Activating patients with chronic disease for self-management: comparison of self-managing patients with those managing by frequent readmissions to hospital

2013 ◽  
Vol 19 (3) ◽  
pp. 198 ◽  
Author(s):  
Sue E. Kirby ◽  
Sarah M. Dennis ◽  
Pat Bazeley ◽  
Mark F. Harris

Understanding the factors that activate people to self-manage chronic disease is important in improving uptake levels. If the many frequent hospital users who present with acute exacerbations of chronic disease were to self-manage at home, some hospital admissions would be avoided. Patient interview and demographic, psychological, clinical and service utilisation data were compared for two groups of patients with chronic disease: those attending self-management services and those who managed by using hospital services. Data were analysed to see whether there were differences that might explain the two different approaches to managing their conditions. The two groups were similar in terms of comorbidity, age, sex, home services, home support and educational level. Self-managing patients were activated by their clinician, accepted their disease, changed their identity, confronted emotions and learnt the skills to self-manage and avoid hospital. Patients who frequently used hospital services to manage their chronic disease were often in denial about their chronic disease, hung on to their identity and expressed little emotional response. However, they reported a stronger sense of coherence and rated their health more highly than self-managing patients. This study shed light on the process of patient activation for self-management. A better understanding of the process of patient activation would encourage clinicians who come into contact with frequently readmitted chronic disease patients to be more proactive in supporting self-management.

2012 ◽  
Vol 18 (3) ◽  
pp. 220 ◽  
Author(s):  
Sue E. Kirby ◽  
Sarah M. Dennis ◽  
Pat Bazeley ◽  
Mark F. Harris

Many frequent readmissions due to acute exacerbations of chronic disease could be prevented if patients self-managed. This study explored factors involved in patient activation for chronic disease self-management by qualitative analysis of interview data from hospital and community-based clinicians and patients. All clinicians reported that many frequently readmitted patients did not readily take up referral to chronic disease self-management services. This reluctance was compounded by system or access barriers. Clinicians who had a defined role in chronic disease management and patient-centred and behaviour change skills reported that although some patients were more resistant than others, patients could be persuaded to adopt self-management behaviours. Hospital clinicians and GPs were more inclined to attribute blame to clinical, social and personal patient factors, such as difficulty with support at home, social circumstances and reluctance to take responsibility. Investment in extending the skills and role of hospital clinicians and GPs to take a more supportive role in patient uptake of referrals to chronic disease self-management services would reduce hospital readmissions. Improvements in access to chronic disease self-management and GP services are also needed to address failure to take up chronic disease self-management.


2008 ◽  
Vol 32 (2) ◽  
pp. 330 ◽  
Author(s):  
Peter W Harvey ◽  
John N Petkov ◽  
Gary Misan ◽  
Jeffrey Fuller ◽  
Malcolm W Battersby ◽  
...  

The Sharing Health Care SA chronic disease selfmanagement (CDSM) project in rural South Australia was designed to assist patients with chronic and complex conditions (diabetes, cardiovascular disease and arthritis) to learn how to participate more effectively in the management of their condition and to improve their self-management skills. Participants with chronic and complex conditions were recruited into the Sharing Health Care SA program and offered a range of education and support options (including a 6-week peer-led chronic disease self-management program) as part of the Enhanced Primary Care care planning process. Patient self-reported data were collected at baseline and subsequent 6-month intervals using the Partners in Health (PIH) scale to assess selfmanagement skill and ability for 175 patients across four data collection points. Health providers also scored patient knowledge and self-management skills using the same scale over the same intervals. Patients also completed a modified Stanford 2000 Health Survey for the same time intervals to assess service utilisation and health-related lifestyle factors. Results show that both mean patient self-reported PIH scores and mean health provider PIH scores for patients improved significantly over time, indicating that patients demonstrated improved understanding of their condition and improved their ability to manage and deal with their symptoms. These results suggest that involvement in peer-led selfmanagement education programs has a positive effect on patient self-management skill, confidence and health-related behaviour.


2010 ◽  
Vol 34 (1) ◽  
pp. 18 ◽  
Author(s):  
Karen Grimmer-Somers ◽  
Wendy Dolesj ◽  
Joanne Atkinson

Background.The Australian Government Medicare Enhanced Primary Care (EPC) initiative for chronic disease management (CDM) supports integrated allied health (AH) and general medical practitioner (GP) care. There are limited examples of how to operationalise this initiative in private practice, and minimal evidence of expected service utilisation or acceptability to patients. This paper reports on a 2007 Australian integrated GP/private sector AH pilot program, based on Medicare EPC guidelines for Type II diabetes. Objectives.Describe how the pilot program was put in place (operationalised). Report on service utilisation and patient perspectives of the pilot program. Methods.Pilot program: patients with Type II diabetes were referred to credentialed diabetes educators (CDEs), dietitians or podiatrists by their GP, via a Medicare-approved team care arrangement (TCA). Dietitians and CDEs operated on a sessional basis from GPs’ rooms, and podiatrists operated from their own clinics. All AH providers accepted the Medicare Plus rebate only, and provided guidelines-based care (focussed on patient education, disease ownership and self-management). Service utilisation was measured by the number and type of AH attendances per patient. Patient perspectives of the pilot program, and what they perceived they had gained from participation in it, were measured by semi-structured telephone interviews. Results.An average of 2.3 AH consultations were consumed by 588 patients, of whom 59 were interviewed. Interviewed patients appreciated the ready and timely access to AH services at no additional cost, the integration of GP/AH care, and being actively involved in managing their disease. Approximately 60% of patients had never previously consulted an AH provider regarding diabetes. Interviewees perceived that collocated, integrated GP–AH care heightened their disease awareness, improved their knowledge of their disease and encouraged them to better self-manage. Most interviewees indicated that they did not require further AH assistance in the short term (having gained what assistance they needed), and ~60% interviewees indicated they would pay a gap fee for similar AH services in the future. Conclusion.Integrated AH/GP guidelines-based care provided in GP clinics appears to be cost efficient. It has the potential to improve patient access to AH care, promote the role of integrated care in the management of Type II diabetes, and improve patient education and self-management. What is known about the topic?There is a growing body of research on the effectiveness of multidisciplinary teams in the management of patients with chronic disease, in terms of promoting better health and self-management education. However little is known in Australia about the operationalisation of the Enhanced Primary Care (EPC) program by general medical practitioners (GPs) and private allied health (AH) providers, to manage any chronic disease. Service utilisation and patient perspectives of integrated GP/AH care under the EPC program are also largely unreported. What does this paper add?This paper describes how the pilot program was put in place (operationalised) within the Australian context using the Medicare EPC initiative, for the management of Type II diabetes. It describes service utilisation, and patient perspectives of integrated private AH and GP care in terms of the process, and what they gained from participating in it. What are the implications for practitioners?Integrating private AH and GP care in GPs’ rooms in Australia, under the EPC program, appears to be cost effective and readily accessible, and provides advantages for patients with Type II diabetes.


2009 ◽  
Author(s):  
H. Zheng ◽  
C.D. Nugent ◽  
P.J. McCullagh ◽  
W.P. Burns ◽  
S. Alexander ◽  
...  

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e048350
Author(s):  
Monika Kastner ◽  
Julie Makarski ◽  
Leigh Hayden ◽  
Jemila S Hamid ◽  
Jayna Holroyd-Leduc ◽  
...  

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.


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