SeMaS: a tool for personalized
counselling and support of selfmanagement in primary care
Nathalie Eikelenboom, MSc
September 2014
SeMaS: Self-Management screening
• Self-management: one size does
not fit all1
• SeMaS: assessment of patients’
competences/barriers for selfmanagement
• 27 items, 10 minutes fill-in time
• Tailored self-management support
by trained practice nurse
1
Trappenburg et al, Self-management: One size does not fit all. Patient Educ Couns (2013)
SeMaS study outline
Stratified cluster randomization of
15 DOH general practices
Control arm: 8 practices
Intervention arm: 7 practices
Training SeMaS en practice visit
Baseline measurement
+/- 400 patients
Baseline measurement
+/- 350 patients
SeMaS profile with feedback
T=0: follow-up consult with
practice nurse ; care as usual
T=1 week: questionnaire
consult
T=0: follow-up consult with practice
nurse with tailored selfmanagement support
T=1 week: questionnaire consult
Eikelenboom et al., Implementation of personalized self-management support using the self-management
screening questionnaire SeMaS; a study protocol for a cluster randomized trial . Trials (2013)
SeMaS profile
Locus of control
Internal
•depri
Self-monitoring
Somewhat willing
More competent
Self-efficacy
High
Social support
Low
Coping
Problem solving
Functioning in groups
Difficult
Anxiety
Sometimes
Computer skills
Average
Burden of disease
Average
Depression
High
© Koninklijke Philips Electronics N.V. 2012
SeMaS categories
100
90
80
70
control 1
60
Intervention 1
50
control 2
40
Intervention 2
30
control 3
20
Intervention 3
10
0
Locus of
control
self-efficacy
social
support
coping
anxiety
depression
Qualitative analysis
Level1
Facilitator
Barrier
Innovation
Provides a structure to
discuss characteristics
Difficult wording of items
Patient
Increased insight in
individual characteristics
Random selection of patients, not
based on current level of selfmanagement
Professional
Provides input for individual
care plan
Attitude towards selfmanagement
1
Grol & Wensing, What drives change? Barriers to and incentives for achieving evidencebased practice. Med J Aust (2004)
Qualitative analysis
Level
Facilitator
Barrier
Social context
Support from colleagues
Interest of GPs is variable
Organizational
context
Sufficient capacity for
innovation
Limited time planned for consult
Financial and
political context
Practice and care group
policy on self-management
Self-monitoring tools for patients
not reimbursed
Quotes
• Innovation
“there was a clear line to self-management in my consult”
“some patients said they found the questions difficult”
• Patient
“patients recognized themselves in the profiles”
“there is a group that is happy that things can be organized differently.
There will also be a middle group, and a group that does not want to, or is
not able to self-manage”
Quotes
• Professional
“SeMaS is usefull when creating an individual care plan with the patient”
“we have to stimulate people, but I notice that it doesn’t work anymore
nowadays”
• Social context
“the GP’s differed in how involved they were in the SeMaS project”
“I discussed the SeMaS with my colleague practice nurse”
Quotes
• Organizational context
“it was sometimes difficult to plan the SeMaS in the consult, besides the
usual subjects and measurements that have to be done”
• Financial and political context
“making people aware of their own responsibility for their health is part of
the policy in our practice”
“sometimes the financial agreements with health insurers are not
translated to the workplace”
Subjects discussed during consult
70
% of patients
60
50
40
30
20
10
0
Control
Intervention
Take home message
SeMaS is the first step in providing personalized
self-management support.
© Health and Social Care Alliance Scotland
Co-creation team SeMaS
Contact:
Nathalie Eikelenboom
nathalie.eikelenboom@radboudumc.nl
n.eikelenboom@doh-huisarts.nl