Self-management Program For Patients Research Articles

The Long-term Effects of a Self-management Program for Inner-city Primary Care Patients With Acute Low Back Pain

We evaluated the effect of a self-management program for low-income primary care patients with acute low back pain (ALBP) from inner-city neighborhood health centers. We conducted a randomized controlled trial of a self-management program compared with usual care at university-affiliated neighborhood health centers and an emergency department of an inner-city public teaching hospital. We enrolled 211 patients who visited a physician for ALBP (<90 days' duration). The self-management program consisted of 3 group sessions and telephone follow-up that focused on understanding back pain, increasing physical activity, and dealing with fears and frustrations. At baseline, 4 months, and 12 months, blinded interviewers assessed back pain physical function (Roland Disability Questionnaire), health status (Arthritis Impact Measurement Scales), self-efficacy, and time spent in physical activity. Compared with patients receiving usual care, intervention patients reported significantly better scores on the Roland Disability Questionnaire (P =.009), mental functioning (P =.009), self-efficacy to manage ALBP (P =.03), time spent in physical activity (P =.047), and reduced fears of movement/reinjury (P =.005) after 12 months. A self-management program can improve and maintain functional status, mental functioning, and self-efficacy to manage future symptoms for 1 year among primary care patients with ALBP living in the urban, inner city.

FOOTSTEP: a randomized controlled trial investigating the clinical and cost effectiveness of a patient self-management program for basic foot care in the elderly

Background and Objectives Podiatry (chiropody) services are one of the most frequently requested services in primary care. The elderly are given priority access to podiatry services in the UK blocking access for other priority groups. To evaluate the clinical and cost-effectiveness of a self-management program as a means of managing nonurgent demands for podiatry services by the elderly without compromising foot-related disability. Method Randomized clinical trial with blinded 6-month follow-up and economic evaluation. People aged 60+ seeking self-initiated or primary referred podiatric consultation were screened. Five hundred ninety-nine were excluded on the basis of health status, and 259 refused to participate or did not attend initially. Seventy-eight were randomized to receive a self-management program, and 75 usual care. The main outcome measure was foot disability, as measured by the Manchester Foot Disability Questionnaire. Results At 6 months, self-management program participants had lower foot disability scores than the usual care group (difference between scores −1, 95% C.I. −2, 0), and returned for fewer treatments within the 6-month study period (39 vs. 92 treatments). The cost per patient for the self-management program (£10.92) was found to be the same as for usual care (£10.71), but this included the cost of nail care packs. Conclusion In this group a self-care program for routine foot care did not compromise therapeutic outcomes, and may be more cost effective in the long term. Further work is required to extend self-management programs to other target groups, such as people with diabetes at low risk for foot problems.

Small-scale rural pilot programs in chronic illness management - what next?

In recent years, rural SA has been the recipient of significant funding to support a range of new primary health care initiatives. Much of this funding, additional to normal recurrent budgets in our health system, has facilitated effective change and development through demonstration and research projects across the state. The resultant work involves programs such as: ? coordinated care trials (COAG) ? more allied health services (MAHS) ? Commonwealth regional health service initiatives (CRHS) ? quality use of medicines (QUM) ? community packages for aged care services ? Indigenous chronic disease self-management pilot programs (CDSM) ? chronic disease self-management (CDSM) programs - Sharing Health Care SA ? chronic disease self-management (CDSM) programs in Indigenous communities. In addition to the resources listed above, funding was also provided by the Commonwealth to establish the South Australian Centre for Rural and Remote Health (SACRRH) and develop the University Department of Rural Health in Whyalla. While this new funding has led to substantial developmental work in chronic illness management in particular, one needs to ask whether the time might not be right now for these hitherto small-scale change initiatives to be transformed into ongoing mainstream programs, informed and guided by research outcomes to date. Is it time to move beyond tentative chronic illness programs and into mainstream reform? We have shown that there is much to be gained, both for patients and for the system, from improved coordination of primary care services and initiatives such as self-management programs for patients with chronic conditions. Better management leads to improved patient health outcomes and can reduce demand for unplanned hospital and emergency services. Many admissions to rural hospitals requiring expensive services, in terms of infrastructure and staffing, could be either prevented, or patients could be managed more effectively in the community as part of a wider primary health care program.

Cost effectiveness of guideline advice for children with asthma: a literature review.

Asthma is an important chronic disease among children. This study reviews the cost effectiveness of interventions in the long-term care of asthmatic children and compares these results with treatment advice in four current guidelines. Cost-effectiveness studies were searched for in Medline, Embase, Healthstar, Biosis, and the Office of Health Economics-Health Economic Evaluations Database (OHE-HEED), and the Cochrane Library was searched for meta-analyses of clinical trials. In the four reviewed guidelines, cost effectiveness is not explicitly used as a criterion. The cost-effectiveness studies show sufficient evidence for the cost effectiveness of treatment with inhaled steroids and for self-management programs for severe asthmatic patients. Inclusion of these results in the guidelines would not lead to significant changes in current treatment advice. The effectiveness of various measures for trigger avoidance is not fully proven, and hence neither is their cost effectiveness. Available information on the cost effectiveness of cromolyn could be used to focus the guidelines. Finally, evidence exists that organizational interventions, e.g., the employment of asthma nurses, can result in cost savings, but it is unclear to what extent these results can be generalized. More cost-effectiveness studies are needed, especially on long-acting bronchodilators and self-management programs for mild and moderate asthma, in order to help make the guidelines more informative and reduce the differences between them.

A Self-Management Program for Adult Asthma. III. Maintenance and Relapse of Skills

Patient self-management programs have become an integral part of asthma treatment. The goal of such programs is to strengthen the partnership between patients and health care providers in controlling the condition. The present study analyzed how well patients maintained or relapsed in performing asthma self-management skills over time and across settings. It was conducted by contacting patients who had been involved in a successful self-management program an average of 6 years after their participation or an average of 7 years after they completed training. Seventy percent of the patients agreed to participate and complete, either by themselves or over the telephone, a structured interview regarding their experiences in performing asthma self-management.On the basis of their responses, 53 participants were categorized into two groups: continuers or relapsers, according to previously developed and published criteria for relapse. Characteristics that distinguished the two groups were described. As anticipated, those classified as continuers reportedly exhibited broader repertoires of self-management skills across an array of settings. They credited their performance with maintaining control over their asthma. However, two unexpected findings emerged in the study: First, all patients continued to use self-management skills to one degree or another 7 years after they had acquired these skills. Even patients who were categorized as relapsers regularly performed some self-management skills, often involving self-monitoring of their breathing. Second, half of the patients in the relapse group reported that their asthma was in remission and that they were asymptomatic. The self-management skills they reportedly used were performed to monitor and prevent a return of asthma.

The Health Hero?? Online Service

This article describes recent developments in remote patient self-management programmes for care management. An overview of current practices in disease management, care management and quality improvement is provided along with descriptions of enabling technologies including interactive voice response (IVR) and new patient communication and data capture systems. A new technology platform for disease management, case management and performance measurement ‘the Health Hero® online service — is presented and described. The Health Hero® platform features a patient information appliance (the Health Hero® Health Buddy® appliance), a central data centre, and an Internet-based service facilitating the daily activities of patient- and population-based care management, disease management and performance measurement. Results from preliminary field testing of the Health Hero® online service are presented. These results indicate that compliance (usage) with the Health Hero® online service is consistently above 90% and that patient satisfaction is high. Surveys conducted on the Health Hero® online service indicate the device is easy to set-up and use, and that the likelihood of patients’ continuing to use the Health Hero® online service is high and increases with time (from 80 to 93% over 3 months). Remote patient care management systems, such as the Health Hero® Internet-based communications platform and some IVR systems, facilitate efficient monitoring of patients. They consequently provide a foundation for better outcomes and quality of life for patients and reductions in the cost of healthcare delivery.

Physical and other non-pharmacological interventions for fibromyalgia.

There is little empirical evidence for the effectiveness of physical and other non-pharmacological approaches to the management of fibromyalgia. Although a number of studies have been conducted into such approaches, many of these are uncontrolled, and relatively few randomized controlled trials of appropriate size and methodological rigour have been carried out. This chapter provides an overview of the evidence available under the following headings: exercise, EMG biofeedback training, electrotherapy and acupuncture, patient education and self-management programmes, multimodal treatment approaches, and other interventions. It is hard to reach firm conclusions from the literature, owing to the variety of interventions that have been evaluated and the varying methodological quality of the studies concerned. Nonetheless, in terms of specific interventions, exercise therapy has received a moderate degree of support from the literature, and has been subjected to more randomized studies than any other intervention. In contrast, there is little or no evidence available for most types of electrotherapy. In terms of overall management strategies, a multimodal programme of management, including physical, psychological and educational components and delivered in a multidisciplinary setting, has gained some support from descriptive and experimental studies, and accords with current understanding of the aetiology and clinical features of fibromyalgia. There is a clear need for further systematic evaluation of the effectiveness of non-pharmacological treatment approaches in fibromyalgia.

Long-term (3-year) economic evaluation of intensive patient education for self-management during the first year in new asthmatics

Patient education and self-management programmes have proved effective in many studies with short follow-up periods. We studied the 3-year cost-effectiveness of an intensive programme of patient education and supervision for self-management. The study consisted of 162 consecutive newly diagnosed asthmatics who were randomized either into an intervention group (IG) receiving intensive patient education and supervision for self-management at an outpatient clinic during the first year, or a control group (CG) receiving conventional education at the baseline visits only. Both groups had 2 additional years of follow-up. Lung functions and health-related quality of life (HRQOL) were measured. Extra direct and indirect costs were recorded. At 3 years the differences in forced expiratory volume in 1 s (FEV 1) and in peak expiratory flow (PEF) were significantly better in the IG being in (% predicted) respectively 5·3 (95% CI 0·6–10·0) and 4·4 (95% CI 0·1–8·7), ( P<0·05). The airway responsiveness (PD 15) did not differ significantly, but the improvement from baseline to 3 years was significantly greater in the IG, being 0·40 dose steps (95% CI 0·05–0·75) ( P<0·05). HRQOL scores did not differ significantly. The risk for sickness day was less in the IG with a RR of 0·6 (95% CI 0·50–0·69) ( P=0·000) and among patients who used the PEF meter. The compliance was similar in both groups when measured by the PEF-based self-management. There was no statistically significant difference in costs, although there was a consistent tendency for lower costs in the intensive programme. The intensive programme was more effective in terms of FEV 1, PEF and improvement in PD 15 and equally effective in terms of other lung functions and HRQOL, but there was no clear difference in the costs.

Patient Self-Management of Oral Anticoagulant Therapy: An International Update.

The clinical use of oral anticoagulant therapy has been complicated by the necessity for frequent determinations of the prothrombin time (PT) to ensure safety and therapeutic efficacy. This requirement has often imposed a significant burden on both providers and patients. In 1985 a German patient, Heike Möller-Jung, initiated her own patient self-testing (PST) and patient self-management (PSM). Today there are over 15,000 patients in Germany managing their oral anticoagulant therapy with PSM options. Pilot PST and PSM programs are in place in many other countries. In the United States, two devices have recently been approved for PST. This method of monitoring has been shown to be as accurate as that of traditional central laboratory PT determinations, to improve the amount of time patients are within the therapeutic INR range, and to decrease the incidence of adverse events associated with anticoagulant therapy.

Compliance with medical regimens, self-management programs, and self-care in childhood asthma.

Compliance with medical regimens is as poor or poorer in childhood asthma than it is for other chronic illnesses. A spate of self-management programs for childhood asthma has been developed to counteract nonadherence and to enable patients to be more confident and competent in their ability to prevent or control asthmatic episodes. The programs offer promise and report some encouraging results, but the programs are still unproven, and they are neither widely available nor widely used. The individual physician remains the key player in mounting effective self-management programs; but if the physician is to function effectively in this role, drastic changes are called for in the way that both medical practice is conducted and patient-health care provider relationships are managed. Steps and strategies that would help providers establish effective individual self-management programs for asthmatic patients are outlined.

Prevention of Lung Cancer

<h3>Background</h3> Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune disease which impacting on physical, psychosocial and economic aspects. Poor disease control will cause flare up and remission periodically and increase the risk of deformity. Various studies indicating that patient education on disease knowledge, treatment plan and self-management skill are all contributing factors for disease control and successful coping with long-term condition. However, barriers such as knowledge deficit on disease and related treatments are common in general public, a patient education and empowerment program (PEEP) was then designed and conducted for newly diagnosed RA patients in a regional hospital of Hong Kong. <h3>Objectives</h3> To evaluate the effectiveness of PEEP on improving disease control; patient9s functional ability and self-management knowledge for newly diagnosed RA patients. <h3>Methods</h3> This was a retrospective and observational study, the data retrieved from January 2014 to December 2015. Patients with newly diagnosed RA were recruited into a health education and patient empowerment program (PEEP) conducted by specialist nurse in rheumatology. The program included one-to-one interview in nurse-led clinic and telephone advice line (TAL) support. A health education checklist was designed to standardize the health education content and ensure essential information was delivered to participants. A disease knowledge assessment form to assess disease knowledge, medication management and self-management skill was designed to measure patient9s understanding; and health assessment questionnaire (HAQ) was used to assess patient9s functional ability and health outcome. Patient9s knowledge score accompanied with disease activity score (DAS 28) and HAQ score were collected before and after the PEEP. <h3>Results</h3> Until the end of year 2015, totally 73 patients have been recruited into the program. 51 patients attended the program once and 22 patients attended twice. Age of participants between 17 and 79, majority (82.2%) was female. Mean knowledge assessment score was increased from 22.6% to 72% after PEEP, reflecting an average increase of 49.4% in the knowledge of disease, treatment and self-management skill. Mean DAS 28 score before PEEP was 4.44 (2.05 to 7.27) while post PEEP was 3.61 (1.55 to 7.0) which indicated improvement on arthritis control (mean difference -0.83; P&lt;0.0001). Mean HAQ score of pre and post PEEP were 0.84 and 0.59 respectively indicated an improved functional and health outcome. During the study period, TAL support was sought for 41 times, in which 19 episodes were related to drug problems and 10 episodes were related to disease flare up. <h3>Conclusions</h3> Health education is an effective way to increase patient9s disease knowledge, improve medication management and enhance self-management skill; which also contribute to better disease control and better functional ability. A structured and comprehensive patient education and self-management program should be promoted for all newly diagnosed RA patients. <h3>Disclosure of Interest</h3> None declared