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Module 4.2 Self management Evidence and theoretical components Presentation purpose Target audience Service providers and project workers on DPMI projects Aim To encourage consumers to self manage Objectives Provide an overview of the concepts of self management

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self management

Module 4.2

Self management

Evidence and theoretical components

presentation purpose
Presentation purpose

Target audience

  • Service providers and project workers on DPMI projects


  • To encourage consumers to self manage


  • Provide an overview of the concepts of self management
  • Review self management programs and evidence
  • Explore the components of self management and integration into practice.
what is self management
What is self management?
  • Self-management is the active participation by people in their own healthcare.
  • Self-management incorporates:
    • health promotion and risk reduction
    • informed decision making
    • following care plans
    • medication management
    • working with health care providers to attain the best possible care and to effectively negotiate the often complex health system.

National Chronic Disease Strategy (Draft) National Health Priority Action Council

is self management effective
Is self management effective?
  • Evidence to support self management
    • Improves quality of life
    • Supports behavior change
    • Decreases health care utilisation
  • Barlow J. et a “Self – management approaches for people with chronic conditions: a review” Patient Education and Counseling 48 (2002) 177-187
  • “Patients as effective collaborators in managing chronic conditions”
  • Adherence to long term therapies go to publications link
diabetes self management education in australia
Diabetes self management education in Australia
  • Norsworthy document reviewed
    • 8 articles in which the authors reviewed up to 153 studies of the effectiveness of diabetes interventions.
    • Each of the studies concludes that diabetes self management education is effective in improving health outcomes for people living with diabetes.
      • influence behaviour change and improve knowledge and skill for diabetes self management
      • reductions in secondary complication rates
      • reducing reliance on health services.

Ann Nosworthy April 2004 ADEA.

measuring effectiveness of self management
Measuring effectiveness of self management
  • Self-management Education Programs in Chronic Disease-A Systematic Review and Methodological Critique of the Literature
  • Conclusions:
    • Self-management education programs resulted in small to moderate effects for selected chronic diseases as measured by clinical markers. ( diabetes, hypertension and asthma)
      • Need to adhere to a standard methodology to help clarify whether self-management education is worthwhile.

Asra Warsi,et al. Arch Intern Med. 2004;164:1641-1649

stanford chronic disease self management program
Stanford Chronic Disease Self Management Program
  • RCT - 952 subjects
    • Demographic Data
      • Age 62 years
      • Male 27%
      • Education 14 years
      • No. Diseases 2.2

Kate Lorig et al. Evidence suggesting that a chronic disease self management program can improve health status while reducing hospitalizations. Medical Care 37,1 1999

stanford chronic disease self management program9
Stanford Chronic Disease Self Management Program
  • Percent With Common Diseases
    • Lung Disease 21%
    • Heart Disease 24%
    • Diabetes 26%
    • Arthritis 42%
stanford chronic disease self management program10
Stanford Chronic Disease Self Management Program
  • 6-Month Improvements in Health Outcomes
    • Self-Rated Health
        • Disability
        • Social and Role Activities Limitations
        • Energy/Fatigue
        • Distress with Health State
stanford chronic disease self management program11
Stanford Chronic Disease Self Management Program
  • Improvements in utilisation and costs
    • Average 0.8 fewer days in hospital in the past six months (p=.02)
    • Trend toward fewer outpatient and ER visits (p=.14)
    • Estimated cost of intervention $100-$200

good life club coaching
Good Life Club – Coaching
  • Six-month outcome data for the Good Life Club project: An outcomes study of diabetes self-management
    • positive changes in four of eight self rated symptom measures
    • reductions in the reported use of GPs,
    • improvements in social functioning
    • large increases in all six confidence in self-management items.

Colette J Browning & Shane A Thomas. Australian Journal of Primary Health — Vol. 9, Nos. 2 & 3, 2003

peer led self management
Peer led self management

key components of self management
Key components of self management
  • Based on patient perceived problems
  • Builds confidence (self-efficacy) to perform 3 tasks
    • Disease Management
    • Role Management
    • Emotional Management
  • Focus on improved health status and appropriatehealth care utilization

Kate Lorig


How self management differs

from patient education

essential elements of self management interventions
Essential elements of self management interventions
  • Disease, medication and health management
  • Role management
  • Emotional management
  • Support enhancement of self efficacy
  • Problem solving training
  • Follow up
  • Tracking and ensuring implementation

The Robert Wood Johnson Foundation.The Centre for the Advancement of Health.

handling self management tasks
Handling self management tasks

S/M Task Passive Active

Medical Deferred Collaborates


Role Relinquishes Strives to

Management maintain

Emotional Erratic Regular use of Management ineffectual coping skills

A. Jerant et al. “Patients perceived barriers to active self-management of chronic disease” Patient education and counseling. 57,3 June 2005

handling self management tasks22
Handling self management tasks

S/M skills Passive Active

Problem Catastrophists Systematic

Solving process

Decision making Made in haste Carefully weighs

fear options

Resource Erratic Regular use of Utilisation ineffectual coping skills

Partnership Minimal Identifies and selects with HPs HPs for support

Action Planning Minimal Applied frequently

Self Tailoring Minimal Frequent

promoting self efficacy
Promoting self efficacy
  • Promote performance accomplishment
  • Use verbal persuasion
  • Role modelling
  • Identifying feelings and helping work through strategies to deal with feelings
goal setting getting started
Goal Setting- Getting started
  • Choose long term goal
    • Goals should be something you want to do
  • Identify steps needed to reach long term goal
  • Choose one of those steps to start working towards goal
  • Specific
  • Measurable
  • Achievable
  • Realistic
  • Timely

Flinders University

guidelines for helping with problem solving
Guidelines for helping with - Problem solving
  • Identify the problem
  • List ideas
  • Select one
  • Assess the results
  • Substitute another idea (if first didn’t work)
  • Accept that the problem may not be solvable

Kate Lorig