Chronic Disease Self-Management

1. Chronic Disease Self-Management Does It work? Sharon Johnson M.S. Associate Professor Health and Human Sciences Oregon State University Extension Service

2. Do you have…. Diabetes, arthritis, osteoarthritis, osteoporosis, osteopenia, cancer, heart disease, hypertension, fybromyalgia, depression, stroke, asthma, lung disease, multiple sclerosis, Parkinson’s disease Question Number 1.

3. How do you feel? Scared? Frustrated? Fatigued? Angry? Depressed? Anxious? Sad? Confused? Uncertain? Isolated? Fearful? Question Number 2.

4. Question Number 3. What are you going to do about it?

5. Close your eyes…. Here’s an idea.

6. Close your eyes…get comfortable…. Imagine you’re holding a big, bright yellow lemon. Picture it in your mind. You can feel the texture of the lemon rind in your hand. Now lift the lemon to your nose. You can smell its strong citrus aroma…now bring the lemon to your mouth and take a big bite out of that lemon. …it’s juicy….that juice squirts through your mouth…you can taste the tart lemon juice filling your mouth…the juice dribbles down your chin…suck the juice of that lemon.

8. There’s a demographic tidal wave and it’s headed our way… • Increased life expectancy • More older adults • More chronic disease Sources: Pew Internet and American Life Project, Centers for Disease Control (CDC), Merck Institute, Gerontological Society of America (GSA)

9. “Chronic diseases are live wolves they travel in packs…” People with chronic diseases report: • Significantly reduced productivity • Living with less income • Accomplishing less • Spending more time in bed—sick • Having poor mental health Sources: Stanford University (Lorig, K.); Center on an Aging Society, National Institute on Aging

10. Stanford University’s patient education program (“Living Well”) Highly structured six-week series of workshops Participative instruction with certified leader peer support Designed to enhance medical treatment Outcome-driven: impacts show potential for reduced or avoided costs Evidence-based: a tested model (intervention) that has demonstrated results Chronic Disease Self-Management Stanford University Model

11. What happens…. • You accept responsibility to manage or co-manage your own disease conditions • You become an active participant in a system of coordinated health care, intervention and communication • You are encouraged to solve your own problems with information (but not orders) from professionals Sources: Stanford University Patient Education Center; Center for Healthy Aging (NCOA)

12. Why these techniques work… • Peer educators • Constant modeling • Brainstorming • Active problem-solving • Action planning • Goal-setting Source: National Council on Aging http://www.ctb.1si.ukans.edu ; www.healthyagingprograms.org

13. What’s the content of these classes? • Distraction and cognitive symptom management • Breathing techniques • Nutrition and fitness • Fatigue management • Relaxation approaches • Communication strategies; working with your health care professional

14. The Stanford Model: Impact All studies look at behavior, health status and utilization. • Improved self-efficacy • Reduced use of doctors, hospital emergency rooms • Improvements in health status— identified by BOTH the participant and the health provider Sources: Stanford University Patient Education Center; Society of Behavioral Medicine publication (2003)

15. Improved quality of life Specific improvements in healthful behaviors Improvement in overall health status Example:(initial findings) Decreased hospital stays: .49 days, per patient, over a two year time period Decreased physician/emergency room use: 2.5 fewer visits to the emergency room and to physicians, per patient, over a two year time period Source: Stanford University Patient Education Center; Center for Healthy Aging Impact…withdetails

16. Increased physical activity Cognitive symptom management Improved communication with physicians Better self-reported general health Improved attitude Less health distress Less fatigue Reduced disability Fewer social/role limitations Sources: Stanford University Patent Education Center; published articles 1997-2003) (Lorig, K) Southern Oregon impacts…

17. Steve: These distraction techniques are remarkable. Counting backward by 3’s from 100….I’m usually pain free by 79.” Timothy: Marveling at the changes in his wife… Timothy’s wife: “I didn’t want to let my class down.” Char: “I lost ten pounds; my blood sugar is down. I even made new friends in the class. I plan to be trained as a program leader….” Sept 2008 Telephone Survey (random sample of eleven individuals who had completed the series five months earlier) All respondents indicated they were still using specific approaches ‘Relaxation techniques’, ‘Action planning” and ‘Communication skills’ most frequently referenced “Attitude improvement” cited in 40% of respondents Impact… …Southern Oregon stories

18. Chronic Disease Assumptions • Patients with different chronic diseases have similar self-management problems and disease-related tasks • Patients can learn to take day-to-day responsibilities for their diseases • Confident, knowledgeable patients, practicing self-management, will experience improved health status and use fewer health resources Source: Lorig and Holeman 2003

19. Reasons to support this approach… • Disease and demographic challenges will be unrelenting (“We need to start yesterday…”) • Limited availability of reliable, evidence-based (proven) approaches to chronic disease management • Better utilization of current resources necessary; more efficient use of physician time desired Sources: Society of Behavioral Medicine publication (Lorig K., Holman, H.)

20. Summary: Chronic Disease Self-Management means: • Managing the work of dealing with a chronic disease and/or multiple disease conditions • Staying involved in daily activities in light of debilitation and disability • Managing emotional changes resulting from or exacerbated by the disease conditions Once a chronic disease is present, one cannot NOT manage, the only question is ‘how.’ (Bateson 1980, Lorig, 2003)

21. For more information Sharon Johnson M.S. Associate Professor Oregon State University Southern Oregon Research and Extension 569 Hanley Road Central Point, OR 97502 541-776-7371 x210 s.johnson@oregonstate.edu www.sohealthyoregon.org 541-864-9611