1 / 21

Bridging the Gap between Health Promotion Theory and Care for Chronic Illness

Bridging the Gap between Health Promotion Theory and Care for Chronic Illness. Empowering for Health Care Management at Home C. L. McWilliam, MScN, EdD The University of Western Ontario, London, Ontario, CANADA E. Vingilis, M. Stewart, E. Vingilis, C. Ward-Griffin, J Hoch, A. Donner, UWO

gayle
Télécharger la présentation

Bridging the Gap between Health Promotion Theory and Care for Chronic Illness

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Bridging the Gap between Health Promotion Theory and Care for Chronic Illness Empowering for Health Care Management at Home C. L. McWilliam, MScN, EdD The University of Western Ontario, London, Ontario, CANADA E. Vingilis, M. Stewart, E. Vingilis, C. Ward-Griffin, J Hoch, A. Donner, UWO G. Browne, McMaster University P. Coyte, University of Toronto S. Golding(PRESENTER), S. Coleman, M. Wilson, et al., CCACs of Ontario, CANADA FUNDED BY: The Canadian Institutes of Health Research

  2. Bridging the Gap between Health Promotion Theory and Care for Chronic Illness Purpose: To evaluate the Costs & Outcomes of an Empowering Partnering Approach to Chronic Care Management at Home (2000-2004)

  3. EVIDENCE-BASED EVOLUTION OF EMPOWERING PARTNERING • RCT of “health promotion” visits achieved: • greater independence (p=.008; p=007) • greater perceived ability to manage own health (p=.014) • less desire for information (p=.021; p=.035) • greater quality of life (p=.006) • 8.2 fewer days in hospital; less in-home service

  4. PHENOMENOLOGICAL STUDY FINDINGS The Empowering Partnering Process Relationship-building +  Conscious Awareness

  5. THE EMPOWERING PARTNERING PROCESS • Building Trust & Meaning • Connecting • Caring • Mutual Knowing • Mutual Creating

  6. Bridging the Gap between Health Promotion Theory and Care for Chronic Illness • Empowering Partnering: • Client-centered • Empowering of all involved, beginning with the client • Relationship-building process • Health-oriented • Strengths-based focus

  7. Bridging the Gap between Health Promotion Theory and Care for Chronic Illness • EMPOWERMENT: • equitable balance of • knowledge • status • authority in the care relationship (Clark, 1989) HEALTH: the ability to realize aspirations, satisfy needs, & respond positively to the environment; a resource for everyday living (WHO, 1986)

  8. Bridging the Gap between Health Promotion Theory and Care for Chronic Illness individual level: clients as care partners client choice of involvement in care mgt.client and provider empowerment organizational level: staff education changed care procedures empowering policies empowering language interorganizational level: shared philosophy shared educational programming shared C.Q.I. strategy collaborative research

  9. Bridging the Gap between Health Promotion Theory and Care for Chronic Illness • Quasi-Experimental Evaluation Research: • intervention and comparator home care programs • 12-month baseline (2000-01) • 12-month follow-up (2002-03)

  10. Bridging the Gap between Health Promotion Theory and Care for Chronic Illness SAMPLE: Baseline Follow-up N (PARTICIPATION RATE) N (PARTICIPATION RATE) Computer Database 7200 (100%) 7200 (100%) Clients 974 (58%) 809 (31%) Caregivers 249 (62%) 303 (49%) Providers 291 (59%) 288 (36%)

  11. Client Demographics: Age: 72 yrs Gender: female 70% Education: </= secondary 75% Income: </= $20,000 65% # Chronic Problems: 2.4 Informal Caregiver: 71%

  12. Provider Demographics Age: 42.5yrs Role: case mgr 12% nurse 34% therapist 11% PSW 43% Status full time 43% part time 57% Experience 10 yrs Qualifications </=diploma 72%

  13. Caregiver Demographics Age: 60 yrs Gender: female 69% Marital Status married 82% Education post secondary 50%

  14. Outcome Measures Correlated with Empowering Partnering VARIABLE: CORRELATION (Pearson’s r) Clients’ Health Status .38 Quality of Life .59 Satisfaction with Care.16 Providers’ Job Satisfaction .39 Perceived Effectiveness .36

  15. Mediating Variables • Government Service Cuts • Shift to Centralized Government Control • Policy & Procedure for Standardized Assessment

  16. The Progress in Implementing Intervention N (%) Providers Trained 349(30%) Trained Staff Attrition 32(2.3%) Clients Engaged 2689(44%)

  17. Client Outcomes: Intervention (I) vs Comparator (C) Organization Health Care Costs: No Difference Satisfaction with Care: No Difference Positive Trend better in (I) Health-promoting effort: No Difference Partnering in Decision-making: No Difference Improved in both (I) and (C)

  18. Provider Outcomes: Intervention (I) vs Comparator (C) Organization Job Satisfaction: Almost Significant (p=.06) No Change in (I); Dropped in (C) Job Motivation: No Difference No Change in (I); Dropped in (C) Job characteristics: Almost Significant (p=.07) Positive Trend in (I) over time Empowerment: No Difference Health-promoting effort: No Difference

  19. Caregiver Outcomes

  20. Mean Total Monthly Services Utilization Costs Over Time Intervention vs. Comparator Intervention Services Utilization Costs by Service Category

  21. Bridging the Gap between Health Promotion Theory and Care for Chronic Illness • Change takes time • The policy context may impede the intervention • Program outcomes affected by many factors • KT requires grassroots perspective transformation • Further research is needed Conclusions:

More Related