Self Management
Support
Dr. Patrick Doorley, HSE
25/10/2012
Self management long term
conditions
What individual or carers can do to manage their condition
and their general health and well being.
Managing
 Symptoms
 Medication
 Treatment
 Emotional impact
 Adapting to impact on activities of daily living
 Watching for changes, coping if symptoms worsen,
knowing when to seek help
 Healthy lifestyle e.g. diet exercise, not smoking
 Knowing when to seek professional support
 Requires support from health services- e.g. information,
improving individual’s confidence and skills.
Traditional paternalistic practise styles
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Create dependency
Discourage self-care
Ignore preferences
Undermine confidence
Do not encourage healthy behaviours.
Common adjustment problems
The goal of self management support is to enable
people to perform three major functions.
• Medical management of their condition
• Carrying out normal roles and responsibilities
• Managing the emotional impact and the
adjustment problems associated with having a
long term condition (Lorig & Holman 2003).
Helps people to maintain independence and
avoid hospital admissions.
Structured self management programmes
Aim - support people to self-manage
 Disease specific focus on educating people in
medical and technical aspects. E.g. Dafne
Desmond
 Peer led, community programmes aim to help
people to manage illness and cope with social
and emotional aspects
 Stanford model best known (called Expert
Patient programme in Uk,Quality of Life
programme in Donegal).
Evidence on disease specific
programmes
Studies on programmes for chronic lung disease,
diabetes asthma heart failure and arthritis found
evidence of reduced hospital admissions
improved clinical outcomes increased quality of
life and wellbeing.
In relation to diabetes better control, improved
self-management skills, increased self
empowerment and food related quality
outcomes.
Evidence on peer led community
programmes e.g. Stanford model
Systematic review of evidence by Centres for
Disease Control (2011) of two programmes from
RCTs
• Generic Chronic Disease Self Management
Programme, a six week series of peer led
classes
• Arthritis Self Management Programme designed
for people with arthritis.
CDC Findings
CDSMP showed improvements in:
• general self efficacy - pain management and other symptoms
• psychological health status-anxiety, depression
• physical health- fatigue
• health behaviour-exercise.
They also suggested that the ASMP and the CDSMP
contribute to improvements in psychological health status,
self efficacy and some health behaviours over 12 months.
Similar findings from HSE Quality of Life Programme
(Donegal) and Arthritis Ireland programme.
Overview of Evidence
Systematic reviews by Coulter and Ellis (2006),
Battersby(2010), and De Silva(2011), which report on
a broad variety of interventions indicate that:
• Information only has limited effectiveness
• Self management associated with improvements in
knowledge, coping behaviour, adherence, self
efficacy and symptom management.
• Some evidence of reduction in health service
utilisation and enhanced quality of life.
• Improvements in health status tend to diminish over
time, quality of life effects more likely to be
sustained.
Summary of most effective forms of self
management support
• Structured use of targeted information resources within
clinical care
• Structured self-management education and support for
people with specific conditions integrated with routine care
planning processes and care pathways
• Generic self-management education programmes (peer led,
community based)
• Interactive web-based self-management education
programmes
• Medication aids, information and other assistive aids and
devices
• Support groups and networks
• Home-based self-monitoring (anti-coagulation blood
pressure and diabetes)
• Telephone support/telecare.
www.pickereurope.org
Conclusions
• Peer led self management programmes
improve self efficacy and quality of life
• Condition specific programmes improve
clinical outcomes
• Both should be available to everyone who
could benefit
• Self-management is a hugely underutilised resource in the health service.
Working together to make
it better
Core elements of self management support
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Partnerships in care
Information
Education
Social support-emotional, peer and
network support
• Technology
• Formal care planning processes, with
clear referral pathways.
HSE A-Z of diseases conditions
• Quality assured information on 850 topics written
in everyday language.
• Original text drafted by medical editors,
approved by subject matter experts for NHS.
• Edited by senior clinicians with a view to
ensuring that content is consistent with clinical
practice in Ireland.
• Links to other websites e.g. NGOs
• Aimed at empowering public and patients on
health and illness.
To be launched before year end.
HSE Progress
• Clinical programmes developing evidence
based guidelines,clinical pathways for long
term illnesses
• A –Z diseases conditions
• Framework for self-management will be
finalised soon
• Agreement to implementation of action
plan will need to be negotiated within HSE
Thank-you for your time and attention
Dr. Patrick Doorley
National Director
HSE
Patrick.doorley@hse.ie