Participation and chronic disease self-management: Are we risking inequitable resource allocation?

2003 ◽  
Vol 9 (3) ◽  
pp. 132 ◽  
Author(s):  
Michele Foster ◽  
Elizabeth Kendall ◽  
Paul Dickson ◽  
Wendy Chaboyer ◽  
Beth Hunter ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Chronic Conditions ◽  
Positive Impact ◽  
Evaluation Studies ◽  
Health Resources ◽  
Management Program ◽  
Self Management ◽  
Self Selection ◽  
Growing Body ◽  
English Speaking

The Ottawa Charter for Health Promotion supported the empowerment of individuals to participate in their health care and have control over their health. For older adults with chronic conditions, the Chronic Disease Self-Management Program has been widely adopted as an adjunct to existing healthcare options. A growing body of literature has supported the positive impact of self-management programs on outcomes for people with a range of chronic conditions. However, evidence also suggests that participation in these programs is biased. This paper draws on pilot data to describe the profile of those people who inquire, enrol, attend, and complete CDSM courses in Queensland, Australia. As expected, there was evidence that males, Indigenous people, people of non-English speaking background, and those with multiple responsibilities were less likely to participate. Most importantly, participation was affected by a self-selection bias associated with health status. Those who were either unwell or well at the time of the course were unlikely to attend, minimising the preventative value of the CDSM program. Further, CDSM evaluation studies are likely to be inherently flawed and the distribution of health resources can become inequitable.

The process of implementing the Stanford Model Chronic Disease Self-Management Program: The Northern Hospital experience

2003 ◽  
Vol 9 (3) ◽  
pp. 127 ◽  
Author(s):  
M Murph y ◽  
J Saunder s ◽  
M Campbel l ◽  
B Jackso n ◽  
D Berlowit z
Keyword(s):  
Chronic Disease ◽  
Adjuvant Therapy ◽  
Chronic Conditions ◽  
Management Program ◽  
Self Management ◽  
Research Centre ◽  
Australian Population ◽  
Admission Rates ◽  
Successful Program ◽  
Stanford Model

In March 2002, The Northern Clinical Research Centre (NCRC), Epping, implemented the Stanford model Chronic Disease Self-Management Program (CDSMP). The NCRC is the first health facility to implement the CDSMP for all cause chronic conditions in the northern suburbs of Melbourne. This paper outlines the establishment, marketing, co-ordination and personnel for a successful program as identified by the NCRC. Barriers to participation in a program were identified by the NCRC and steps to minimise these were implemented. The evaluation of this program in a scientific manner enables the effect of this adjuvant therapy to be examined in the Australian population. Fifty-two participants have graduated from the CDSMP at The Northern Hospital since the program commenced. This paper reviews the unplanned re-admission rates for people who have participated in the CDSMP as part of an ongoing study.

scholarly journals The Effectiveness of a Chronic Disease Self-Management Program for Elderly People: a Systematic Review

2020 ◽  
Author(s):  
Khairunnisa Mansoor ◽  
Hussain Maqbool Ahmed Khuwaja
Keyword(s):  
Systematic Review ◽  
Chronic Disease ◽  
Elderly People ◽  
Chronic Conditions ◽  
Experimental Studies ◽  
Health Behaviours ◽  
Chronically Ill ◽  
Management Program ◽  
Self Management ◽  
The Impact

Introduction: Elderly population is increasing in Pakistan. Majority of people aged 50 – 64, suffer from two or more chronic conditions. Care of elderly people is sub-optimal. Healthcare system has limited resources to provide healthcare support to elderly people. Thus, there is need to empower the elderly to self-manage their health conditions. Chronic Disease Self-Management Program (CDSMP) is the most widely accepted self-management patient education program. It is designed to help people to gain confidence and skills to better manage their chronic conditions. Evidence of the effectiveness of CDSMP specifically for elderly people aged 60 years and above is lacking. Therefore, the aim of this systematic review was to determine the effects of the program among chronically ill elderly people. Methods: MEDLINED, CINHAL, EMBASE, PSYINFO, JBI and ASSIA were searched between April and May, 2020 for studies that tested the effects of generic CDSMP. A total of 750 articles were identified, of which 5 were included in the core review (four randomized controlled trials and one quasi-experimental).  Results: Eligible 5 studies yielded 2971 participants (mean aged 60.4 to 76.0 years). Elder people who participated in CDSMP improved their self-efficacy to manage disease in general and to manage symptoms. The effects on health status were mixed. Self-rated health and health distress showed significant improvement. Some health behaviours showed improvement, particularly exercise component showed significant improvement. For health services utilization, there was no improvement.  Conclusion: The result of this review suggests that CDSMP is beneficial for elderly people who attended the structured CDSMP either through a trained care provider or layman. Experimental studies in low and middle income countries, with large sample sizes are suggested to further understand the impact of CDSMP.  

Attendance, activation and health profiles of participants in a regional chronic disease self-management program in Laval, Canada

2020 ◽  
Author(s):  
Magali Girard ◽  
Janusz Kaczorowski ◽  
Marie-Thérèse Lussier ◽  
Vivianne Martin
Keyword(s):  
Chronic Disease ◽  
Waist Circumference ◽  
Chronic Conditions ◽  
Cardiovascular Health ◽  
Management Program ◽  
Self Management ◽  
Controlled Study ◽  
High Waist Circumference ◽  
Physical Measurements ◽  
High Level

Abstract Background : Chronic diseases are responsible for over 70% of all deaths globally. While some self-management programs have been shown to be efficacious in preventing or altering trajectories for some chronic conditions, scaling-up and sustaining such programs beyond tightly-controlled study conditions remain a major challenge. The objective of the current study was to describe the profile of attendees and the level of engagement of participants in a new, region-wide cardiometabolic disease self-management program offered in Laval, Canada. Methods : CISSS-Laval partnered with the Cardiovascular Health Awareness Program team to co-develop Cible-santé and evaluate the first cohort of participants enrolled in the program, in order to better understand the program's implementation and scope. Trained volunteers (supervised by a nurse) assisted participants with physical measurements (blood pressure, height, weight and waist circumference), a questionnaire on healthy habits, and assessment of cardiovascular disease and type 2 diabetes risk. Results : The evaluation of the first cohort of Cible-Santé participants showed very low attendance. Furthermore, only 1 in 10 of enrolled participants completed the full program. The program typically attracted adults with some risk factors associated with their chronic conditions (high waist circumference, obesity), but with an already high level of knowledge, skills and confidence to participate in self-management activities. Conclusion : A limitation of the study is the lack of data regarding the number of professionals who referred their patients to the program. This study provides a portrait of new participants to a self-management chronic disease program, which highlights the potential of supporting chronic disease patients ready to make changes but also exposes the difficulty of attracting a larger number and diversity of participants and in encouraging completion of the program.

scholarly journals Effectiveness of an eHealth self-management tool for older adults with multimorbidity (KeepWell): protocol for a hybrid effectiveness–implementation randomised controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e048350
Author(s):  
Monika Kastner ◽  
Julie Makarski ◽  
Leigh Hayden ◽  
Jemila S Hamid ◽  
Jayna Holroyd-Leduc ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Disease ◽  
Randomised Controlled Trial ◽  
Disease Management ◽  
Chronic Conditions ◽  
Controlled Trial ◽  
Management Tool ◽  
Self Management ◽  
Plain Language ◽  
Randomised Controlled

IntroductionIn response to the burden of chronic disease among older adults, different chronic disease self-management tools have been created to optimise disease management. However, these seldom consider all aspects of disease management are not usually developed specifically for seniors or created for sustained use and are primarily focused on a single disease. We created an eHealth self-management application called ‘KeepWell’ that supports seniors with complex care needs in their homes. It incorporates the care for two or more chronic conditions from among the most prevalent high-burden chronic diseases.Methods and analysisWe will evaluate the effectiveness, cost and uptake of KeepWell in a 6-month, pragmatic, hybrid effectiveness–implementation randomised controlled trial. Older adults age ≥65 years with one or more chronic conditions who are English speaking are able to consent and have access to a computer or tablet device, internet and an email address will be eligible. All consenting participants will be randomly assigned to KeepWell or control. The allocation sequence will be determined using a random number generator.Primary outcome is perceived self-efficacy at 6 months. Secondary outcomes include quality of life, health background/status, lifestyle (nutrition, physical activity, caffeine, alcohol, smoking and bladder health), social engagement and connections, eHealth literacy; all collected via a Health Risk Questionnaire embedded within KeepWell (intervention) or a survey platform (control). Implementation outcomes will include reach, effectiveness, adoption, fidelity, implementation cost and sustainability.Ethics and disseminationEthics approval has been received from the North York General Hospital Research and Ethics Board. The study is funded by the Canadian Institutes of Health Research and the Ontario Ministry of Health. We will work with our team to develop a dissemination strategy which will include publications, presentations, plain language summaries and an end-of-grant meeting.Trial registration numberNCT04437238.

Implementation and evaluation of the chronic-disease self-management program among Chinese immigrant older adults in the U.S.

2014 ◽  
Vol 35 (6) ◽  
pp. 448-450 ◽  
Author(s):  
XiaoRong Wang ◽  
Heather K. Hardin ◽  
Lei Zhou ◽  
Lei Fang ◽  
Pan Shi ◽  
...  
Keyword(s):  
Older Adults ◽  
Chronic Disease ◽  
Management Program ◽  
Self Management ◽  
Chinese Immigrant ◽  
The U.S

scholarly journals Standardising the Lay: Logics of Change in Programs of Disease Self-management

2012 ◽  
Vol 4 (3) ◽  
pp. 425-442 ◽  
Author(s):  
Annegrete Juul Nielsen ◽  
Lone Grøn
Keyword(s):  
Chronic Disease ◽  
Role Models ◽  
Chronic Condition ◽  
Expert Knowledge ◽  
Management Program ◽  
The Self ◽  
Self Management ◽  
Social Settings ◽  
Patient Centric ◽  
Forms Of Knowledge

The health political discourse on self-care is dominated by the view that the selfmanaging patient represents a more democratic and patient-centric perspective, as he or she is believed to renegotiate the terms on which patient participation in health care has hitherto taken place. The self-managing patient is intended as a challenge to traditional medical authority by introducing lay methods of knowing disease. Rather than a meeting between authoritative professionals and vulnerable patients, the self-managing patient seeks to open up new spaces for a meeting between experts. The present paper questions these assumptions through an ethnographic exploration of a patient-led self-management program called the Chronic Disease Self-Management Program. The program is concerned with what its developers call the social and mental aspects of living with a chronic disease and uses trained patients as role models and program leaders. Drawing inspiration from Annemarie Mol’s term ’logic’, we explore the rationale of ’situations of selfmanagement’ and identify what we call a ’logic of change’, which involves very specific ideas on how life with a chronic condition should be dealt with and directs attention towards particular manageable aspects of life with a chronic condition. This logic of change entails, we argue, a clash not between ’medical’ and ’lay’ forms of knowledge but between different logics or perceptions of how transformation can be achieved: through open-ended and ongoing reflection and experimentation in social settings or through standardised trajectories of change. Returning to the literature on lay forms of knowledge and illness perspectives, we question whether programs such as the Chronic Disease Self-Management Program – despite its apparent patient-centric perspective – reproduces classical hierarchical relations between lay and expert knowledge, albeit in new forms.

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