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Requirements for Effective Disease Management Integrated, multidisciplinary health services Informed, activated patients HCP support matched to patient capacity and
willingness (to self-manage) WINNERS = HCPs doing ONLY what is HAS to
be done by professional; patient all the rest
What is Patient Self-Management?
The tasks that an individual must undertake to live well with one or more chronic conditions. These tasks include having confidence to deal with medical management, role management, and emotional management.
Report of a Summit. The 1st Annual Crossing the Quality Chasm Summit. 2 0 0 4S e p t e m b e r
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Why Patient Self-Management? Nearly half of all Canadians have Chronic
Condition = 16.5 million Canadians As population ages, number of Canadians in
need of chronic care will rise Most patients have multiple risk factors and
multiple conditions requiring management Shift from acute to chronic disease = shift
from provide-based care to patient-based care
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Acute versus Chronic DiseaseAcute versus Chronic Disease ACUTE DISEASE CHRONIC DISEASE
BEGINNING Rapid Gradual
CAUSE Usually one Many
DURATION Short Indefinite
DIAGNOSIS Commonly accurate Often uncertain, especially early
DIAGNOSTIC TESTS
Often decisive Often of limited value
TREATMENT Cure common Cure rare
ROLE OF PROFESSIONAL
Select and conduct therapy
Teacher and partner
ROLE OF PATIENT Follow ordersPartner with health professionals, responsible for daily management
HCP and Patient Self-Management
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Patient Knowledge (Risks, Benefits, Alternatives, Resources)
Pat
ien
t S
kills
(P
rob
lem
-so
lvin
g &
Dec
isio
n M
akin
g)
Patient Directs (Low Risk)“Patient Self-Reliance”
Patient seeks other information; choice on beliefs, values, fears
HCP: challenges, supportsGuidance: Internet,alternatives
Rely on self, faith, othersPatient distrustful of system
HCP Directs (Acute)“Doctor Knows Best”
Patient relies on HCP to make choicePatient does not question; complies
with prescribed treatment Guidance: Healthcare professional
Rely totally on professional judgmentPatient trusts, relies totally
Patient Self-Manages (Chronic)“Patient Informed Choice”
Patient seeks information; makes plans, responsible for choice
HCP listens, informs, supports Guidance: Patient peers, caregivers
Rely on family and peer supportPatient feels empowered
HCP Navigates (High Risk)“HCP Guidance”
HCP defines options, “care maps”; Patient seeks guidance, supportHCP clarifies & recommends
Guidance: Healthcare professionalsRely on professional guidance
Patient feels supported
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How HCPs support PSMSelf-management support•the systematic provision of education and supportive interventions by health care staff •to increase patients’ skills and confidence in managing their health problems,
•regular assessment of progress and problems, •goal setting, and problem-solving support.
Patient Self-Management Tools
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Patient Role
Tec
hn
olo
gy
Collaborative Patient Role
Med Tech: Chronic Disease management aids; decision support aids
Med Tech: Patient education materials online
Lo Tech: Patient education materials on paper
Subordinate Patient Role
Hi Tech: Sensor-based surveillance
Med Tech: Video camera surveillance
Lo Tech: Personal supervision and monitoring
Autonomous Patient RoleHi Tech: Advanced Assistive Technologies
Med Tech: Online support groups, provider and health plan comparison engines
Lo Tech: Self-help books on paper
Structured Patient RoleHi Tech: Interactive Telemedicine consultation
Med Tech: Monitoring and messaging system with multiple peripherals
Med Tech: Home and portable testing peripheral
From: California Healthcare Foundation: Patient Self-Management Tools: An Overview, June 2005
How is PSM Provided?
PSM are offered through managed care programs in the USA, such as Kaiser Permanante
In the UK “expert patient” programs mandated for all regional health units
In Alberta, PSM integrated into Calgary Regional Health Authority and provided by all Regional Health Authorities
In BC, PSM available to all residents paid for by BC Health Services
PSM provided in more than 25 countries
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Who provides PSM in Ontario? Arthritis Society, Baycrest, Toronto Rehab,
Bridgepoint offer PSM programs for specific clients
Training & support by Institute for Optimizing Health Outcomes and North York Hospital
PSM offered institutions and community-based services in Thunder Bay, Lindsay, Mississauga
Programs coming in Sudbury, Lanark County, Kingston, Ottawa, London, Sault Ste Marie
Programs: Canadian Cancer Society, Kidney Foundation, Northern Diabetes Network, Hep C
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Opportunities in Ontario Advent of Local Health Integration Networks and Family
Health Teams = opportunities for PSM to become integrated in Chronic Disease Management
Emphasis in Ontario Health on CDM as part of healthcare reform
Inclusion of PSM as part of Ontario Drug Strategy Ontario Patient Self-Management Network: Collaborative
Initiative among programs and services offering PSM
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Vision for Patient Self-Management People with long term disease actively and
effectively manage their care, supported by accessible, relevant and timely training delivered through informed patient centred communities of care.
Institute for Optimizing Health Outcomeswww.optimizinghealth.org
416-969-7431
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