
with disease
To change
behaviors
To increase skills
/self confidence
To increase
knowledge
To problem solve
and make decisions
To use specific
tools
Kate Lorig

19. How self management differs from patient education
Needs
Assessment
Patient
problems
What patients need to know
Content
Disease, role,
& emotional management
Disease knowledge and behaviors
Leader
Leader is guide
Leader is expert
Kate Lorig

20. Essential elements of self management interventions
Disease, medication and health management
Role management
Emotional management
Support enhancement of self efficacy
Problem solving training
Follow up
Tracking and ensuring implementation
The Robert Wood Johnson Foundation.The Centre for the Advancement of Health.

21. Handling self management tasks
S/M Task Passive Active
Medical Deferred Collaborates
Management
Role Relinquishes Strives to
Management maintain
Emotional Erratic Regular use of Management ineffectual coping skills
A. Jerant et al. “Patients perceived barriers to active self-management of chronic disease” Patient education and counseling. 57,3 June 2005

22. Handling self management tasks
S/M skills Passive Active
Problem Catastrophists Systematic
Solving process
Decision making Made in haste Carefully weighs
fear options
Resource Erratic Regular use of Utilisation ineffectual coping skills
Partnership Minimal Identifies and selects with HPs HPs for support
Action Planning Minimal Applied frequently
Self Tailoring Minimal Frequent

23. Promoting self efficacy
Promote performance accomplishment
Use verbal persuasion
Role modelling
Identifying feelings and helping work through strategies to deal with feelings

24. Goal Setting- Getting started
Choose long term goal
Goals should be something you want to do
Identify steps needed to reach long term goal
Choose one of those steps to start working towards goal

25. SMART Specific Measurable Achievable Realistic Timely
Flinders University

26. Guidelines for helping with - Problem solving
Identify the problem
List ideas
Select one
Assess the results
Substitute another idea (if first didn’t work)
Accept that the problem may not be solvable
Kate Lorig