Arthritis program could Save millions of dollars
Arthritis program could Save millions of dollars
Study supports low-cost self-care approach
A self-care program targeting employees with chronic arthritis has the potential to save employers and health care plans millions of dollars, according to a study in the June 8 issue of the Archives of Internal Medicine. "An insurer or health care organization that implements the course among just 10,000 individuals with arthritis can expect a net savings of more than $2.5 million over four years while simultaneously reducing pain among clients by 18%,"1 write the authors.
They go on to note that only pain and costs were evaluated. "If we had examined depression, physical activity levels, and self-efficacy, all of which showed beneficial effects in other evaluations, we might have found improved measures for these indicators, as well,"1 they added.
This is no small matter for employers, considering that the Atlanta-based Centers for Disease Control and Prevention recently stated that arthritis and other rheumatic conditions are the leading cause of disability in the United States. (Please see the chart on p. 104. Also, for more on the impact of arthritis, see the contact information on p. 104.)
The program, called the Arthritis Self-help Course, or ASH, was developed at Stanford University in Palo Alto, CA, in 1980, and is sponsored by the Atlanta-based Arthritis Foundation. Despite the impressive potential savings, the program "is usually provided free of charge, or with a minimal fee, to try to cover our costs," notes Michele Boutaugh, MPH, vice president for patient and community services for the Arthritis foundation, who provided much of the data for the study. Those costs, she says, include a leader's manual, an arthritis self-help book for participants, and travel and lodging costs for a trainer, if one is provided by the foundation.
Mid-course corrections
One of the keys to the program's success, notes Boutaugh, is that it has been re-evaluated and revised several times since its inception, based on the most recent research and published data. "The most recent revision was in 1996, and it's due for revision again next year," she says.
Since the late 1980s, the course has focused on incorporating what the foundation refers to as self-efficacy enhancing strategies. "In earlier Stanford studies we saw that people who were successful in dealing with their arthritis exercised more, relaxed more, and improved their quality of life, but when we looked at the data there was no direct correlation between people changing behaviors and decreasing their pain," Boutaugh explains. "We conducted more studies, and found that people who were most successful in this area were those who felt more in control of their lives and their ability to control their arthritis. So, we systematically set about do the sorts of things we knew from the research would help people feel more confident."
Goal-setting a key
The program is a six-week course, consisting of weekly 2.5-hour classes. Two major components of every class session are "contracting," or goal-setting, and feedback. "At the end of each session we will go around and ask people what specific things they want to accomplish by the end of the week -- what they want to do, how often, and with what frequency," says Boutaugh. "They are also asked how confident they feel about their ability to do it. If that confidence level is not between seven and nine on a scale of 10, they are asked to alter the contract so that it falls within a realistic range."
The entire focus of the program is on making small changes, she explains. "Let's say I want to start walking a mile three or five times a week. The leaders will ask me what I'm doing now. If I only walk to the end of the block, I'm instructed to start there and move forward with gradual, short-term goals. If I want lose 20 pounds, my first contract will address what I can do by the next week."
At the following session, the first part of the meeting is a feedback session, addressing what happened - good or bad - during the previous week. "Then, we use group problem-solving to deal with any barriers we have identified," says Boutaugh. "This builds confidence and peer support for the next week."
While the foundation will supply trainers, it actually prefers that leaders be lay people who have arthritis. "If the company has a wellness coordinator or an occupational health nurse, they often act as a liaison, or two co-leaders are matched up," says Boutaugh. Arthritis patients are preferred because, "We have found from research that you can help increase self-efficacy if you are using role models, people the participants can identify with."
Elizabeth Doyle, wellness director for the LifeSteps program at the UAW/GM health promotion program in Flint, MI, was trained to teach the course last summer, along with a co-worker who has had arthritis since childhood.
"I originally became interested in arthritis because of her, and we were trained together," she recalls. Their class was first offered last fall, and had 16 participants - which was all the room could hold. "We had great participation. People really loved getting the book, and they enjoyed getting together to talk about their similar experiences, about ideas for coping with and taking control of their arthritis," she says. "They really thrived off of the [group] support."
[For more information, contact: The Arthritis Foundation, 1330 West Peachtree St., Atlanta, GA 30309. Telephone: (800) 283-7800. Fax: (404) 872-0457. World Wide Web: http://www.arthritis.org.]
References
1. Kruger JMS, Helmick CG, Callahan LF, et al. Cost-effectiveness of the Arthritis Self-Help Course. Arch Intern Med. 1998;158:1245-1249.
2. Morbidity and Mortality Weekly Report 1998; 47:17. Centers for Disease Control and Prevention, Atlanta.
Recommended reading
Helmick CG, Lawrence RC, Pollard RA, Lloyd E, Heyse SP. Arthritis and other rheumatic conditions: who is affected now, who will be affected later? Arthritis Care Res 1995;8:203-211.
Yelin E, Callahan L. The economic cost and social and psychological impact of musculoskeletal conditions. Arthritis Rheum 1995; 10:1351-1362.
Haddix AC, Teutsch SM, Schaffer PA, Dunet DO, eds. Prevention Effectiveness: A Guide to Decision Analysis and Economic Evaluation. New York, NY: Oxford University Press; 1996.
Lorig K, Lorin J, Gines GES. Arthritis self-management: a five-year history of a patient education program. Nurse Clin North Am 1984;19:637-645.
Lorig K, Lubeck D, Kraines RG, Seleznick M, Holman HR. Outcomes of self-help education for patients with arthritis. Arthritis Rheum 1985;28:680-685.
Lorig K, Holman HR. Long-term outcomes of an arthritis self-management study: effects of reinforcement efforts. Soc Sci Med 1989;29:221-224.
Lorig K, Holman HR. Arthritis self-management studies: a twelve-year review. Health Educ 1993;20:17-26.
Lorig KR, Mazonson PD, Holman HR. Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. Arthritis Rheum 1993;38:439-446.
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