Self-management Guidelines Research Articles

EFFECT OF SELF-MANAGEMENT GUIDELINES ON THE QUALITY OF LIFE FOR POST-MASTECTOMY PATIENTS

Background: Mastectomy causes negative impact on patients’ quality of life (QOL), thus highlight critical clues for improving QOL through enhancement self-management for these patients are needed. The aim of the study was to determine the effect of self-management guidelines on the QOL for post-mastectomy patients. Method: This quasi-experimental study was conducted in Oncology Department, Suez Canal University Hospital, Ismailia, Egypt. A purposive sample of 72 patients with post-mastectomy was included. Study tools (1) Interviewing questionnaire comprised of three parts was used; first part included socio demographic characteristics, second part included medical data, third part included patients’ knowledge questionnaire (2) self-management scale. (3) QOL scale included Short-Form 36 (SF-36) Health Survey. Three tools were used pre- and post-implementation of the self-management guidelines. Results: The patients’ knowledge scores and self- management scales were both significantly improved after implementation of guidelines. SF-36 QOL score was extremely better after implementation of guidelines (28.7±7.7 versus 80.0±6.4, respectively). There was a significant positive correlation between self- management and QOL post-guidelines implementation (p < 0.0001). Conclusions: There was a significant improvement in post-mastectomy patients QOL after self-management guidelines implementation. There was a significant positive correlation between self- management and QOL post-guidelines implementation for post-mastectomy patients. Recommendations: Self-management guidelines should be conducted for post-mastectomy patients as they are the key to improving their QOL.

EFFECT OF SELF-MANAGEMENT GUIDELINES ON THE QUALITY OF LIFE FOR POST-MASTECTOMY PATIENTS

Background: Mastectomy causes negative impact on patients’ quality of life (QOL), thus highlight critical clues for improving QOL through enhancement self-management for these patients are needed. The aim of the study was to determine the effect of self-management guidelines on the QOL for post-mastectomy patients. Method: This quasi-experimental study was conducted in Oncology Department, Suez Canal University Hospital, Ismailia, Egypt. A purposive sample of 72 patients with post-mastectomy was included. Study tools (1) Interviewing questionnaire comprised of three parts was used; first part included sociodemographic characteristics, second part included medical data, third part included patients’ knowledge questionnaire (2) self-management scale. (3) QOL scale included Short-Form 36 (SF-36) Health Survey. Three tools were used pre- and post-implementation of the self-management guidelines. Results: The patients’ knowledge scores and self-management scales were both significantly improved after implementation of guidelines. SF-36 QOL score was extremely better after implementation of guidelines (28.7±7.7 versus 80.0±6.4, respectively). There was a significant positive correlation between self-management and QOL post-guidelines implementation (p < 0.0001). Conclusions: There was a significant improvement in post-mastectomy patients QOL after self-management guidelines implementation. There was a significant positive correlation between self-management and QOL post-guidelines implementation for post-mastectomy patients. Recommendations: Self-management guidelines should be conducted for post-mastectomy patients as they are the key to improving their QOL.

A framework for measuring self-management effectiveness and health care use among pediatric asthma patients and families.

Asthma is associated with substantial health care expenditures, including an estimated US$56 billion per year in direct costs. A recurring theme in the asthma management literature is that costly asthma symptoms, including hospitalizations and multiple emergency department (ED)/outpatient visits, can often be prevented through patient/family adherence to the national (National Institutes of Health Expert Panel Report-3) guidelines for effective self-management of asthma, specifically 1) medication adherence and 2) environmental trigger avoidance, as outlined in the patient’s personalized Asthma-Action Plan. It is important to note however that while effective self-management of asthma is known to reduce ED visits and hospitalizations, the relationship between asthma self-management effectiveness and outpatient visit frequency remains ambiguous, reflecting a gap in the literature. For instance, do patients/families who self-manage effectively visit outpatient clinics more frequently for asthma care (compared to those who do not self-manage effectively), after accounting for differences in asthma severity, demographic characteristics, and risk factors? Do patients/families who visit outpatient clinics more frequently for asthma care, in turn have fewer ED and inpatient encounters for asthma? On the other hand, do patients/families who do not revisit outpatient clinics regularly have higher ED visits and hospitalizations? It is important to address these gaps, in order to reduce the costs and public health burden of asthma. This paper provides a foundation for addressing these gaps, by conducting an integrative review of the asthma management literature, to develop a conceptual framework for measuring self-management effectiveness and health care use among pediatric asthma patients/families. In doing so, the paper lays the groundwork for future research seeking to explicate the relationship between asthma self-management effectiveness and health care use, which in turn has potential to engage asthma providers in promoting ideal self-management and optimal health care use for pediatric asthma, in accordance with national evidence-based guidelines for asthma management.

Effects of a home-based activation intervention on self-management adherence and readmission in rural heart failure patients: the PATCH randomized controlled trial.

BackgroundHeart failure (HF) patients discharged from rural hospitals have higher 30-day readmission rates. Self-management (SM) reduces readmissions, but adherence to SM guidelines is low in the rural HF population. We tested a home-based intervention to enhance patient activation and lead to improved SM adherence.MethodsIn this two-group, repeated measures randomized control trial, the main outcomes were patient reported and clinical outcomes associated with SM adherence, and all-cause readmission at 30, 90 and 180 days.ResultsThe study included 100 HF patients discharged from a rural critical access hospital. The intervention group received a 12-week SM training and coaching program delivered by telephone and tailored on subjects’ activation levels. At α = .10, the PATCH intervention showed significantly greater improvement compared to usual care in patient-reported SM adherence: weighing themselves, following a low-sodium diet, taking prescribed medication, and exercising daily (all p < .0005) at 3 and 6 months after discharge. In contrast, groups did not differ in physical activity assessed by actigraphy or in clinical biomarkers. Contrary to expectation, the 30-day readmission rate was significantly higher (p = .088) in the intervention group (19.6 %) than in the control group (6.1 %), with no differences at 90 or 180 days.ConclusionIt is feasible to conduct a randomized controlled trial in HF patients discharged from rural critical access hospitals. Significantly higher patient-reported SM adherence was not accompanied by lower clinical biomarkers or readmission rates. Further research is needed to understand mechanisms that influence outcomes and healthcare utilization in this population.Trial registrationClinical Trial Registration Information: ClinicalTrials.gov; NCT01964053.

Relationships between activation level, knowledge, self-efficacy, and self-management behavior in heart failure patients discharged from rural hospitals

Non-adherence to self-management guidelines accounted for 50% of hospital readmissions in heart failure patients. Evidence showed that patient activation affects self-management behaviors in populations living with chronic conditions. The purpose of this study was to describe patient activation level and its relationship with knowledge, self-efficacy and self-management behaviors in heart failure patients discharged from rural hospitals. Our study populations were recruited from two hospitals in rural areas of Nebraska. We found that two-thirds of the participants reported low activation levels (e.g., taking no action to manage their heart failure condition). In addition, low patient activation levels were associated with inadequate heart failure knowledge (p=.005), low self-efficacy (p<.001) and low engagement in heart failure self-management behaviors (p<.001) after discharge from hospital.

Relationships between activation level, knowledge, self-efficacy, and self-management behavior in heart failure patients discharged from rural hospitals.

Non-adherence to self-management guidelines accounted for 50% of hospital readmissions in heart failure patients. Evidence showed that patient activation affects self-management behaviors in populations living with chronic conditions. The purpose of this study was to describe patient activation level and its relationship with knowledge, self-efficacy and self-management behaviors in heart failure patients discharged from rural hospitals. Our study populations were recruited from two hospitals in rural areas of Nebraska. We found that two-thirds of the participants reported low activation levels (e.g., taking no action to manage their heart failure condition). In addition, low patient activation levels were associated with inadequate heart failure knowledge (p=.005), low self-efficacy (p<.001) and low engagement in heart failure self-management behaviors (p<.001) after discharge from hospital.

Promoting self-management through adherence among heart failure patients discharged from rural hospitals: a study protocol.

Background Heart failure is one of the most prevalent chronic conditions in adults, leading to prolonged morbidity, repeated hospitalizations, and placing tremendous economic burden on the healthcare system. Heart failure patients discharged from rural hospitals, or primarily critical access hospitals, have higher 30-day readmission and mortality rates compared to patients discharged from urban hospitals. Self-management improves heart failure patients' health outcomes and reduces re-hospitalizations, but adherence to self-management guidelines is low. We propose a home based post-acute care service managed by advanced practice nurses to enhance patient activation and lead to the improvement of self-management adherence in heart failure patients discharged from rural hospitals. Objective This article describes the study design and research methods used to implement and evaluate the intervention. Method Our intervention is a 12-week patient activation (Patient AcTivated Care at Home [PATCH]) to improve self-management adherence. Patients were randomized into two parallel groups (12-week PATCH intervention + usual care vs. usual care only) to evaluate the effectiveness of this intervention. Outcomes were measured at baseline, 3 and 6 months. Discussion This study aimed to examine the effectiveness of a rural theory based, advance practice nurse led, activation enhancing intervention on the self-management adherence in heart failure patients residing in rural areas. Our expectation is to facilitate adherence to self-management behaviors in heart failure patients following discharge from rural hospitals and decrease complications and hospital readmissions, leading to the reduction of economic burden. ClinicalTrials.gov; https://register.clinicaltrials.gov/ NCT01964053.

Promoting self-management through adherence among heart failure patients discharged from rural hospitals: a study protocol

Background Heart failure is one of the most prevalent chronic conditions in adults, leading to prolonged morbidity, repeated hospitalizations, and placing tremendous economic burden on the healthcare system. Heart failure patients discharged from rural hospitals, or primarily critical access hospitals, have higher 30-day readmission and mortality rates compared to patients discharged from urban hospitals. Self-management improves heart failure patients’ health outcomes and reduces re-hospitalizations, but adherence to self-management guidelines is low. We propose a home based post-acute care service managed by advanced practice nurses to enhance patient activation and lead to the improvement of self-management adherence in heart failure patients discharged from rural hospitals. Objective This article describes the study design and research methods used to implement and evaluate the intervention. Method Our intervention is a 12-week patient activation (Patient AcTivated Care at Home [PATCH]) to improve self-management adherence. Patients were randomized into two parallel groups (12-week PATCH intervention + usual care vs. usual care only) to evaluate the effectiveness of this intervention. Outcomes were measured at baseline, 3 and 6 months. Discussion This study aimed to examine the effectiveness of a rural theory based, advance practice nurse led, activation enhancing intervention on the self-management adherence in heart failure patients residing in rural areas. Our expectation is to facilitate adherence to self-management behaviors in heart failure patients following discharge from rural hospitals and decrease complications and hospital readmissions, leading to the reduction of economic burden. Clinical Trial Registration Information: ClinicalTrials.gov; https://register.clinicaltrials.gov/ NCT01964053

Promoting self-management through adherence among heart failure patients discharged from rural hospitals: a study protocol.

Background Heart failure is one of the most prevalent chronic conditions in adults, leading to prolonged morbidity, repeated hospitalizations, and placing tremendous economic burden on the healthcare system. Heart failure patients discharged from rural hospitals, or primarily critical access hospitals, have higher 30-day readmission and mortality rates compared to patients discharged from urban hospitals. Self-management improves heart failure patients' health outcomes and reduces re-hospitalizations, but adherence to self-management guidelines is low. We propose a home based post-acute care service managed by advanced practice nurses to enhance patient activation and lead to the improvement of self-management adherence in heart failure patients discharged from rural hospitals. Objective This article describes the study design and research methods used to implement and evaluate the intervention. Method Our intervention is a 12-week patient activation (Patient AcTivated Care at Home [PATCH]) to improve self-management adherence. Patients were randomized into two parallel groups (12-week PATCH intervention + usual care vs. usual care only) to evaluate the effectiveness of this intervention. Outcomes were measured at baseline, 3 and 6 months. Discussion This study aimed to examine the effectiveness of a rural theory based, advance practice nurse led, activation enhancing intervention on the self-management adherence in heart failure patients residing in rural areas. Our expectation is to facilitate adherence to self-management behaviors in heart failure patients following discharge from rural hospitals and decrease complications and hospital readmissions, leading to the reduction of economic burden. ClinicalTrials.gov; https://register.clinicaltrials.gov/ NCT01964053.

The effect of diabetes self-management education on body weight, glycemic control, and other metabolic markers in patients with type 2 diabetes mellitus.

Aims. To comprehensively evaluate the effect of a short-term diabetes self-management education (DSME) on metabolic markers and atherosclerotic parameters in patients with type 2 diabetes. Methods. 76 patients with type 2 diabetes were recruited in this study. They were divided into the intervention group (n = 36) and control group (n = 40). The patients in the intervention group received a 3-month intervention, including an 8-week education on self-management of diabetes mellitus and subsequent 4 weeks of practice of the self-management guidelines. The patients in the control group received standard advice on medical nutrition therapy. Metabolic markers, carotid intima-media thickness (CIMT), and carotid arterial stiffness (CAS) of the patients in both groups were assessed before and after the 3-month intervention. Results. There was a significant reduction in hemoglobin A1c (HbA1c, −0.2 ± 0.56% versus 0.08 ± 0.741%; P < 0.05) and body weight (−1.19 ± 1.39 kg versus −0.61 ± 2.04 kg; P < 0.05) in the intervention group as compared to the control group. However, no significant improvements were found in other metabolic markers, CIMT and CAS (P > 0.05). Conclusions. DSME can improve HbA1c and body weight in patients with type 2 diabetes.

Challenges and Opportunities for Implementing Diabetes Self-Management Guidelines

The purpose of this article was to examine primary care providers' perceived challenges when implementing evidence-based diabetes self-management guidelines and opportunities for promoting the use of such guidelines in practice. We engaged 3 group discussions with 43 key stakeholders representing family physicians, medical directors, and quality assurance leaders in a large, university-affiliated, integrated health care organization in Central Texas. Transcripts from group discussions were summarized using thematic content analysis. Key themes that emerged as challenges of implementing evidence-based diabetes self-management guidelines included lack of easily retrievable electronic patient health information, inadequate coordination with other health care providers when implementing guidelines, conflict between information in the guidelines and physicians' knowledge, and physician compensation by patient load rather than by quality of care. Two main opportunities identified were the use of health coaches or nurses trained in diabetes self-management and active collaboration between practicing providers and key stakeholders in the development and dissemination of guidelines. Our study shows a need for involving front-line family physicians and other primary care providers as well as patients in the design and development of best practice guidelines to enhance implementation of diabetes self-management guidelines in primary care settings.

Improving patient adherence with asthma self-management practices: what works?

Effective asthma control is as dependent on patient behavior as it is on guideline-based asthma therapies. More than for many chronic illnesses, asthma management requires patients to be actively engaged in multiple self-management behaviors, including self-monitoring of symptoms, use of an asthma action plan, environmental control practices, and regular adherence with pharmacotherapy using appropriate device technique. When patients are appropriately adherent with these multiple recommendations there is a strong evidence-base that asthma can be very effectively controlled.1 However, multiple studies have found that poor adherence with asthma self-management is very common and a significant contributor to inadequately controlled asthma.2 Studies in adult and pediatric asthma patients suggest that adherence with controller therapies range from 30-70%.3 Less than half of families with asthma complete prescribed environmental control measures to reduce exposure to triggers such as appropriate cleaning measures,4 and dust mite covers, and only one in five families report willingness for pet removal5. Furthermore, up to 55% of patients with asthma still have frequent exposure to nicotine, despite intensive intervention. 6 Poor adherence to asthma self-management guidelines contributes to greater asthma morbidity and mortality.7 Medication nonadherence has been associated with increased symptoms and healthcare utilization8 and more frequent oral steroid bursts.9 Exposure to secondhand smoke has been associated with lower quality of life scores, greater rescue inhaler use, lower lung function, and greater risk for emergency room visits, hospitalization and intensive care unit admission.10 Because of the central role adherence plays in effective asthma control it is critical for clinicians to pay as much attention to patient behavior as to pharmacotherapy. We outline below key factors in promoting optimal patient adherence.

Psychosocial Impacts of Type 2 Diabetes Self-Management in a Rural African-American Population

This qualitative study explored the underlying psychosocial factors and conditions that may influence type 2 diabetes (T2D) self-management among adult T2D-diagnosed African Americans in the Arkansas Delta. Listening to participants' narratives in their own voices provided meaningful insights in their real-life experiences of T2D-related psychological and emotional challenges in African American social cultural contexts. Self-determination theory was used to conceptualize the participants' motivations for making health behavior changes. Using purposive sampling, 31 participants total (16 women and 15 men) were interviewed. The study participants described their (1) concern over prescribed dietary and physical exercise guidelines as impractical and culturally not relevant to them; (2) doubts over the availability of social supports necessary to implement T2D self-management; and (3) fatalistic expectations of negative outcomes that undermined their self-motivation to follow self-management guidelines. Specific strategies for developing culturally competent T2D self management guidelines and community-based communication outreach initiatives are discussed.

Participants’ perceptions of the factors that influence Diabetes Self‐Management Following a Structured Education (DAFNE) programme

The aim of this study was to understand the experience of participants in the Dose Adjustment for Normal Eating programme and to identify factors that influence participants' implementation of the self-management guidelines. The literature revealed that structured education programmes, such as Dose Adjustment for Normal Eating programme, have many positive outcomes for people with Type 1 diabetes including: a decrease in HbA1c levels, reductions in hypoglycaemic events, reduction in hospital admissions and increased and sustained quality of life. Few researchers, however, have gathered participants' perspectives on the impact of participation in a Dose Adjustment for Normal Eating programme on self-management capacity. A grounded theory design focused on description guided by Corbin and Strauss was used. Data collection and analysis were concurrent using the constant comparative technique. Over 24 months, 2006-2008, interviews were undertaken with 40 participants who had completed a Dose Adjustment for Normal Eating programme in one of five study sites across Ireland. Purposive sampling was used, initially, with theoretical relational sampling towards the end of the interviews as concepts emerged. The interviews lasted from 30-60 minutes and were transcribed verbatim. Five factors that influenced participants' self-management of their diabetes following dose adjustment for normal eating were identified. These were knowledge, support, motivation, relationship shift and empowerment, and these were all related to the core category, 'Being in Control'. Understanding the factors that influence self-management in Ireland is important as it broadens prior knowledge and confirms the factors that are important to facilitate self-management. Understanding the factors that influence the implementation of dose adjustment for normal eating principles can help health professionals give more focused and empowering care to persons with diabetes. Using the persons' experience and expertise is essential as it can help them develop their internal resources.

Treatment of low back pain: monitoring clinical practice through audit

Objectives Back pain is one of the most common causes of disability in the UK. Management guidelines for the treatment of acute back pain have been published. Auditing patients’ physiotherapy treatment records is one way of monitoring standards of care. Standards were developed using published evidence-based treatment, self-management guidelines and local standards within a physiotherapy outpatient department. Design Physiotherapy treatment notes for patients referred with low back pain were audited in 1996 (Audit 1). The audit was repeated in 2001 (Audit 2) after additional standards were implemented following the results of Audit 1. Setting Physiotherapy Outpatient Department, Addenbrooke's NHS Trust Hospital, Cambridge, UK. Results In Audit 1, 66% and 88% of patient records indicated that they were compliant with the standards for acute and chronic back pain, respectively. Sixty-four percent of patients were advised to keep active, 96% showed evidence of diagnostic triage, 65% showed evidence of mobilisation, none were recommended bed rest (100% compliance), and there was no evidence of manipulation. In Audit 2, 57% and 51% of patient records indicated that they were compliant with the standards for acute and chronic back pain, respectively. Thirty percent were considered to be yellow flags, 59% showed evidence of mobilisation, 100% showed evidence of diagnostic triage and did not recommend bed rest, 60% were referred for rehabilitation, and there was no evidence of manipulation. Changes instigated included new appointment and referral systems and new topics for staff education. Conclusion Auditing physiotherapy treatment notes of patients with low back pain has been shown to be useful in monitoring areas of good practice and in identifying practice in need of development. Clinical audit should be seen as a quality improvement process that aims to optimise patient care.

SELF-MANAGEMENT OF ALCOHOL PROBLEMS Among Aging Adults

Alcohol abuse among aging adults is thought to be one of the fastest growing health concerns in the United States. To manage this problem, a stepped-care approach is recommended. This approach consists of brief interventions and, if necessary, a more extensive treatment program to help individuals self-manage their drinking habits. Brief interventions fall within the harm reduction philosophy and normally consist of one to five short sessions. In contrast, The Gerontology Alcohol Project (GAP) offers a more comprehensive treatment protocol for individuals who require enhanced self-management guidelines. Both treatment strategies are supported by research conducted with older alcohol abusers.