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Self Management Programs: Better Choices, Better Health
Powerful Tools for Caregiviers Marie Mulroy
May 12, 2105
ONCE A CHRONIC DISEASE IS PRESENT, ONE CANNOT NOT MANAGE, THE ONLY QUESTION IS “HOW.”
(Bateson 1980, Lorig, 2003)
Informed,
Activated
Patient
Productive
Interactions
Prepared,
Proactive
Practice Team
Delivery
System
Design
Decision
Support
Clinical
Information
Systems
Self-
Management
Support
Health System
Resources and
Policies
Community
Health Care Organization
Chronic Care Model
Improved Outcomes
Have significant reduced productivity
Live with less income
Accomplish less normal activities
Spend more time in bed sick
Tend to feel less in contol of their lives
Individuals with Chronic Disease
Some Evidence-Based Programs
•SELF-MANAGEMENT •Chronic Disease Self-Management •Tomando Control de su Salud •Chronic Pain Self-Management •Diabetes Self-Management Program •PHYSICAL ACTIVITY •Enhanced Fitness & Enhanced Wellness •Healthy Moves •Fit & Strong •Arthritis Foundation Exercise Program •Arthritis Foundation Walk With Ease Program •Active Start •Active Living Every Day
•MEDICATION MANAGEMENT •HomeMeds •FALL RISK REDUCTION •Stepping On •Tai Chi Moving for Better Balance •Matter of Balance •DEPRESSION MANAGEMENT
•Healthy Ideas •PEARLS •CAREGIVER PROGRAMS •Powerful Tools for Caregivers •Savvy Caregiver •NUTRITION •Healthy Eating •DRUG AND ALCOHOL •Prevention & Management of Alcohol Problems
BETTER CHOICES BETTER HEALTH
Stanford’s Chronic Disease
Self Management Program
What Is it?
• Stanford Based Program
• 2.5 hours/week
• Six weeks
• Community workshop
• Led by two trained co-leaders
Who Should Attend
•People with at least one chronic condition
•A family member, friend or caregiver of someone with a chronic condition
Chronic Disease
Self Management
Assumptions:
Patients with different chronic diseases have
similar self-management problems and disease-related tasks.
Patients can learn to take day-to-day responsibility for their diseases.
Confident, knowledgeable patients practicing self-management will experience improved health status and use fewer health resources.
Source: Lorig and Holeman 2003
Self Managing with a
Chronic Disease Involves:
Taking care of your illness (using medicines, exercise, diet, technology, physician partnership)
Carrying out normal activities (employment, chores,social life)
Managing emotional changes (anger, uncertainty about the future, changed expectations and goals, and depression)
Better Choices,
Better Health
Program Content Week
1
Week
2
Week
3
Week
4
Week
5
Week
6
Overview of self-management and chronic health
conditions •
Using your mind to manage symptoms • • • •
Getting a good night’s sleep •
Making an action plan • • • • • •
Feedback and problem-solving • • • • •
Dealing with difficult emotions •
Physical activity and exercise • •
Preventing falls •
Making decisions •
Pain and fatigue management •
Better breathing •
Healthy eating • •
Communication skills •
Medication usage •
Making Informed treatment decisions •
Dealing with depression •
Working with your health care professional and
system •
Weight management •
Future plans •
Participant’s Learn How to Manage
the Symptom Cycle. . .
Poor Sleep
Fatigue
Depression
Physical Limitations
Stress/Anxiety
Difficult Emotions
Symptom Cycle Pain
Shortness Of Breath
Physical activity
Medications
Decision Making
Action Planning
Weight Management
Breathing Techniques Understanding
Emotions
Problem Solving Using Your Mind
Sleep
Healthy Eating
Working with Health Professionals
Using the Self-Management Tool Box
Participants Report
• Fewer participants indicated that health issues were interfering with their daily Activities
• More participants made list of questions to take to their providers’ appointments
• Increase in individual’ s confidence in being able to handle their diseases
• More Participants were stretching and incorporating strength training
• A doubling of people who reported walking three times a week
Source: Oct.2014 SNHAHEC Report
Powerful Tools For Caregivers
• Is designed to provide caregivers the tools to increase their self-care
• Increase their confidence to handle difficult situations, emotions,
• Thrive-- not just survive as caregivers
What Is it:
• Stanford Based Program
• 2.5 hours/week or 90 minutes/week
• Six weeks
• Community workshop
• Led by two trained co-leaders
Overview of Program
•Caregiver’s self-care behaviors
•Management of Emotions
•Self-Efficacy
•Use of Community Resources
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Powerful Tools for Caregivers Empower family caregivers to take better care of themselves by teaching them how to:
• reduce stress
•improve caregiving confidence
•establish balance in their lives
•communicate their needs
•make tough decisions
•locate helpful resources
Who Is It For?
• Family
–Spouses/partners
–Adult children of aging parents
• Whether care receiver is living:
–At home alone, with others or with caregiver
–At home or in a facility
–In same town or across the country
Six Week Content
• Taking Care of You
• Identifying and Reducing Personal Stress
• Communicating Feelings, Needs and Concerns
• Communicating in Challenging Situations
• Learning from Our Emotions
• Master Caregiving Decisions
Program Content Workshop Overview
Week
1
Week
2
Week
3
Week
4
Week
5
Week
6
You are Not Alone •
Challenges of Caregivers •
Managing Self-Care Principles •
Using Community Resources • • • • • •
Managing the Stress of Caregiving • • • • •
Identifying Signs and Sources •
Identifying What You Can Change •
Stress Reducers - Taking Action •
Using Positive Self Talk •
Breathing for Relaxation •
Benefits of Good Communication •
How Best to Express Yourself •
I and You Messaging •
Progressive Muscle Relaxation •
Being Assertive - Not Agressive •
Assertive Communication - DESC •
AIKIDO Communication Style •
Community with the Memory Impaired
•
Guided Imagery - Relaxation •
Workshop Overview Week
1 Week
2
Week
3
Week
4
Week
5
Week
6
Listening to Our Emotions •
Dealing With Anger •
Dealing with Guilt •
Dealing with Depression •
Guidelines for Managing Emotions
•
Progressive Muscle Relaxation
•
Understanding the Transition Process
•
The Family Meeting •
Using the Power of Optimism
•
Setting Future Goals •
Shoulder Lifts - Relaxation •
Powerful Tools for Caregivers class
participants report they: • Are better at caring for themselves,
• Have fewer feelings of anger, guilt and depression,
• Have increased confidence and ability to cope with the demands of caregiving, and
• Are more likely to use community services.
For the Caregiver What they have in common • Both are Six Week Programs
• Co-lead by two lay or professional leaders
• Caregivers can go to either Chronic Disease Self Management and Powerful Tools for Caregivers
• Action Plans begin and end both of the programs
• Several Communication techniques overlap
Summary
• The disease doesn’t matter – these are general tips which help everyone
• Chronic Disease like wolves – travels in packs – so most are handling several chronic diseases
• Both programs are complementary to regular clinical treatments
• For Caregivers – both programs offer ways to help without stress
• Both programs are designed to improve the quality of life for those living or caring for someone with chronic disease
Living Well with Chronic Disease
Community Clinical Linkages
Jason Aziz, MS,CSCS
CDC National Diabetes Prevention Program Coordinator
Concord Hospital
Diabetes is one of the most prevalent chronic diseases of our generation.
It represents our culture’s most pressing public health issues.
The focus on prevention is paramount.
In Clinical settings, historically, treatment, has been the focus….this is changing.
In Community settings, prevention, is the focus.
Background
Diabetes Prevention
Type 2 Diabetes can be prevented.
In 2002 in the NE Journal of Medicine, research demonstrating this was published.
Lifestyle change actually outperformed metformin in preventing or delaying Type 2 NIDDM!
Intensive lifestyle change that lasts is imperative.
For the NDPP: 16 weeks, 1x/week, then for 6 additional months, 1x/month
Weekly body mass measures and self report of PA
Two primary measures: Body Mass AND PA (min/week)
The population of individuals ideal for this programming is all around us.
The Community Clinical linkage is powerful
Advantages: Physician referrals, access to lab results, closes the continuum of care, breaks barriers
Disadvantages: Stigmas with ‘overly-clinical’ approach. Non-compliance rates in Community settings.
Community Clinical combination is ideal blend!
Source Populations
Therapeutic Treatment Algorithm
HbA1C: [5.7-6.4%]
Pts who have had an HbA1C
HbA1C > 6.4% HbA1C < 5.7%
Diabetes Self Management
CDC NDPP MY UTOPIA!
Promotional Flyer
Mondays; 12-1pm
Concord Hospital’s Center for Health Promotion’49. S Main St Concord
230-7300
In the Fall: Wednesday evenings 5:30-6:30pm
Concord Hospital’s Center for Health Promotion’49. S Main St Concord
230-7300
Contact Info:
Jason Aziz; MS, CSCS
603-227-7000 x4258
Questions?
REDUCTION IN THE INCIDENCE OF TYPE 2 DIABETES WITH LIFESTYLE INTERVENTION OR METFORMIN
N Engl J Med, Vol. 346, No. 6, February 7, 2002, 393-403
http://www.nejm.org/doi/pdf/10.1056/NEJMoa012512
NE Journal of Medicine Article
DSME or DSMT Diabetes Self Management Education or
Training by
Liz Kennett RN BSN CDE
DSME is a
“Foundation of Care”
DSME—What is it?
• Ongoing processes of facilitating • Knowledge
• skill
• abilities necessary for diabetes self care • American Diabetes Association, Standards of Medical Care in Diabetes 2015
DSME—What is it?
• Supports informed decision making, self-care behaviors, problem-solving and active collaboration with health care teams to improve
• Clinical outcomes
• Health status
• Quality of Life in a cost effective manner
• American Diabetes Association, Standards of Medical Care in Diabetes 2015
Quality of
Life $
As recommended by the American Diabetes Association1
DSME • Should be provided at
diagnosis and as needed thereafter
• Effectiveness should be measured and monitored
• Should address psychosocial issues such as emotional well being which impacts positive diabetes outcomes
• Should be adequately reimbursed because
• DSME can result in cost savings • DSME can result in Improved
outcomes 1Clinical Diabetes, Volume 33, Number 2 Spring 2015
DSME is defined by National Standards
American Diabetes Association Standards of Medical Care in Diabetes
• Needed for both American Diabetes Association and American Association of Diabetes Educators Recognition
• National Standards Require • That your administration is behind you • That the Diabetes Community has input • A position to coordinate the program and instructors who are
RNs, RDs, pharmacists or CDEs • A Formal Curriculum • Individualized Assessment of the client with diabetes • Ongoing Support • Client meeting his/her personalized goals • Quality Improvement
DSME assures that we are giving the right information about Diabetes
• Not outdated and sometimes obsolete information
• Current information • Required by the national
standards • Verified through ADA or
AADE Recognition • Often provided by
Certified Diabetes Educators
• Rigorous exam process • Continuing Education in
Diabetes
Why does DSME make a difference? Based on individual assessment of the client
• What’s their life story
• Family history of diabetes?
• Did the family member develop complications?
• What is their greatest concern?
• Can I continue in my occupation?—interstate truck drivers
• Will my insurance pay for my medication?
• What do I do if my co-pays are too high
• And then, there are the “need to knows”
• Meter but can they use the preferred insurance product?
• Insulin Pens desirable product but prior authorization is needed
Diabetes Educator in a DSME
• Work with the PCP for authorization for insulin pen use
Educator in a DSME Program will
• Get creative
DSME is measured
• Many programs use the AADE 7 Self Care Behaviors
• Allows the patient to make individualized measurable behavior change in
• Eating Habits
• Being Active
• Monitoring
• Taking medications
• Problem-solving
• Reducing Risks
• Healthy Coping
• Outcome measures • Reduces costs in Medicare patients by
$135/mo. 1 • Improves clinical outcomes such as
• A1C, • lower self-reported weight gain, • improved quality of life • lower costs 2
1Diabetes Self Management Education/Training Toolkit 2013
2 Diabetes Care, Standards of Medical Care in Diabetes 2015, S20-21
DSME is always looking to improve
the quality of education1
• By recognizing that our clients need follow-up support • That our education is culturally sensitive • That our education is age appropriate • That it addresses psychosocial issues such as depression
and competing demands on time • That as Diabetes Educators,
• We always look at health literacy 2
• We always look at numeracy
1 Diabetes Care, American Diabetes Association Standards of medical Care in Diabetes-2015, 20-21
2 Ferguson MO, et al. Diabetes Educator, 2015
Where does NH stand with recognized
DSME programs?
Do we have enough recognized programs for our population with diabetes?
Do we have enough certified educators for our population?
Unfortunately No
• Parts of the state are under-served
• If clients are referred, they may have to drive long distances to participate in DSME services.
• Further complicated because Medicare restricts Medical Nutrition therapy by Registered Dietitians on the same day as DSME.
Barriers to Increasing Number of Programs • Difficulty keeping
administrative support because of low revenues
• Reimbursement by Medicare is low; client may have high co-pays and deductible and decline the service
• Cost of recognition $800-$1000
• Record-keeping process is time-consuming but necessary.
• Prescribers don’t always refer
• Clients choose not to participate
How can we jump the barriers? • Explore providing Recognition
Program Training in NH
• Explore satellite programs • Already recognized program
allows a smaller site to join them
• May be successful if facilities have other contractual relationships
• May ease the financial and record-keeping burden
• Educate prescribers and clients about the benefits of DSME
• Pass national legislation for CDEs to be Medicare Providers
• Allow CDEs to move to less costly facilities
Adequate number of CDEs for NH??? No
• Not just a NH problem but a problem throughout the US
• Department of Health and Human Services and Granite State Diabetes Educators conducted Diabetes Educator Survey
• Results will be shared at Stakeholder’s Meeting
• Preview of a few facts—Aging group of professionals; many are working as Diabetes Educators part time
Gathering ideas to increase the number of CDEs
• Stakeholders Meeting to discuss survey and brainstorm
• Engage current CDEs to participate in a mentoring program for “CDE want-to-be’s”
• Entice nursing, nutrition, and pharmacy students to think about a career helping those with diabetes and becoming a CDE
We can do this. We must do this. Our clients with diabetes are
depending on us!!
Questions
Will be addressed during the discussion
Thank you
Teresa Brown Treatment Specialist Tobacco Prevention and Control Program
NH Tobacco Helpline
Understand the science of quitting-2As &
R to QuitWorks-NH
Physiological
Psychological
NH Tobacco Helpline Services
www.TryToStopNH.org
www.QuitWorksNH.org
2006 Surgeon General Report The Health Consequences of Involuntary Exposure to Tobacco Smoke
NO SAFE LEVEL of exposure
Over 4,000 chemicals in the smoke including carcinogens
Smoke (gas) cools to a solid and forms a layer on walls, clothes, furniture, etc
6,000 research articles
Dose-response
Multiple medications
Counseling
Quitlines are effective
What type/s Dual use is common
How much (packs per day/tins per day)
How early in the morning?
In the middle of the night?
E-cigarettes used Exclusively
In combination with other tobacco products
“On a scale of 1-10…” Willing to talk about quitting
Willing to set a quit date in the next 30 days
Willing to use nicotine replacement therapy
Offer to DIRECTLY refer patient to QuitWorks-NH A Quit-Coach will call them within 2 days
Call is from a 1-800 #
Up to 5 counseling calls are available at no cost and around their schedule over the phone
If “no” offer INDIRECT referral www.TryToStopNH.org
Better Breathers Clubs
May 12, 2015
Better Breathers Clubs
71
Lung disease is increasing
• COPD is the third leading cause of death in
the U.S.
• Almost 13 million people have been
diagnosed, but as many as another 12 million
may have the disease and not know it.
Medical costs continue to rise
Better Breathers Clubs
72
• Increasing concern that more emphasis needs to be
placed upon helping patients manage chronic diseases
to improve their quality of life.
• One of the strategies for managing chronic disease is
patient education and support.
• Research has shown that support groups do positively
impact disease management.
• Better Breather Clubs are support groups for people
with chronic lung disease and their loved ones.
Better Breathers Clubs
73
Purpose:
to offer patient-centered, and community-based
educational opportunities and support to persons with
chronic lung disease and their families, friends and
support persons
Goal:
to improve the quality of life and functional status for
members by providing disease-specific education and
emotional connection which may help prevent
exacerbation, thereby reducing the health, economic and
social burden of lung disease.
Better Breathers Clubs
74
• People living with COPD or other chronic lung disease
often feel alone and isolated the Better Breathers Club
provides a venue for them to come together for
support and socialization as well as education.
Learn new skills to manage their condition
Support each other
Family members and caregivers are invited
Clubs meet regularly (monthly) for 1-2 hours
Facilitator oversees and coordinates the meeting,
communication, finds speakers to address topics
American Lung Association of the Northeast Can
Provide
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For the Facilitator –
• Online BBC Facilitator Training
• Better Breathers Facilitator Manual
• BBC Brochures, Flyers
• COPD Management Plans
• Educational materials on COPD
• Club information listed on ALANE’s website, Better
Breathers Clubs page
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Interested? Want to learn more?
Contact:
Lee B. Gilman, MS CHES
American Lung Association of the Northeast
New Hampshire
603-410-5108
Our Credo
77
We will breathe easier when the air in every
American community is clean and healthy.
We will breathe easier when people are free from the addictive
grip of tobacco and the debilitating effects of lung disease.
We will breathe easier when the air in our public spaces and
workplaces is clear of secondhand smoke.
We will breathe easier when children no longer
battle airborne poisons or fear an asthma attack.
Until then, we are fighting for air.
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