Self-management Support: Getting from me to we... - Impact

Self Management SupportOntario FHTPharmacistsNetworking DayNov 10, 2009Tracy Howson

MissionThe Quality Improvement and Innovation Partnership will bethe provincial leader in quality improvement methods forprimary healthcare.VisionOntario’s primary healthcare system will be recognized asproviding exemplary primary healthcare driven by acommitment to continuous quality improvementGoalTo advance the development of a high performingprimary healthcare system.

SupportiveEnvironmentsOntario’s CDPM FrameworkHealthyPublicPolicyINDIVIDUALSAND FAMILIESPersonalSkills & Self-ManagementSupportHEALTH CAREORGANIZATIONSCommunityActionDeliverySystemDesignProviderDecisionSupportInformationSystemsProductive interactions and relationshipsActivatedcommunities &prepared,proactivecommunitypartnersInformed,activatedindividuals& familiesPrepared,proactivepracticeteamsImproved clinical, functional and population health outcomes4

24‐Hour Diet &Exercise ChallengeWhat did you eat and drink yesterday?BreakfastSnackLunchSnackDinnerSnackBedtimeHow were you physically activeyesterday?5

Changing from me to weSelf Management Support

‘Chronic Disease’ Patient Contact with HealthProfessionals(Diabetes, Arthritis, Lung/Heart Disease)Time spent over 1 year:• GP visits per annum = 1 hour• Visits to specialists = 1 hour• Nurse, PT, OT, Dietitian = 10 hoursTotal = 12 hours• 364.5 days managing on their own or 8748 hoursBarlow, J. Interdisciplinary Research Centre in Health, School of Health & SocialSciences, Coventry University, May 2003.7

Definitions•Self Management◦ Actions taken by patients in caring for chronicconditions (e.g. taking medications, exercise,managing functional limitations)•Self Management Support◦ Actions by health care providers that strengthenand support self management

People with chronic illness who are able to selfmanage their disease are likely to moreappropriately use health care services, havefewer disease related complications, andexperience greater quality of life and betteroverall health than those who do not selfmanage their condition• Bycroft & Tracy, 2006• Chodosh, Morton, Jojica et al 2005• Decoster & Cummings 2005• National Health Priority Action Council 2006

The problem (with Physicists ) is not that wecan not learn ‐‐‐it is that we can not forget.Werner HeinsbergChanging a paradigm

Patient Education v.s.Self‐Management SupportDisease focusedPatient EducationEducation on how to managesymptoms of chronic conditionEducation on how to managedisease to reduce impact on lifeTreatment goals and changesdetermined by HCPPatient educated to comply withtreatmentHCP monitors patient outcomes andrecommends changes to therapySelf-Management SupportPatient focusedSupport on managing stress andemotional impact of conditionSupport on how to improve lifestyle tominimize impact of diseaseLifestyle goals and changes chosenby patientPatient supported to make actionplans to meet goalsPatient supported to self-monitor andto modify changes to action plans

VideoCoaching Patients forEffective Self ManagementAugust 2008California Healthcare FoundationTom Bodenheimer, MD

1. Problem Solving2. Decision Making3. Resource Utilization5 Core Self ManagementSkill components4. Forming a productive Patient Health CareProvider Partnership5. Taking Action –making action plansIf a program does not include 3 of 5 then it can not becalled “self management support” (Wagner)

Self Management ApproachesIndividual– 5 As– Health Promoting Process– Flinders Model– 3 Minute EmpowermentGroup Approaches– Stanford (peer led)– NHS

Self‐Management Support Interventionsare Varied & ComplementaryGroup ProgramsStanford University Chronic Disease Self-management ProgramNHS’ Expert Patient Program1:1 Empowerment CounsellingNP/ Physician VisitHome Care Nursing VisitFollow-upBy Health Professional or Lay Staff/ VolunteerFace to FaceTele-monitoring & Telephone CallInternet e.g. Patient Portal15

Making it your ownQuality improvement

Measurement is critical to improvementModel for ImprovementWhat are we trying toaccomplish?How will we know that achange is an improvement?What change can we make thatwill result in improvement?ActStudyPlanDo

The SM one minute ChallengeSelf Management SupportQuality Improvement

• At least one thing you are going to do,• Address the envelop where you want itto be sent• Seal it, no one else will read this• I will mail it to you in the next few weeksImproving your practiceThe Envelop, please!

PLANOne thing you are going to test, that you believe is achievable____________________________________________________________________________________________________________________How long are you going to undertake the test?When are you going to do this?1 pt/1 min/1 hr?_________________________day of the week, time of the day?__________________Is there anyone else you need to recruit?__________________________Measure: How will you know if the change is an improvement?___________________________________how confident are you? 1...2.…3.…4...5….6...7....8....10?DO_____________________________STUDY__________________________________ACT__________________________________

Measure, improve, measure

Resources tool box:• Books and Documents– Partnering in Self Management Support: A toolkit forClinicians (IHI)– Chronic Physical Illness: Self Management and BehaviouralInterventions , 2009, edited Newman, s., Steed L., Mulligan– Self Management in Theory and Practice; a guide forHealthcare Providers (www‐selfmanagementtoolkit.ca)• Websites– SWLHIN– www.Selfmanagementtoolkit.com– CELHINhttps://www.healthylifeworkshop.ca/Home.aspx?PageID=46&mid=_ctl0_MainMenu__ctl1‐menuItem010‐subMenu‐menuItem000– ImpactBChttp://www.impactbc.ca/practicesupport/practicesupportmodules/patientself‐management– Optimizing Healthhttp://www.optimizinghealth.org• Courses– Self management tool kit website modules– Optimizing Health Conference November 24, 25, 2009– Become a Stanford peer leader– Impact BC modules• People– Kate Loring– Patrick McKowen– Tom Bodenheimer– Mike Hindmarsh

Improving Chronic Illness Care ‐ Chronic Care Modelwww.improvingchroniccare.orgCalifornia Health Care Foundation (videos)www.chcf.orgBrief Negotiation Roadmap ‐ Kaiser Permanente(online tutorial)http://kphealtheducation.org/bnroadmap/index.htmlQuality Improvement and Innovation Partnershipwww.qiip.caStanford Universityhttp://patienteducation.stanford.edu/programs/cdsmp.htmlNHS Expert Patients Programmehttp://www.nhs.uk/conditions/Expert‐patientsprogramme‐/Pages/Introduction.aspxMoreLearningResources23

http://www.selfmanagementtoolkit.caWith Companion literature –Self Management in Theoryand Practice: A guide forHealthcare Providers

Go from here?Take the Time it Takes, so it takes less Time• 1. Recommend reviewing the resources, highly recommend mining,http://www.selfmanagementtoolkit.ca• 2. Allow yourself to do test of change/ pdsas, building your skill and your patientsability to self manage, it is a life long journey ‐‐‐• 3. And if you can, participate as a patient in a Stanford CDSM program workshop.Not to necessary become a peer leader but to really understand and walk in theshoes of your patients, so you can become a better partner

Questions

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