Self management and community resources

1. Self management and community resources Sarah Dennis and Anna Williams

2. UNSW research centre for primary health care and equity Definitions Self management support Collaboratively helping patients and their families to acquire the skills and confidence to manage their condition. Provide self management tools, referrals to community resources, routinely assessing progress. Community resources Linkages with hospitals providing patient education classes or home care agencies to provide case managers Linkages with community based resources � exercise programs, self help groups, and senior centres.

3. UNSW research centre for primary health care and equity Self-management support

4. UNSW research centre for primary health care and equity Effective self-management support People Well trained Health professional > usual care Lay /peer led > usual care Health professional v lay/peer led ? Education content Specific > general Therapeutic patient interventions Empowerment Motivation to change Annual top-up

5. UNSW research centre for primary health care and equity Community resources for self management Group > one to one Class size not important Community gathering places > home Particularly for population groups Culturally specific

6. UNSW research centre for primary health care and equity Summary Beneficial effects Improvements in disease outcomes (HbA1c), quality of life, health and functional status, satisfaction and health service use Types of self-management intervention Patient education, motivational counseling, intensive, specific, group or community based to one, empowerment Difficult to sustain, increased knowledge does not always translate into improved health outcomes Chronic diseases Improved patient outcomes with diabetes, hypertension, lipid disorders and to lesser extent arthritis Evidence less clear for COPD and asthma

7. UNSW research centre for primary health care and equity CPHCE Focus: Self Management Addressing issues of uptake and sustainability of self management in general practice and broader PHC Contributing evidence to the field of self management Developing and evaluating innovative models of CDSM CPHCE has had an increasing focus on self management as part of the chronic disease streams research since 2005 Past, present and future work of the Centre can be described within 3 main aims: Addressing issues of uptake and sustainability of self management in general practice and broader PHC 2. Contribution of evidence to the international literature on self management 3. Developing and evaluating innovative models of CDSM CPHCE has had an increasing focus on self management as part of the chronic disease streams research since 2005 Past, present and future work of the Centre can be described within 3 main aims: Addressing issues of uptake and sustainability of self management in general practice and broader PHC 2. Contribution of evidence to the international literature on self management 3. Developing and evaluating innovative models of CDSM

8. UNSW research centre for primary health care and equity Uptake and Sustainability: SM in General Practice Scoping Paper (Pascoe et al 2006) Aims effectiveness of Chronic Disease Self Management and its interaction with other elements of the Chronic Care Model highlight important considerations for integration of Chronic Disease Self Management into the core functions of general practice Methods Review of the Literature Consultation with key informants To date little research has been conducted into the most effective means of integrating self management support into the routine functions of general practice. To date little research has been conducted into the most effective means of integrating self management support into the routine functions of general practice.

9. UNSW research centre for primary health care and equity Uptake and Sustainability: SM in General Practice Scoping Paper Key Findings Increased use of non GP staff Information systems (registers) Decision support tools Building external links with community agencies by having key contacts with individuals The scoping paper highlighted that successful integration of SM into the routine activities of general practice would require specific education, workforce development and funding. In addition, in rural areas a greater focus on support allied health professionals would need to be considered. The five main elements considered to be important in the uptake and sustainability of SM in general practice included: Increased use of non GP staff Existence of Information Systems, in particular registers Decision support tools Building external links with community agenciesThe scoping paper highlighted that successful integration of SM into the routine activities of general practice would require specific education, workforce development and funding. In addition, in rural areas a greater focus on support allied health professionals would need to be considered. The five main elements considered to be important in the uptake and sustainability of SM in general practice included: Increased use of non GP staff Existence of Information Systems, in particular registers Decision support tools Building external links with community agencies

10. UNSW research centre for primary health care and equity Uptake & Sustainability CDSM: Primary Health Care Sharing Health Care Initiative Follow Up study (Williams, Harris et al 2006). Aim Explore the uptake and sustainability of CDSM within the routine activities of primary health care clinicians Methods Interviews Focus Groups This was a small qualitative follow up study of one Demonstration project of the Sharing Health Care Initiative. The study aimed to explore the uptake and sustainability of CDSM within the routine activities of primary health care clinicians. Methods employed included semi-structured face to face interviews (6 in total) with health managers and focus groups with PHC clinicians (13 clinicians in total) This was a small qualitative follow up study of one Demonstration project of the Sharing Health Care Initiative. The study aimed to explore the uptake and sustainability of CDSM within the routine activities of primary health care clinicians. Methods employed included semi-structured face to face interviews (6 in total) with health managers and focus groups with PHC clinicians (13 clinicians in total)

11. UNSW research centre for primary health care and equity Uptake & Sustainability CDSM: Primary Health Care Follow Up study Key Findings SM activities congruent with PHC clinician role but workforce issues challenge sustainability Well received by clients Poor linkages with general practice Limitations of mainstream program in CALD communities Reduced sustainability Workforce issues included: Increased focus on post acute care in the community (competing clinical demands) High turnover of staff. Both factors effecting the uptake and sustainability of the SM activities Poor linkages with general practice largely resulted from excluding GPs during the project design phase, GPs seeing it as a one off limited project not worth an investment. This impacted on continuity of care between providers. The project was conducted in a population characterised by a large proportion of CALD communities. Poor fit was found between the Lorig program eligibility criteria and the communties the PHC clinicians were working with. Workforce issues included: Increased focus on post acute care in the community (competing clinical demands) High turnover of staff. Both factors effecting the uptake and sustainability of the SM activities Poor linkages with general practice largely resulted from excluding GPs during the project design phase, GPs seeing it as a one off limited project not worth an investment. This impacted on continuity of care between providers. The project was conducted in a population characterised by a large proportion of CALD communities. Poor fit was found between the Lorig program eligibility criteria and the communties the PHC clinicians were working with.

12. UNSW research centre for primary health care and equity Contribution to evidence Systematic Review Zwar N, Harris M, Griffiths R, Roland M, Dennis S, Powell Davies G, et al. A systematic review of chronic disease management. UNSW Research Centre for Primary Health Care and Equity, Canberra: Australian Primary Health Care Research Institute (APHCRI); 2006 McDonald J, Harris E, Kurti L, Furler J, Apollini L, Tudball J. Action on Health Inequalities: early intervention and chronic condition self management, Sydney: HIRC; 2004 Although all work undertaken by CPHCE related to self management has added to the growing body of information or evidence around Self management two projects in particular have provided core insights. This includes the findings of the systematic review undertaken by Zwar et al in which Sarah has summarised the results earlier. Julie McDonald and Colleagues reviewed the evidence on the effectiveness of chronic condition self-management programs, with a special emphasis on arthritis, asthma and diabetes; and suggest a range of policy options to improve the health of disadvantaged communities and reduce health disparities. Although all work undertaken by CPHCE related to self management has added to the growing body of information or evidence around Self management two projects in particular have provided core insights. This includes the findings of the systematic review undertaken by Zwar et al in which Sarah has summarised the results earlier. Julie McDonald and Colleagues reviewed the evidence on the effectiveness of chronic condition self-management programs, with a special emphasis on arthritis, asthma and diabetes; and suggest a range of policy options to improve the health of disadvantaged communities and reduce health disparities.

13. UNSW research centre for primary health care and equity Contribution to evidence difficulties in making comparisons between different types of self-management models in order to identify those that are more successful little analysis of the impact of self-management interventions for disadvantaged populations in systematic reviews limited generalisability of findings to the Australian context; and limitations in the strength of the evidence for disadvantaged groups Part of this review findings included: difficulties in making comparisons between different types of self-management models in order to identify those that are more successful little analysis of the impact of self-management interventions for disadvantaged populations in systematic reviews limited generalisability of findings to the Australian context; and limitations in the strength of the evidence for disadvantaged groupsPart of this review findings included: difficulties in making comparisons between different types of self-management models in order to identify those that are more successful little analysis of the impact of self-management interventions for disadvantaged populations in systematic reviews limited generalisability of findings to the Australian context; and limitations in the strength of the evidence for disadvantaged groups

14. UNSW research centre for primary health care and equity Developing and evaluating innovative models of CDSM Evaluation of Moving On: a chronic disease program for people with a chronic illness NHMRC Application: Chronic disease self-management in Chinese and Vietnamese from socio-economically disadvantaged backgrounds

15. UNSW research centre for primary health care and equity Current & Future Activities Appropriate, accessible, affordable & effective mainstream CDSM program Culturally appropriate approach to SM for Chinese and Vietnamese populations Stronger linkages with general practice Improved coordination of care and SM activities into overall management plans