Gotowa bibliografia na temat „Stanford Model Chronic Disease Self-Management Program”

In March 2002, The Northern Clinical Research Centre (NCRC), Epping, implemented the Stanford model Chronic Disease Self-Management Program (CDSMP). The NCRC is the first health facility to implement the CDSMP for all cause chronic conditions in the northern suburbs of Melbourne. This paper outlines the establishment, marketing, co-ordination and personnel for a successful program as identified by the NCRC. Barriers to participation in a program were identified by the NCRC and steps to minimise these were implemented. The evaluation of this program in a scientific manner enables the effect of this adjuvant therapy to be examined in the Australian population. Fifty-two participants have graduated from the CDSMP at The Northern Hospital since the program commenced. This paper reviews the unplanned re-admission rates for people who have participated in the CDSMP as part of an ongoing study.

The evaluation of the Sharing Health Care Initiative addressed the translation of different models of chronic disease self-management into health and community service contexts in Australia. Across seven projects, four intervention models were adopted: (1) the Stanford Chronic Disease Self Management course; (2) generic disease management planning, training and support; (3) tailored disease management planning, training and support, and; (4) telephone coaching. Targeted recruitment through support groups and patient lists was most successful for reaching high-needs clients. Projects with well developed organisational structures and health system networks demonstrated more effective implementation. Engagement of GPs in recruitment and client support was limited. Future self-management programs will require flexible delivery methods in the primary health care setting, involving practice nurses or the equivalent. After 12 months there was little evidence of potential sustainability, although structures such as consumer resource centres and client support clubs were established in some locations. Only one project was able to use Medicare chronic disease-related items to integrate self-management support into routine general practice. Participants in all projects showed improvements in self-management practices, but those receiving Model 3, flexible and tailored support, and Model 4, telephone coaching, reported the greatest benefits

This study was designed to test a causality-based model in the context of relationships based on social cognitive theory and the literature for the purpose of examining how self-efficacy directly affects the quality of life of migraine patients through self- disease management skills. The sample of the study consisted of 343 migraine patients selected from a neurology outpatient clinic. The data were collected with self-report method using Self-Disease Management Strategies Scale in Migraine Patients developed by the researcher, the interview form, Quality of Life Scale in Migraine Patients and Self-Efficacy for Managing Chronic Disease 6-Item Scale, SEMCD developed by Stanford Patient Education Research Center. In order to test construct validity of scales, explanatory factor analysis and varimax axis rotation basic component analysis were applied. Cronbach's alpha values were calculated by analyzing the internal consistency for all the items in the scales and each subscale of the scale. The model proposed in the study was tested by using Structural Equation Model (SEM)-path analysis with latent variables in lisrel program. In SEM application, direct effect of self-efficacy on quality of life and indirect effect on self-disease management strategies were found to be statistically significant. Based on these results, self-efficacy can be thought to be a determinant of self-efficacy, quality of life of the patient and the patient’s skills of using self-disease management strategies. In order to improve the quality of life of migraine patients, their self-efficacy on disease management should be assessed and nursing practices should be planned to increase their confidence in the ability of preventing and managing migraine attacks.Extended English abstract is in the end of PDF (TURKISH) file. ÖzetBu araştırma, öz yeterliğin migrenli hastaların yaşam kalitesini doğrudan ve kendi kendine hastalık yönetimi becerileri aracılığı yoluyla ne kadar etkilediğini incelemek amacıyla, sosyal bilişsel teoriden temel alarak ve literatüre dayalı ilişkiler bağlamında nedensellik temelli bir modeli test etmek amacıyla planlanmıştır. Araştırmanın örneklemini bir nöroloji polikliniğinden seçilen 343 migren hastası oluşturmuştur. Veriler, görüşme formu, araştırmacı tarafından geliştirilen Migrenli Hastalarda Kendi Kendine Hastalık Yönetim Stratejileri Ölçeği, Migrenli Hastalarda Yaşam Kalitesi Ölçeği ve Standford Hasta Eğitim Araştırma Merkezi tarafından geliştirilen[WK1] [Mh2] Kronik Hastalıkları Yönetimde Öz Yeterlik Ölçeği (Self-Efficacy for Managing Chronic Disease 6-Item Scale, SEMCD) kullanılarak öz bildirim yöntemi ile toplanmıştır. Ölçeklerin yapı geçerliliğini test etmek için açıklayıcı faktör analizi ve varimaks’ eksen döndürme temel bileşenler analizi uygulanmıştır. Ölçeklerde yer alan maddelerin tamamı ve ölçeğin her bir alt boyutu için, iç tutarlık analizi yapılarak, Cronbach Alfa değerleri hesaplanmıştır. Araştırmada ileri sürülen model, lisrel programında Yapısal Eşitlik Modeli (YEM)-örtük değişkenlerle yol analizi yapılarak test edilmiştir. YEM uygulamasında öz yeterliğin yaşam kalitesi üzerine doğrudan etkisi ve kendi kendine hastalık yönetim stratejileri üzerinden dolaylı etkisi istatiksel olarak anlamlı bulunmuştur. Bu sonuçlara dayanarak; öz yeterlik, hastanın yaşam kalitesini, kendi kendine hastalık yönetim stratejilerini kullanma becerisinin bir belirleyicisi olarak düşünülebilir. Migrenli hastaların yaşam kalitesini artırmak için migrenli hastaların hastalık yönetimi konusundaki öz yeterlikleri değerlendirilmeli, hemşirelik uygulamaları hastaların migren atağını önleme ve yönetme becerileri konusundaki kendilerine olan güvenini artıracak şekilde planlanmalıdır.// // // //

Objective: To assess the effectiveness of a Spanish-language version of the Stanford Chronic Disease Self-management Program among adults who received medical care in community health centers in Mexico.Methods: This was a prospective, randomized study with Mexican users of community health centers in Tampico, Mexico, conducted between September 2015 and July 2016. A total of 120 adults aged 18 years or older were randomly assigned to intervention (n = 62) and control (n = 58) groups. Data were collected at baseline and at 3 and 6 months post intervention using a structured questionnaire. A repeated measures ANOVA was used for data analysis.Results: Statistically significant differences were found in intervention participants at 3 and 6 months post intervention compared to baseline and the control group for self-management behaviors, including: social activity limitation, quality of life perception, depression, stress, physical activity, communication with physicians, adherence to physician visits, and self-management behaviors.Conclusions: Chronic disease self-management programs (CDSMP) with Mexican adults in community settings are effective in improving their health and self-management behaviors. Further research is needed to assess CDSMP in Mexico and Latin America using objective measurements and examining health outcomes and self-management maintenance over longer periods of time.

Objectives. To evaluate the effectiveness of an online chronic disease self-management program for South Australia residents. Method. Data were collected online at baseline, 6 months, and 12 months. The intervention was an asynchronous 6-week chronic disease self-management program offered online. The authors measured eight health status measures, seven behaviors, and four utilization measures; self-efficacy; and health care satisfaction. Results. Two hundred fifty-four South Australian adults with one or more chronic conditions completed baseline data. One hundred forty-four completed 6 months and 194 completed 1 year. Significant improvements ( p < .05) were found at 6 months for four health status measures, six health behaviors, self-efficacy, and visits to emergency departments. At 12 months, five health status indicators, six health behaviors, self-efficacy, and visits to emergency departments remained significant. Satisfaction with health care trended toward significance. Discussion. The peer-led online program was both acceptable and useful for this population. It appeared to decrease symptoms, improve health behaviors, self-efficacy, and reduce health care utilization up to 1 year. This intervention also has large potential implications for the use of a public health education model for reaching large numbers of people. It demonstrates that an Internet self-management program, which includes social media, can reach rural and underserved people as well as be effective and reduce health care costs. If this intervention can be brought to scale, it has the potential for improving the lives of large numbers of people with chronic illness. It represents a way the medical care and public health sectors can interact.

Background and Purpose: Self-management programs may improve quality of life and self-efficacy for stroke survivors, but participation is low. In a randomized controlled trial of a complex, multidisciplinary, team-based secondary stroke prevention intervention, we offered participants Chronic Disease Self-Management Program (CDSMP) workshops in addition to clinic visits and home visits. To enhance participation, workshops were facilitated by community health workers who were culturally and linguistically concordant with most participants and scheduled CDSMP sessions at convenient venues and times. Over time, we implemented additional strategies such as free transportation and financial incentives. In this study, we aimed to determine factors associated with CDSMP participation and attendance. Methods: From 2014 to 2018, 18 CDSMP workshop series were offered to 241 English and Spanish-speaking individuals (age ≥40 years) with recent stroke or transient ischemic attack. Zero-inflated Poisson regression was used to identify factors associated with participation and attendance (ie, number of sessions attended) in CDSMP. Missing values were imputed using multiple imputation methods. Results: Nearly one-third (29%) of intervention subjects participated in CDSMP. Moderate disability and more clinic/home visits were associated with participation. Participants with higher numbers of clinic and home visits (incidence rate ratio [IRR], 1.06 [95% CI, 1.01–1.12]), severe (IRR, 2.34 [95% CI, 1.65–3.31]), and moderately severe disability (IRR, 1.55 [95% CI, 1.07–2.23]), and who enrolled later in the study (IRR, 1.12 [95% CI, 1.08–1.16]) attended more sessions. Individuals with higher chaos scores attended fewer sessions (IRR, 0.97 [95% CI, 0.95–0.99]). Conclusions: Less than one-third of subjects enrolled in the SUCCEED (Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities) intervention participated in CDSMP; however, participation improved as transportation and financial barriers were addressed. Strategies to address social determinants of health contributing to chaos and engage individuals in healthcare may facilitate attendance. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01763203.

Abstract Chronic Disease Self-Management Program (CDSMP) is an evidence-based program shown to improve health status, healthcare utilization, and health behaviors among individuals diagnosed with chronic conditions. Aging African Americans, a population at a greater risk of chronic disease diagnosis and burden, are underrepresented in the utilization of self-management behavioral programs. Previous research suggested that cultural distinctions (e.g., values, beliefs, preferences, experiences) impact the participation of racial/ethnic minorities in health-related research, health behavior outcomes, and healthcare utilization. Little is known about unique cultural influences on CDSMP utilization among this target group. To our knowledge, no research has applied a culture-specific theory to understand preferences or use of CDSMP among aging African Americans. Guided by the PEN-3 cultural model, this study examines preferences, barriers, and facilitators that may influence CDSMP utilization for the management of diagnosed chronic conditions. Using a qualitative research design, African Americans (N=50) from six Atlanta Metropolitan faith-based organizations participated in the 6-week CDSMP and one of six focus groups. Participants were largely female (70%) experiencing multiple chronic conditions (M=2) with an average age of 70. Focus groups were transcribed, and a thematic analysis was applied to identify emergent themes. Participants preferred programs that included family, community liaisons, and relevant advertisement material suggesting the importance of cultural identity. Accessing CDSMP at a familiar location with an endorsement of program benefit from trusted sources suggests the importance of relationship and expectations. Findings shed light on factors that may cause aging African Americans to embrace or avoid CDSMP as a healthcare option.

Objectives Review the evidence for the effectiveness of chronic condition self-management programs applied to Aboriginal and Torres Strait Islander Peoples. Methods A rapid review methodology was followed to develop an evidence summary from peer-reviewed and grey literature. Results Only seven peer-reviewed studies were identified. The evidence indicated that group programs, particularly the Stanford Program, and structured individual chronic condition self-management programs were of good quality for Aboriginal and Torres Strait Islander Peoples, although these need to be integrated into practice in order to see the greatest benefits. The Flinders Program showed promise as a standardised program with content designed specifically with and for these populations. Numerous grey literature sources were identified, many using strong participatory approaches developed locally within Aboriginal and Torres Strait Islander Peoples. However, few of these programs have been subject to rigorous evaluation. Discussion Despite the significant focus on chronic condition self-management programs to help address the burden of disease for Aboriginal and Torres Strait Islander Peoples, few studies exist that have been properly evaluated. The Closing the Gap Principles developed by the Australian Institute of Health and Welfare offer important guidance for how to proceed to maximise engagement, cultural appropriateness and ownership of program initiatives.

The Sharing Health Care SA chronic disease selfmanagement (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. 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 Enhanced Primary Care care planning process. Patient self-reported data were collected at baseline and subsequent 6-month intervals using the Partners in Health (PIH) scale to assess selfmanagement skill and ability for 175 patients across four data collection points. Health providers also scored patient knowledge and self-management skills using the same scale over the same intervals. Patients also completed a modified Stanford 2000 Health Survey for the same time intervals to assess service utilisation and health-related lifestyle factors. 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 selfmanagement education programs has a positive effect on patient self-management skill, confidence and health-related behaviour.

Previous researchers have identified that participation in a pulmonary rehabilitation program improves health outcomes yet, continuation in a weekly maintenance program yielded mixed results. Self-management programs have had reported use in chronic obstructive pulmonary disease (COPD). A meta analysis has identified that no self-management program had evaluated the effect of this type of intervention on the functional status of the participant with COPD. Reduced functional status is well reported as an indicator of disease progression in COPD. Adjuvant therapies for people with COPD need to demonstrate an effect in this domain. The Stanford model chronic disease self-management program (CDSMP) had been reported as a program that may optimise the health of people with chronic health conditions. However, its utility has not been formally evaluated for people with COPD. There have not been any reports of a comparison of the Stanford model CDSMP with pulmonary rehabilitation via a randomised controlled study in COPD. Aim: To compare and evaluate the health outcomes from participation in nurse ledwellness-promoting interventions conducted in the ambulatory care setting of a metropolitan hospital. Participants were randomised to either a six-week behavioural intervention: the Stanford model CDSMP or, a six-week pulmonary rehabilitation program and results compared to usual care (a historical control group). The efficacy of the interventions was measured at week seven and repeated at week 26 and 52. Following the week seven evaluation, the pulmonary rehabilitation program participants were rerandomised to usual care or, weekly maintenance pulmonary rehabilitation for 18 weeks and, followed up until the study completion at week 52.Little is reported about the costs of care for people with COPD in Australia. This study prospectively evaluated the costs of the interventions and health resource for the 52 weeks and undertook a cost utility analysis. Methods: Walking tests (The Incremental Shuttle Walking Test) and questionnaires asking participants about their health related quality of life, mood status, dyspnoea and self efficacy were assessed prior to randomisation to either six week intervention and repeated at weeks 7, 26 and 52. The implementation of these adjuvant therapies enabled all costs associated with the interventions to be prospectively examined and compared. Results: During the two years of recruitment 252 people (54% males) with a mean age 71 years (SD 11, range 39-93 years) were referred to the study. Student’s ttests identified that there were no statistically significant differences (P=0.16) between all those referred by age and gender as compared to all those admitted to Hospital A with an exacerbation of COPD. Ninety-seven people (51% male) with a mean age of 68 years (SD 9, range 39-87 years) agreed to participate in the study. Follow up in the study continued for 12 months following enrolment with only a modest level of attrition by week seven (3%) and week 52 (25%). Following the six-week interventions, both the pulmonary rehabilitation and CDSMP groups recorded statistically significant increases in functional capacity, self-efficacy and health related quality of life.Functional performance was additionally evaluated in the intervention arms with participants wearing pedometers for the six-week period of the interventions. There were no statistically significant differences between steps per week (P=0.15) and kilometres per week (P=0.17) walked between these two groups in functional performance. The Spearman rho statistic identified no statistically significant relationship between functional performance and the severity of COPD (rs (33) = 0.19, P = 0.26). No significant correlation between functional capacity and functional performance was identified (rs (32) = 0.19, P = 0.29). This suggests that other factors contribute to daily functional performance. The largest cost of care for people with COPD has been reported to be unplanned admissions due to an exacerbation of COPD.In this study there were no statistically significant differences between the three intervention groups in the prospective measurement of ambulatory care visits, Emergency Department presentations and admissions to hospital. The calculation of costs illuminated the costs of care in COPD are greater than the population norm. In addition, maintenance pulmonary rehabilitation generated a greater quality adjusted life year (QALY) than a six-week program. Despite the strength of the participants preferences (as measured by the QALY) for maintenance PRP, there were no significant differences in use of hospital resources throughout the study period by the three intervention groups, which suggests some degree of equivalence.

The history of proposals for patient-centered medicine begins with Michael Balint’s proposal for patient-centered medicine as an alternative to illness-centered medicine. This has been weakened in more recent calls for patient-centered care from clinicians, foundations, and professional organizations. It is argued that patient-centeredness consists of both taking the patient’s perspective and activating the patient. Taking the patient’s perspective involves communication skills and may involve developing a “shared mind” with the patient. Two programs for activating patients are contrasted, 1) the Expert Patient program based on the Chronic Disease Self-Management Program of Lorig and Holman and 2) the Patient-Centered Medical Home based on the Chronic Care Model developed by Wagner and colleagues. Patient empowerment involves activating patients on their own behalf and in service of their own goals. A truly patient-centered chronic care model aims not only for patient empowerment, but also for patient capability to pursue health and other vital goals.