CHRONIC DISEASE SELF-MANAGEMENT: Improving Health Outcomes

Abstract

Information such as cognitive facts, epidemiologic data, and other pieces of information generally taught in patient education classes may not be the most effective way to help patients change toward healthier behavior. This pilot clearly supported Lorig's findings that enhanced self-efficacy promotes and strengthens attitude changes and increases patients' beliefs in their ability to cope with the challenges of chronic disease. The program focused on the patient's confidence in his or her own ability to learn or perform skills rather than the actual skills involved. Self-efficacy was situational in that some individuals had a high level of self-efficacy for certain behaviors and a low level of self-efficacy for others. Self-efficacy was enhanced by successful performance, watching others succeed in similar circumstances, setting and attaining goals with clear and observable outcomes, and as an adjunct to other strategies (verbal persuasion and reinterpretation of symptoms). Self-efficacy supported the active participation of the veterans in the setting of treatment goals as well as in family support. The pilot intervention was successful for patients with multiple and mixed chronic disease such as arthritis, COPD, heart disease, diabetes, and hypertension. The cornerstone for effective behavior change lay with the patients' confidence levels in performing new health behaviors; thus the specific chronic disease took on a less significant part of this intervention. The generic approach worked on patients with mixed and multiple diseases, because it was educating them on life skills rather than disease-specific knowledge. This intervention confronted VA demand to provide cost-effective health care in a managed care environment. The VA needs models of patient responsibility and self-care management that assist the veterans in taking responsibility for maximizing of their health potential. The costs of managing veterans with chronic disease with comorbidity are astronomical. The pilot of this model has shown potential for revolutionizing the way chronic disease patient education is implemented throughout the VA and for making a significant impact on improving chronic care and reducing expenditures.