Self-Management Support (SMS) from a Chronic Disease Worker in a Rural Primary Health Service, a Pilot Study

Ervin K,Koschel A

doi:10.4172/2167-1079.1000211

Abstract

Abstract The benefits of self-management in chronic disease have been proven and are a recommendation by the peak body for primary care in Australia. In a region of rural Victoria Self-Management Support (SMS) programs have had limited success due to a lack of implementation by trained staff? In this study a small rural health service trained and supported staff to provide SMS care and evaluated the effect compared to usual general medical practitioner (GP) care. All clients (over the age of 18) allocated a GP care plan at local consenting medical clinics and those receiving SMS care at the rural health service were invited to participate in a survey using the Patient Assessment of Care for Chronic Conditions survey (PACIC). The PACIC is a brief, validated patient self-report instrument to assess the extent to which clients with chronic illness report care that is patient-centred, proactive, planned and includes collaborative goal setting; problem-solving and follow-up support. Responses were compared using non-parametric testing to determine differences between the SMS group and the patients from the GP group (usual care). Overall the SMS group reported higher frequencies of always or often receiving care that supported a patient centred, planned approach to chronic disease management. In particular for client involvement in making the plan, choosing their own goals, having a written list, understanding how their own self-care influences their condition and post visit contact. Client feedback supported the provision of the SMS program.

Highlights

The prevalence of chronic conditions is increasing in Australia with more than half of the population aged 65-84 years having five or more long term conditions, which contributes to 80% of disease burden in Australia [1,2,3]
Survey responses were collected from 15 clients (55.5%) in the General Practitioner (GP) group and 23 (95.8%) in the Self-Management Support (SMS) group
In the SMS group seven clients were referred to other services for care, one client was deceased and three clients refused to participate in the SMS program

Summary

Introduction

The prevalence of chronic conditions is increasing in Australia with more than half of the population aged 65-84 years having five or more long term conditions, which contributes to 80% of disease burden in Australia [1,2,3]. It is imperative that successful models of care are implemented to manage the growing burden. There is a growing consensus that clients have a more active role to play in defining and reforming healthcare, in chronic disease management, where clients monitor and manage the majority of their own care, related to their illness, day-to-day [4,5,6]. The management plan provide financial rebates for GPs to manage chronic or terminal medical conditions by preparing, coordinating, reviewing or contributing to plans for ongoing care. The rebates for GPs recognise the increased time required to structure and co-ordinate the often complex care required for these clients [10]

Methods

Results

Discussion

Conclusion