Patient Self Management Education for Chronic Disease In Health Care and Nursing

Health Care and Nursing of Patient Self Management Education for Chronic Disease

Preparation for Patient Self Management of Chronic Disease,Program for Patient Self Management Education,Self Management Preparation For Common/Chronic Diseases.

Preparation for Patient Self Management of Chronic Disease

    Patient preparation for self management (SM) should begin if a chronic condition has lasted or is expected to last a year or longer, limits what one can do, and may require ongoing care. Optimum disease management by persons with chronic disease achieves the highest degree of functioning and the lowest level of symptoms given the severity of a condition (Clark, 2003).

Program for Patient Self Management Education

   Self management is best taught in a formalized program aimed at teaching skills needed to carry out medical regimens specific to the disease, guide health behavior change, and provide emotional support for patients to control their disease and live functional lives. SM preparation requires that the patient develop skills in problem solving and clinical judgment, self efficacy, and belief modification and symptom reinterpretation as necessary.

    My earlier work (Redman, 2004) by looking briefly at further advances in diseases or symptoms for which SM preparation has been acknowledged (cancer, arthritis, mental health, pain, cardiovascular, asthma and chronic obstructive pulmonary disease, and diabetes) . It then examines SM preparation for diseases for which there is no well established tradition but clearly patient need. 

Self Management Preparation For Common/Chronic Diseases

    The Arthritis Self  Management Program (ASMP) is perhaps the best known example of a SM program. It is based on social learning theory with a strong focus on strengthening patient self efficacy, and taught by persons with the disease. A full review of this program may be found in Redman (2004). 

    A mail based ASMP called “SelfManagement Arthritis Relief Therapy” or SMART uses computer supported tailored print intervention with a series of interactive questionnaires and responses. Results have been similar to those with the ASMP course. 

    Currently, a Web based ASMP with an interactive “learning center” where participants can learn self-management techniques, and a “communications center” where participants and leaders can interact by use of bulletin boards and e-mail, is being developed (Fries , Lorig, & Holman, 2003).

    The chronic disease most associated with SM is diabetes, a large literature describes preparation for SM of this disease. One of the most difficult skills to teach patients is an adequate level of problem solving to provide good control. Yet, the role of problem solving skills in diabetes control has received relatively little empirical investigation. 

    A recent study of very low income inner city and minority population affirms that those with good control of their disease and those in poor control have similar problems. Those in good control showed good problem solving skills, reflected a positive orientation towards diabetes SM and a rational problem solving process, and actively used past experience to solve current problems. 

    Those in poor control had poor problem solving skills with a negative orientation, impulsive or careless or avoidant problem solving processes, negative transfer of past experience, and an insufficient fund of knowledge. More of these individuals reported having completed formal diabetes education than did those in the good control group. 

    Depression is strongly associated with ineffective problem solving styles and negative problem-solving orientation, both because the depression reduces problem solving skills and because poor problem solving skills exacerbates conditions that lead to depression (Hill Briggs, Cooper, Loman, Brancati, & Cooper, 2003). 

    Consistent with the chapter 1 report of patient-centered care, Heisler and others (2003) found that patient adherence was more likely if patients and their doctors shared disease models and agreed on which medical problems were important and how to evaluate therapeutic success. 

    Among 127 patient care provider pairs, agreement on top treatment goals and strategies was low, perhaps because collaborative goal setting is not a standard part of chronic disease management in many primary care practices. Since better agreement is associated with proven self efficacy and self management, increased patient provider discussion of treatment goals and specific strategies to meet these goals seems important.

    A prior review of standards for SM; evidence of the efficacy and effectiveness of interventions to develop skills, judgment, and confidence; and instruments to measure need and outcome from interventions found much of this infrastructure missing. This deficiency strongly impacts patient morbidity and mortality, patient and family well being, and economic productivity, yet no organized effort to improve this error exists. 

    Poor, elderly, and uneducated persons suffer disproportionately from this state of affairs. Redman (2004) notes that SM is frequently seen as an add-on to routine medical management including use of pharmaceuticals, the drugs are reimbursed while the SM preparation is not, even if they show equal positive effects. 

    Philosophically, the strong focus on patient compliance with the medical regimen prescribed for them has diverted attention from attempting to understand a person's SM strategies and helping to develop them rather than judging them.

    A story of the difficulties a group of patients had with self-management of heart failure provides detail of the challenge before us. Although too small a sample size to be widely generalizable, the learning difficulties these patients depict ring true (Horowitz, Rein, & Leventhal, 2004). 

    These patients did not connect heart failure to their symptoms and did not have a clear understanding of acute and chronic heart failure-related symptoms. Many patients isolated symptoms and attributed them to other illnesses such as dyspnea caused by asthma, unaware they were also related to a weak heart. 

    They didn't understand that they could detect fluid buildup at early stages by regularly assessing their weight and symptoms, and very few believed they could control their symptoms. Most thought diuretics were needed only when their symptoms (such as leg swelling) were severe. 

    Despite strong interest in learning, most had inadequate information about heart failure and were not given the tools to prevent, thwart, or recognize mild or moderate exacerbation.