Living Well with Chronic Conditions - Utah Department of Healthhealth.utah.gov/arthritis/pdf/Website...

10/11/2012

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Living Well with

Rebecca Castleton – Christine WeissUtah Arthritis Program

gChronic Conditions

A Group Model Sustained by a Network of Partners

Inthepast20yearsorso,theStanfordUniversity,PatientEducationResearchCenterhasdeveloped,tested,andevaluatedself‐managementprogramsforpeoplewithchronichealthproblems

Living Well with Chronic ConditionsStanford Model of CDSMP

Allprogramsaredesignedtohelppeoplegainself‐confidenceintheirabilitytocontroltheirsymptomsandhowtheirhealthproblemsaffecttheirlives

Workshopsarehighlyinteractive,focusingonbuildingskills,sharingexperiencesandsupport

Onceaprogramisdeveloped,itisevaluatedforeffectivenessthrougharandomized,controlledtrial,whichis2‐4yearsinlength

It is ONLY after a program has been shown to be safe


ItisONLYafteraprogramhasbeenshowntobesafeandeffectivethroughthesetrialsthatitisreleasedfordissemination

ThiswastheprocedurefortheChronicDiseaseSelf‐ManagementProgram(CDSMP)


ProgramDescription

Designedforpeoplewholivewithanychroniccondition


Basedonthesymptomsofchronicconditions

Participantslearntoolsthatenablethemtoself‐managetheirsymptoms

Communityorhealthcare‐basedsettings

Chronic Conditions Represented in CDSMP Workshops

• 44.5%Arthritis• 40.3%Hypertension• 33.3%Diabetes• 31.6%HighCholesterol

• 14.9%Asthma• 9.8%Fibromyalgia• 9.1%Cancer• 7.7%KidneyDisease

Source: Utah Arthritis Program, 2010

% g• 29.3%ChronicJointPain• 27.7%ChronicPain• 23.9%Depression• 17.4%HeartDisease

% y• 5.6%Osteoporosis• 4.0%LungDisease• 3.3%Stroke

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Chronic Conditions Represented in CDSMP Workshops

20.9%(465)

12.9%

9.5%(211)

3.1%(68)

FiveorMore

Four

h

Source: Utah Arthritis Program, 2011

20.4%(454)

17.6%(391)

15.7%(350)

12.9%(286) Three

Two

One

Missing

None


PatientEngagementActivities

Participantslearnhowtoidentifyproblems

Participants learn how to act on problems Participantslearnhowtoactonproblems

Participantslearnhowtogenerateshort‐termactionplans

Participantslearnproblem‐solvingskillsrelatedtochronicconditionsingeneral


ProgramSubjectMatter Dealingwithfrustration,fatigue,painandisolation

Exercise for maintaining and improving strength, Exerciseformaintainingandimprovingstrength,flexibilityandendurance

Appropriateuseofmedicationandpropernutrition

Communicatingeffectivelywithfamily,friendsandhealthprofessionals

Evaluatingnewtreatments


ProgramStructure

Seriesof6sessions,1sessionperweek,2hourspersession

Heldincommunitysettings(includinghealthcare)

Highlyscriptedcurriculum


ProgramStructure

Designedtobelay‐led;2leadersfacilitateeachclass;atleast1facilitatoralsohasachroniccondition

Workshopsofferedatnocharge

AvailableinUtahin:English,Spanish,Tongan,Samoan,andNavajo


Week1 Differencebetweenacuteand

chronicconditions Shorttermdistractions Introduceactionplans

Week2

Healthyeating Communicationskills Problemsolving

• Week5 Medicationusage

Dealingwithdifficultemotions Physicalactivityandexercise

Week3 Betterbreathingtechniques Musclerelaxation Painandfatiguemanagement

Week4 Futureplansforhealthcare

g Makinginformedtreatment

decisions Depressionmanagement Positivethinking Guidedimagery

• Week6 Workingwithyour

healthcareprofessional Planningforthefuture

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ActionPlans

• Somethingtheywanttodo

A h bl

• ConfidenceLevel

• Problem Solving


• Achievable

• ActionSpecificWhatHowmuchWhenHowoften

ProblemSolving


ImprovedOutcomes6mo. 2yrs.

Selfefficacy √ √Selfratedhealth √ √Disability √Roleactivity √Energy/fatigue √ √Healthdistress √ √MD/ERvisits √ √Hospitalization √

Lorig, et al 1999, 2001


ImprovedOutcomes1 2 3 4 5

Self‐efficacy X X X XSelf‐ratedhealth X XFatigue X X XFatigue X X XAnxiety/Distress X X XRolelimitation X XHRQOL XPain XExercise X X XCog.Sympmgmt X X X1=Lorig 05, 2=Barlow 05, 3=Goeppinger 07, 4=Kennedy 07, 5=Gitlin 08


WorkshopResources

Resourcebook:LivingaHealthyLifewithChronicConditions

CD: Time for Healing CD:TimeforHealing

Weeklyactionplansandfeedback

Groupsaresmall:10‐15people Shareinformation,interactivelearningactivities,problem‐solving,decision‐making,socialsupportforchange


Whatparticipantsaresaying.... “IknowIcanself‐manageafewproblemsandmakelifebetterformeandmyhusband.”

“Itgavemesomeimportantcopingmechanisms.”

“Thisclasshashelpedmegetmylifeinorder.”

“Irecommendthiscourseandhandbooktoallseniors.”

“Wehavesetgoals,accomplishedthemandwillcontinuetomanageourlivesbetterduetothisclass.”

Source:ClassparticipantsofWasatchandSummitCountycourses

Tomando Control de Su SaludStanford Model of Spanish CDSMP

SpanishProgramDevelopment

NotatranslationbutanindependentdevelopmentinSpanishSpanish

Developedtobeculturallyappropriate

FocusgroupsconductedinSpanish

Healthcareprofessionalsworkingwithpersonswithchronicconditions

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Tomando Control de Su SaludStanford Model of Spanish CDSMP

SpanishProgramDevelopment

Participantsincorporatehealthyhabitsintotheirlives: Healthyeatinghabits

Exercise(physicalactivity)

Cognitivemanagementofsymptoms

Bettercommunicationwithhealthcareproviders

Overallperceptionofbetterhealth


Infrastructure MasterTrainers– 11instateofUtahasofOctober2011(8English,2Spanish) Attend4½daytrainingatStanfordUniversity Teach classes and train leaders Teachclassesandtrainleaders

PeerLeaders/Instructors Complete4‐daytrainingtaughtby2MasterTrainersinordertoteachclasses

StanfordLicense EachorganizationteachingthisprogrammustpurchasealicensefromStanford– UtahislookingintoaStatewidelicense

TrainingMaterial ResourcebooksandCDsforparticipantsandleaders


GeneralPatientandProviderBenefits

Anevidence‐basedprogramsuchasLivingWell/CDSMPcancapturemanychronicdiseasesthroughthisonechannelg

Self‐managementsupportoption

Canimproveself‐ratedhealthandenergylevels

Reducedhealthcareutilization(EDvisits)

AstheNewJerseyprogramputsit:FeelBetter!

Inconservativeterms,thetwo‐yearsavingsduetoreducedhospitaldaysandoutpatientvisitsisapproximately$590perparticipant($490in

$

Costs vs. Savings

hospitalizationand$100inoutpatientvisits).Afteradjustingforparticipantcostsandeconomiesofscaletheactual2‐yearsavingsperparticipantwerebetween$390and$520.

Lorig,etal.MedicalCare,2001

Implementation‐• Partnerswhowouldliketoadministertheprogramontheirown

Th ld f d h l d d

CDSMP Partnership Model

• Theagencywouldfindtheirownleadersandruntheworkshopstowhatsuitstheirneedsthebest

• AreaAgenciesonAging,Clinics,LocalHealthDepartmentsareexamples


Host‐• Theseareagenciesthatmaynothavetheresourcestoimplement,butwouldstillliketohave a workshop offered at their sitehaveaworkshopofferedattheirsite

• Alocalpartnerwouldthenbringtheworkshoptothem

• TheHostPartnerwouldsimplyprovidefacilityuseandrecruitparticipants

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Referral‐

• Partnerswhohaveaccesstoapopulationbutdonothaveabilityordesiretoimplementclassesinownsetting

• Referpatients/clientsintocurrentclasses

• Healthcareprovidersandhealthplansareexamples


Marketing‐• Partnerswhomaynotfallintotheotherthreepartnershipcategoriesp p g

• Examplesincludeagencieswithaccesstonewsletters,listservs andothermediachannels


Resources StanfordUniversity’ssiteonCDSMPhttp://patienteducation.stanford.edu

UtahArthritisProgram(classschedules)http://health.utah.gov/arthritis

AdministrationonAging:www.aoa.gov

NationalCouncilonAging:http://healthyagingprograms.org


ContactInformation

[email protected]; 801‐538‐[email protected];801 538 9340

[email protected];801‐538‐9458

UtahArthritisProgram:www.health.utah.gov/arthritis(forclassschedules)

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Living Well with Chronic Conditions - Utah Department of Healthhealth.utah.gov/arthritis/pdf/Website...

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