Presentation for January 17 2011

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TAKE CONTROL OF YOUR HEALTH

Chronic Disease Self-‐Management Program

NJ Department of Health and Senior Services

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Impact of Chronic Disease •  Heart disease, cancer, and diabetes are leading causes of disability and death in the United States.

•  More than 1.7 million Americans die every year from chronic diseases and are responsible for 7 of every 10 deaths.

•  1 out of every 10 Americans (or 25 million people) suffer a major limitaJon in daily living from a chronic illness.

•  Pain, debilitaJon, disability, dependence, lost physical funcJon and less mobility.

Take Control of Your Health

Impact of Chronic Disease • Average health care costs for someone who has one or more chronic condiJons is 5 Jmes greater than for someone without any chronic condiJons

•  The U.S. spends more on health care than any other country; 95% is for chronic condiJons in older adults.

•  Total spending on health care would rise from 16 percent of gross domesJc product (GDP) in 2007 to 25 percent in 2025, 37 percent in 2050, and 49 percent in 2082.


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NaDonal Council on Aging Survey of Americans Over Age 44

•  68% have 2 or more chronic condiJons. •  32% are living with frequent or constant pain. •  44% wish their provider would spend more Jme with them. •  32% are confused about what to do when they leave

provider’s office. •  45% don’t receive referrals to resources such as counseling. •  57% say their provider never asks if they can manage their

condiJon at home


Informed, Activated Patient

Productive Interactions

Prepared, Proactive Practice Team

Improved Outcomes

Delivery System Design

Clinical Information

Systems Self-

Management Support

Health System Health Care Organization

Chronic Care Model

Community Resources and Policies Self-��

Management ��Support

Delivery��System Design

Decision Support

Clinical��Information ��Systems

Health System Health Care Organization

MacColl Institute for HealthCare Innovation

Role of CDSMP •  NaJonal Focus •  PlaZorm for Delivery of Evidence-‐Based Disease PrevenJon Programs

•  Place in Health Care Reform


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Health PromoDon

The process of enabling people to increase control over, and to improve their health. (1986 Oaawa Charter, emerged from World Health OrganizaJon)


Chronic Disease Self-‐Management Program

In NJ: “Take Control of Your Health”


•  Developed in the early 1990s by the Stanford Center for Research in PaDent EducaDon

•  This ‘gold standard’ of evidence-‐based disease prevenDon programs has been able to duplicate clinical trial results in a variety of seQngs, populaDons, and chronic condiDons.

•  Used internaDonally in 17 countries and 46 U.S. states.

•  Provides knowledge and skills for individuals to take a more acDve role in their own health.

Program Background


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People with long-‐term health condiDons such as diabetes, arthriDs and heart disease:

•  Have similar concerns and problems •  Deal not only with their condiDon, but with the impact of the condiDon on their lives and emoDons, and

•  Can teach the workshop as effecDvely, if not more effecDvely, than health professionals

Program Philosophy


•  Six weekly 2-‐1/2 hour sessions •  PracDcal, interacDve curriculum •  Led by a pair of trained peer leaders (or professionals acDng as peer leaders) •  Convenient locaDons •  OpportuniDes for discussion and problem solving • Mutually supporDve seQng •  For adults age 18 and older and caregivers

Program Basics


Who Is Appropriate to Participate? Almost any patient or caregiver age 18 and over would be appropriate to refer to this program.

Exceptions? •  Homebound or too frail to participate •  Memory Impaired •  Unable to travel to workshop site


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Triggers for Referral to CDSMP •  Recently diagnosed with a chronic disease

•  Expresses concern, fear, anxiety, frustration, sadness, etc. •  Reports that social and physical activities have declined •  Wants to take control of health issues - spend less time, energy, money, or other

resources on managing symptoms •  Interested in speaking to others with similar issues •  Has taken other steps; attending educational programs or support groups,

consulting a counselor, or talking to their physician •  Seems open to learning new options •  Responds well to completing specific tasks or goal-setting activities •  Family members / caregivers are having difficulty managing needs

Let’s Try an Activity Using Your Mind to Manage Symptoms

and Distraction

The mind is a very powerful tool. To demonstrate how your mind can affect your body, we’re going to do a short activity using the mind. So close your eyes and get comfortable.

Self-‐Management Toolbox

Physical AcJvity Problem-‐Solving MedicaJons Using Your Mind Managing FaJgue Managing Pain Planning CommunicaJon Beaer Breathing Healthy EaJng Working with Understanding EmoJons Health Professionals


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•  Goal Seeng (AcJon Planning) •  Brainstorming •  Group Problem-‐Solving with Individual Decision-‐Making •  Helping Others •  Feedback and Sharing •  Modeling •  Ongoing Assessment and ReinterpretaJon of Symptoms

The CDSMP Process


The Symptom Cycle Disease

Tense Muscles

Shortness of Breath

Stress/Anxiety

Pain

Fatigue

Depression

Difficult Emotions

SYMPTOM CYCLE


Self-‐Management DefiniDon “Involves [the person with the chronic disease] engaging in acJviJes that protect and promote health, monitoring and managing of symptoms and signs of illness, managing the impacts of illness on funcJoning, emoJons and interpersonal relaJonships and adhering to treatment regimes.”


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Self-‐Management Differs from PaDent EducaDon

•  PaJent EducaJon –  Instruct how to change behavior –  Increase knowledge –  Use specific tools

•  Care plans (health care professional)

•  Self-‐Management –  Manage life with disease –  Increase skills & self-‐confidence –  Problem solve and make decisions


Making a Choice:

AcJve or Passive Manager??


Goal SeQng • Making an acJon plan, feedback and sharing •  25-‐35% of each class •  ParJcipants learn to:

–  Set an achievable goal –  Successfully accomplish their goal, resulJng in increased confidence

– Help one another


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Parts of an AcDon Plan •  Something YOU want to do •  Achievable •  AcJon-‐specific •  Answer the quesJons:

• What? • How much? • When? • How open?

•  Confidence Level Take Control of Your Health

Let’s Try Another Activity

Action Planning

One of the most important self-management skills is goal setting. Goals are generally too big to work on all at once. Action plans help us to achieve a goal by breaking it down into smaller, more “doable” tasks.

Problem Solving

•  IdenJfy the Problem •  List Ideas •  Select One •  Assess the Results •  SubsJtute Another Idea •  UJlize Other Resources •  Accept that the Problem May Not be Solvable Now


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Self-‐Reported Outcomes •  The workshops help parJcipants regain control of their life and do the things that maaer to them.

•  People feel calmer, less worried and more confident about managing their health.

•  ParJcipants report they have energy to do more and get relief from pain, faJgue and other symptoms.


Health Benefits -‐ 6 months later •  Improved self-‐reported health

•  Decreased disability

•  Increased energy •  Decreased faJgue

•  Lower health distress •  More exercise and relaxaJon

•  Fewer social role limitaJons

•  Greater partnerships with clinicians Lorig, Sobel, et al., 1999; Sobel, Lorig & Hobbs, 2002


Health Care UDlizaDon –

1 Year Later •  Fewer visits to physicians and emergency

departments

•  Fewer days in the hospital •  Fewer hospitalizaJons •  Cost savings per parJcipant are projected

between $390 -‐ $750 Lorig, Riaer, et al., 2001; Sobel, Lorig & Hobbs, 2002


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Health Benefits –

Two Years Later •  ReducJon in health distress

•  Increased self-‐efficacy

•  Improved health status

•  Improved faJgue level

Lorig, Riaer, et al., 2001; Sobel, Lorig, & Hobbs, 2002


Synergy Between Public Health and Community-‐Based Programs

•  The power to influence •  A tool to extend your “reach” into the community

•  Hands-‐on training to enhance self-‐management and support behavior change


CDSMP and Public Health -‐ Experience in NJ

Public health departments act as lead agencies and as partners to offer CDSMP

CDSMP offered in response to public health prioriJes idenJfied in CHIPs


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CDSMP IniDaDves in New Jersey •  Capacity being built by the NJ Department of Health and Senior Services (DHSS) through mulJple federal grants in collaboraJon with varied state and local partners.

•  Goal: For “Take Control of Your Health” to be available statewide, accessible both geographically and culturally.


Take Control of Your Health: CDSMP Infrastructure

Stanford

NJ DHSS

Local Lead Agencies

Master Trainers

Peer Leaders

Workshop ParDcipants


•  Leaders in all 21 counJes

•  3,000 + parJcipants •  Approximately ½ from minority populaJons

CDSMP Delivery in NJ


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Languages

English Spanish French Creole Mandarin Cantonese Korean Hindi Vietnamese


How to Access Program/Refer a PaDent •  Take Control of Your Health workshops are held periodically in local sites (community centers, public housing, libraries, faith-‐based faciliJes, etc.) throughout the state.

•  Contact a local lead agency to learn about planned workshops or to express interest in parJcipaJng.

•  NJ Lead agencies: www.state.nj.us/health/senior/cdsmp/tch_agencies.shtml


Your program encouraged us to think about problems, find soluJons and implement them to the best of our ability.

Had it not been for this group, I do not know when I would have taken up the reigns of my life again.

I’ll be able to deal with the ups and downs of my life in a beaer

way.

I feel beaer, but most of all, I am accomplishing so much more each day.


What Recent NJ ParDcipants Said About CDSMP

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[Add your own quotes or use these & remove this line] “I was tired. My pain was my boss. It was telling me what I could and couldn’t do. {insert your program name} workshops put me back in charge.” “Now I have the energy to do the things that matter. I am calmer and more confident about my health. I got relief from my pain.” “I put life back in my life.”

For More Information

Department of Health and Senior Services

Gerry Mackenzie 609-943-3499 [email protected]

Andrea Brandsness 609-943-3500 [email protected]


Evidence-‐Based Programs PromoDonal Video

HighlighJng Take Control of Your Health and

Featuring NJ Program ParJcipants and Leaders


Presentation for January 17 2011

Documents

Transcript of Presentation for January 17 2011