Program delays disability in the chronically ill
Program delays disability in the chronically ill
Self-efficacy is basis of program for chronically ill
In any self-care program, the key to success rests with the participants themselves. And in one extremely successful program, it depends on whether the participants believe they can do what’s required of them.
The Chronic Disease Self-Management Program (CDSMP), developed through research sponsored by the Agency for Healthcare Research and Quality (AHRQ) in Rockville, MD, has achieved impressive results. It has demonstrated the ability to help prevent or delay disability in patients with arthritis, heart disease, and hypertension. What’s more, the CDSMP saved from $390 to $520 per patient over a two-year study period because participants used fewer health care services.
This program is based on self-efficacy," says Barbara L. Kass-Bartelmes, MPH, CHES, program analyst for the AHRQ. "In any health management, the amount of belief [people have] that they can successfully do something means they’re more likely to get the outcome they want."
In a program that mainly targets the elderly, this becomes even more critical. "How do I weight-lift to build up muscles? How do I manage five meds a day? How do I get up a flight of stairs or use a cane?" poses Kass-Bartelmes. "Most people just go out and buy a cane and use it."
The program, which is delivered in hospitals, senior centers, churches, and libraries, consists of seven weekly sessions for a total of 17 hours. Patients are taught to control their symptoms through these methods:
- relaxation techniques;
- diet change;
- managing sleep and fatigue;
- using medications correctly;
- exercise;
- communication with health care providers.
Since the course is taught by lay individuals, the first step is a "train-the-trainers" session. Often, the trainers are people who have one or more of the chronic diseases themselves. "This is preferred," Kass-Bartelmes says. The hospital or community center sponsoring the program would send the lay trainers to Stanford [CA] University, which offers a 4½ day training course to teach representatives of health care organizations how to implement the CDSMP. (For more information, go to: www.stanford.edu/group/perc/.)
Once the course begins, each participant receives a copy of Living a Healthy Life With Chronic Condit-ions, 2nd Edition, developed by Stanford. The text teaches self-management behaviors for chronic lung disease, heart disease, high blood pressure, arthritis, and diabetes.
Each session includes a short lecture, a demonstration, and a Q & A session. "Trainers also talk about such issues as fear of learning, frustration with disease, and how to handle the emotional impact," Kass-Bartelmes explains. "They learn practical applications of taking care of themselves and managing their disease, but mostly they build that faith in themselves."
Another benefit of the program is that much of the course addresses several conditions at once. "A lot of these diseases involve being functionally disabled at some level: weakness, pain, and [shortness] of breath," she adds. "For all of these, you’ve got to be able to manage a diet and meds. For many of these diseases, you need to learn things like how to manage pain to get through the day, or how to get enough rest. Once you’re taught how to manage meds for diabetes, for example, you can use the same skills for your heart medications."
Participants also learn important disease-specific skills, such as how to detect an irregular heartbeat when exercising, recognizing the symptoms of a heart attack, or anticipating your diabetes being out of control without needing to take a blood test.
"Once the participants start feeling better and building their confidence, they continue with the program," Kass-Bartelmes says. "They are then less likely to suffer dysfunction, end up in the hospital, or go to the emergency room. The course may not cure anything, but it helps them manage their disease longer."
CDSMP Program Results
After 6 months, Chronic Disease Self-Management Program (CDSMP) participants exhibited:
- increased exercise;
- better coping strategies and symptom management;
- better communication with physicians;
- improvement in self-rated health, disability, social and role activities, and health distress;
- more energy and less fatigue;
- decreased disability;
- fewer physician visits and hospitalizations.
After 1 year, CDSMP participants exhibited:
- significant improvement in energy, health status, social and role activities, and self-efficacy;
- less fatigue or health distress;
- fewer visits to the emergency department (ED);
- no decline in activity or role functions, even though there was a slight increase in disability after one year.
After 2 years, CDSMP participants exhibited:
- no further increase in disability;
- reduced health distress;
- fewer visits to physicians and EDs;
- increased self-efficacy.
Source: Agency for Healthcare Research and Quality, Rockville, MD.
Need More Information?
For more information, contact:
- Barbara L. Kass-Bartelmes, MPH, CHES, Program Analyst, Agency for Healthcare Research and Quality, 2101 E. Jefferson St., Suite 501, Rockville, MD 20852. Telephone: (301) 594-7076. Web site: www.ahrq.gov.
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