Abstract
BackgroundTo enable delivery of high quality patient-centered care, as well as to allow primary care health systems to allocate appropriate resources that align with patients’ identified self-management problems (SM-Problems) and priorities (SM-Priorities), a practical, systematic method for assessing self-management needs and priorities is needed. In the current report, we present patient reported data generated from Connection to Health (CTH), to identify the frequency of patients’ reported SM-Problems and SM-Priorities; and examine the degree of alignment between patient SM-Priorities and the ultimate Patient-Healthcare team member selected Behavioral Goal.MethodsCTH, an electronic self-management support system, was embedded into the flow of existing primary care visits in 25 primary care clinics and was used to assess patient-reported SM-Problems across 12 areas, patient identified SM-Priorities, and guide the selection of a Patient-Healthcare team member selected Behavioral Goal. SM-Problems included: BMI, diet (fruits and vegetables, salt, fat, sugar sweetened beverages), physical activity, missed medications, tobacco and alcohol use, health-related distress, general life stress, and depression symptoms. Descriptive analyses documented SM-Problems and SM-Priorities, and alignment between SM-Priorities and Goal Selection, followed by mixed models adjusting for clinic.Results446 participants with ≥ one chronic diseases (mean age 55.4 ± 12.6; 58.5% female) participated. On average, participants reported experiencing challenges in 7 out of the 12 SM-Problems areas; with the most frequent problems including: BMI, aspects of diet, and physical activity. Patient SM-Priorities were variable across the self-management areas. Patient- Healthcare team member Goal selection aligned well with patient SM-Priorities when patients prioritized weight loss or physical activity, but not in other self-management areas.ConclusionParticipants reported experiencing multiple SM-Problems. While patients show great variability in their SM-Priorities, the resulting action plan goals that patients create with their healthcare team member show a lack of diversity, with a disproportionate focus on weight loss and physical activity with missed opportunities for using goal setting to create targeted patient-centered plans focused in other SM-Priority areas. Aggregated results can assist with the identification of high frequency patient SM-Problems and SM-Priority areas, and in turn inform resource allocation to meet patient needs.Trial registrationClinicalTrials.gov ID: NCT01945918.
Highlights
To enable delivery of high quality patient-centered care, as well as to allow primary care health systems to allocate appropriate resources that align with patients’ identified self-management problems (SMProblems) and priorities (SM-Priorities), a practical, systematic method for assessing self-management needs and priorities is needed
While patients show great variability in their SM-Priorities, the resulting action plan goals that patients create with their healthcare team member show a lack of diversity, with a disproportionate focus on weight loss and physical activity with missed opportunities for using goal setting to create targeted patient-centered plans focused in other SM-Priority areas
Self-Management Support (SMS) refers to the process of education and support provided to people with chronic health conditions and their families to help them understand their central role in managing their disease, to make informed decisions about care, and to engage in healthy behaviors [7,8,9]
Summary
To enable delivery of high quality patient-centered care, as well as to allow primary care health systems to allocate appropriate resources that align with patients’ identified self-management problems (SMProblems) and priorities (SM-Priorities), a practical, systematic method for assessing self-management needs and priorities is needed. Given that almost all daily management decisions are made by patients outside of a healthcare setting with < 1% of an individuals’ time spent with their healthcare team [4], it is crucial to foster patient engagement and persistence in managing their chronic illness to achieve desired clinical goals [5, 6]. Self-Management Support (SMS) refers to the process of education and support provided to people with chronic health conditions and their families to help them understand their central role in managing their disease, to make informed decisions about care, and to engage in healthy behaviors [7,8,9]. Clinicians and other members of the healthcare team often are unaware of patient priorities and resources, making it hard to align patient needs with clinician/healthcare team preferences [10, 11]. In Krist and colleagues’ review, they note that only 10–20% of smokers report being told to quit smoking by their clinician and less than 20% of obese patients report being told by their clinician that they are overweight [14, 15]
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