The Basics of Selfmanagement Support

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The Basics of Self-management Support

• Connie Sixta

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Self-management Support

• It is all about helping the patient change
  behaviors that decrease risk and encourage
  health.
• It must be patient driven, patient centered
• Our role is to help guide, and to support
• Behavior change takes time

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What is chronic illness?

• What experiences have you personally had with
  chronic illness?

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Self-management in the Chronic Care Model
ASSESS Knowledge, Beliefs, and Behaviors
PERSONAL ACTION PLAN List specific goals in
behavioral terms. List barriers and strategies to
address barriers. Specify follow-up plan. Share
the plan with the patients practice Team and
social support
ARRANGE FOLLOW UP Specify plan for follow up
ADVISE Provide information on health risks and
benefits of change
ASSIST Identify personal barriers and strategies
for problem solving
AGREE Collaboratively set behavioral goals based
on patient interest and confidence
Adapted from Glasgow, RE, et al. (2002)
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Assessment

• Knowledge
• Beliefs
• Behaviors

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Advise

• Sharing information about health risks
• Sharing information about healthy behaviors
• Sharing information about disease
• Sharing information about the treatment

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Rules to the giving of advice

• 1) Share information that is most relevant to
  the patient. Ask the patient what his questions
  are, what he wants to know.
• 2) Keep the advise as clear and simple as
  possible.
• 3) Build from the patients knowledge level.
  Start by asking the patient what he already
  knows.
• 4) Give advice in small doses. Do not
  overwhelm the patient with too much information.
• 5) Help the patient connect the advise to his
  areas of concern.

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Remember that the management of a chronic
illness is a lifetime proposition, and give
advice appropriately overtime based on patient
interest and needs. 
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Agree

• Helping the patient set a behavioral goal

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Make sure the self-management goal is

• 1)     The patients choice.
• 2)     Important to the patient.
• 3)     A goal that the patient is confident in
  achieving.
• 4)     Small, realistic, and measurable.

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Ask the Patient What He Would Like to Work on

• 1)     Determine what overall goal the patient
  would like to work on (diet, exercise,
  medications, stress management, etc.).
• An example of a behavioral objective might be
  to start getting more exercise.

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Ask the Patient How He Would Like to Achieve that
Goal

• 2. Determine how the patient would like to move
  toward achieving that overall goal.
• --How would you like to go about
  increasing your exercise?
• --What exercise or activity would you like
  to do?
• To help the patient decide what he would like to
  do, ask the patient what his usual activity is.
• This helps the patient move toward a reasonable,
  and safe activity that he can be successful
  doing. The answer might be walking.

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Help the patient design a goal that is specific
and measurable

• 3. Make sure that the activity or small goal is
  specific, measurable, and reasonable. The
  activity or small goal statement should answer
  the following questions what,
• where,
• when, and
• how often?

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What, Where, When, How Often

• Example I am going to walk three blocks (what)
  around the neighborhood (where) in the early
  morning before I go to work (when) three
  days/week on Monday, Wednesday, and Friday (how
  often).

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Ask the patient to rate the importance of the goal

• 4.  Ask the patient to rate the goal on a scale
  of 1 to 10, with 1 being low importance, and 10
  being high importance. If the patient rates the
  goal at 7 or below, ask the select another goal
  that is more important.

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Importance Ruler

• 2 3 4 5 6 7 8 9
  10
• Not Unsure Somewhat Very
• Important Important Important

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Ask the patient to determine his confidence in
achieving the goal.

• 5. Ask the patient to rate the goal on a scale
  of 1 to 10, with 1 being low confidence, and 10
  being high confidence. If the patient rates the
  goal at 7 or below, help the patient revise the
  goal or select another goal that is he is more
  confident he can achieve.

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Confidence Ruler

• 2 3 4 5 6 7 8 9
  10
• Not Unsure Somewhat Very
• Confident Confident Confident

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Assist

• Assisting the patient in identifying barriers and
  problem solving

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The steps in the problem solving process are

•    1. Identify the problem.
• 2. List all possible solutions.
• 3. Pick one solution to try
• 4. Try the solution for 2 weeks.
• 5. If it doesnt work, try another.
• 6. If that doesnt work, find a resource for
  ideas.
• 7. If that doesnt work, accept that the
  problem may not be solvable now
•  

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Personal Action Plan for ______________ Date
_____________________ 1. Something the Patient
wants to do 2. Describe How What
When Where How often 3.
Barriers 4. Plans to Overcome Barriers 5.
Confidence Rating 6. Follow up Plan
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Self-management Support

• 1)     The patients concerns, needs, questions
  guide the conversation.
• 2)     The patient is given relevant advice about
  healthy behaviors that decrease risks.
• 3)     The patients current behaviors are
  assessed.
• 4)     The patient is supported in setting a
  realistic and measurable goal.
• 5)     The patient is assisted in problem solving
  to meet the goal.
• 6)     The goal is designed so that the patient
  feels confident about reaching the goal.
• 7)     Follow up is arranged with the patient
  before the clinic visit is finished. 

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Arrange

• Arranging follow up

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Questions??