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

Self-ManagingChronic Conditions

Cindy Corbett, PhD RNSusan E. Fleming, MN, RN

Cindy Corbett, PhD, RN

Susan E. Fleming, MN, RN

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

Chronic Disease, Condition, Illness: Non-communicable Disease

Characterized by:o Durationo Prognosiso Patterno Sequalae

Projected foregone national income from heart disease, stroke, diabetes

WHO, 2005

Chronic Conditionsleading cause of death globally

Highly impacts low-income countriesFrom poverty to chronic diseases

WHO, 2005

Global Burden: Disability Adjusted Life Year (DALY)

Reducing the burden of chronic disease

Self-Managing: What is it?

• Complex concept• Patients often under-prepared

for self-management• Ethical responsibility for

providers?

Chronic Care Model

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

• 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

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

©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

Investigate Resources

Local, national, and international resources aimed at promoting health behaviors

Peer support groups

Group health care visits

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/programs/cdsmp.html

CDSMP Research Findings

• Evidence-based

• Beneficial effects– Physical outcomes– Emotional outcomes– Health-related quality of life– Healthcare savings

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

Principles of MI

Express empathy

Develop discrepancy

Roll with resistance

Support self-efficacy

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

Summaryo 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

Cindy Corbett, PhD, RNcorbett@wsu.edu

Susan E. Fleming, MN, RNsefleming@wsu.edu

Contact Information