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Living Well with Chronic Conditions. Also known nationally as the Chronic Disease Self-Management Program - Developed by Stanford University - . Introductory Note. The Utah Approach to CDSMP and Diabetes Care : In no way is CDSMP to take the place of Diabetes Self-Management Education (DSME)
Leads the administration of the Chronic Disease Self-Management Program in Utah
Funding sources are the Centers for Disease Control and Prevention (CDC) and the Administration on Aging (AoA)
Work in partnership with the CDC and AoA to address the burden of arthritis, and other chronic diseases, in Utah
Primary objective is to develop partnerships around the state to increase access to and use of evidence-based programs
I love CDSMP and ADEU!
To improve the quality of life for people affected by arthritis and other chronic conditions.
Research has shown that an increasing number of U.S. families are experiencing high financial burdens from medical care expenses, as rapidly rising health care costs are passed on to families in the form of higher premiums, deductibles, co-payments, and even reduced benefits. For people with chronic health conditions, such burdens can be a long-term problem that threatens their families' financial well-being.
Commonwealth Fund (July 23, 2009)
Sources: BRFSS, 2007; Centers of Disease Control and Prevention (CDC)
Approximately 30% of Utahns have at least one chronic condition (similar number for U.S.)
Chronic diseases are the most prevalent and costly healthcare problems in the U.S.
More than two-thirds of all deaths are caused by one or more of five chronic conditions: heart disease, cancer, stroke, COPD, and diabetes
High Cholesterol 37.6%
High Cholesterol 25.9%
Utah Data: Utah BRFSS 2009
U.S. Data: National Center for Chronic Disease Prevention and Health Promotion, BRFSS Survey
Source: BRFSS, 2009
In the past 20 years or so, the Stanford University, Patient Education Research Center has developed, tested, and evaluated self-management programs for people with chronic health problems
All programs are designed to help people gain self-confidence in their ability to control their symptoms and how their health problems affect their lives
Workshops are highly interactive, focusing on building skills, sharing experiences and support
Once a program is developed, it is evaluated for effectiveness through a randomized, controlled trial, which is 2-4 years in length
It is ONLY after a program has been shown to be safe and effective through these trials that it is released for dissemination
This was the procedure for the Chronic Disease Self-Management Program (CDSMP)
Source: Utah Arthritis Program, 2010
41.0% High Blood Pressure
36.6% Chronic Joint Pain
33.2% High Cholesterol
27.4% Chronic Pain
Source: Utah Arthritis Program, 2011
Patient Engagement Activities
Program Subject Matter:
6 mo. 2 yrs.
Self efficacy √ √
Self rated health √ √
Role activity √
Energy/fatigue √ √
Health distress √ √
MD/ER visits √ √
Lorig, et al 1999, 2001
1 2 3 4 5
Self-efficacy X X X X
Self-rated health X X
Fatigue X X X
Anxiety/Distress X X X
Role limitation X X
Exercise X X X
Cog. Symp mgmt X X X
1=Lorig 05, 2=Barlow 05, 3=Goeppinger 07, 4=Kennedy 07, 5=Gitlin 08
Source: Class participants of Wasatch and Summit County courses
What participants are saying. . . .
Spanish Program Development
Spanish Program Development
The Utah Approach to CDSMP and Diabetes Care: In no way is CDSMP to take the place of Diabetes Self-Management Education (DSME)
DSME comes first and foremost for a patient with diabetes
That said, we would like to encourage referrals from Diabetes Programs into local CDSMP classes for some of the following reasons….
Self-management support option for post-DSME (National DSME Standard #7)
Great option for follow up work with patients with diabetes (National DSME Standard #8)
Supports and complements self-management efforts of diabetes educators/healthcare providers
Continuous quality improvement opportunity??
Opportunity to connect to community resources (perhaps as part of a planned care model)
Reinforces lifestyle behaviors so that patients continue implementing healthy choices such as regular physical activity and nutrition
General Patient and Provider Benefits
Marci Nelson, B.S., CHES
Tobacco Prevention and Control Program
Utah Department of Health
More than 200,000 Utahns use tobacco
More than 1,330 die annually from their smoking
Nearly 17,150 children exposed to secondhand smoke in their homes
$663 million each year in smoking-attributable medical and lost productivity costs
Source: Tobacco Prevention and Control in Utah Tenth Annual Report - August 2010
about tobacco USE
tobacco users to QUIT
to other resources
Patient receives assistance, with follow-up counseling arranged, from other resources such as the Utah Tobacco Quit Line
Ask EVERY patient about tobacco use status at
This occurs most consistently when there are systems in place, such as question on intake form, chart stickers, or electronic prompts on electronic medical records. Chart stickers are available.
Clinicians should urge all tobacco users to quit.
Even brief advice to quit by a clinician results in greater
quit rates. Smokers cite a clinician's advice to quit as an
important motivator for attempting to stop smoking.
Advice should be:
Specific to the individual 's own situation
(e.g. oral health condition, family status, costs of tobacco).
Offer a motivational intervention, the “5 R's”
Relevance:Why is quitting important to their own personal situation?
Risks:Outline the risks of continued tobacco use.
Rewards:Outline the benefits of quitting.
Roadblocks:What are the barriers preventing this person from quitting? What are some solutions to these barriers?
Repetition:Repeat this discussion frequently, until the person is ready to quit.
- Ending Nicotine Dependence (youth)
- First Step (pregnant women)
- Spanish: 1.877.629.1585
- TTY: 1-877-777-6534
“Would you like the Utah Tobacco
Quit Line to help you quit?”
Text messaging service that offers Utahns daily quit tips to help them get through the quitting process
Source: The Lancet, news release, June 29, 2011
Nicotine polacrilex gum
Nicotine transdermal patch
Nicotine nasal spray
Bupropion SR (Zyban)
These are the only medications that are
FDA-approved for smoking cessation.
It takes an average of 7 quit attempts to successfully quit using tobacco!
Address tobacco use with all patients.
At a minimum, make a commitment to incorporate brief tobacco interventions as part of routine patient care.
Ask, Advise, and Refer.
For more information, contact:
Tobacco Free Resource Line: 1-877-220-3466 or