Self-management training for people with chronic conditions

Background The ‘Sharing Health Care SA” chronic disease self-management (CDSM) project in rural South Australia was designed to assist patients with chronic and complex conditions (diabetes, cardiovascular disease and arthritis) to learn how to participate more effectively in the management of their condition and to improve their self-management skills. Implicit in the work is the idea that structured behaviour change strategies can lead to improved self-management skills and abilities for patients with chronic illness and have the potential to facilitate long-term behaviour and lifestyle change. These processes, in turn may also support sustainable health-related behaviour change and improve overall health and wellbeing for the patients. Aims The project was designed to determine whether community-based patient education and support programs could be successfully implemented and, if so, whether patient and provider participation in these programs might lead to improved patient self-management skills and abilities and improved quality of life for people with chronic and complex conditions such as diabetes and arthritis. Methods Participants with chronic and complex conditions were recruited into the Sharing Health Care SA program and offered a range of education and support options (including a 6-week peer-led chronic disease self-management program) as part of the EPC care planning process. All patients were given a care plan via the Partners in Health process and then provided with a range of materials and information about their condition. This was reinforced during review sessions and re-care planning. Patients, of course, chose whether to participate in the 6-week training or not. Patient self-reported data were collected at baseline and subsequent six-month intervals using the Partners in Health (PIH) scale to assess self-management skill and ability for 258 patients across four data collection points. Health providers also scored patient knowledge and self-management skills using the same scale over the same intervals. The scale therefore assesses, from both provider and patient perspectives, patient knowledge of their condition and the extent to which they have the ability to manage and cope with the impact of their chronic illness on their daily lives. In addition to completing the PIH at six-month intervals, patients also completed a modified ‘Stanford 2000 Health Survey’ for the same time intervals and through which overall patient health status was assessed along with service utilisation and other health related lifestyle factors such as smoking and alcohol consumption. Results Results show that both mean patient self-reported PIH scores and mean health provider PIH scores for patients improved significantly over time, indicating that patients demonstrated improved understanding of their condition and improved their ability to manage and deal with their symptoms. These results suggest that involvement in peer-led self-management education programs has a positive effect on patient self-management skill, confidence and health related behaviour. It may also lead to participants enjoying improved overall health and wellbeing and improved quality of life. Cost/benefit analysis of the program is very promising with significant savings shown.