Self-management Plan Research Articles

Children and young people need to be engaged in asthma treatment

Despite clear guidelines and recommendations for the education of and inclusion of patients in the development of personalised asthma self-management plans (British Thoracic Society and Scottish Intercollegiate Guideline Network 2016, Royal College of Physicians 2014), national audits report continued and unacceptable asthma-associated morbidity and mortality in the UK (Royal College of Physicians 2014, Hagell et al 2017).

Use of Group Concept Mapping to Identify Patient Domains of Uncertainty That Contribute to Emergency Department Use

IntroductionPrior research suggests that uncertainty related to symptoms is a driver of emergency department (ED) use, and that patients often leave the ED with uncertainty not being addressed. Our objective was to engage patients to identify domains that contribute to feelings of uncertainty and decisions to use the ED. MethodsWe used Group Concept Mapping, a quasi-qualitative/quasi-quantitative method, to elicit patients’ views on how uncertainty related to experiencing symptoms contributes to decisions to access the ED. Purposive sampling was used to recruit participants who either sought treatment at the ED twice within a 30-day period, or visited both the ED and a primary care provider at least once within the past year. ResultsThirty-four participants engaged in two rounds of Group Concept Mapping during which participants participated in structured brainstorming of ideas, followed by ranking and clustering of ideas into domains. The first round generated 47 idea statements reflecting uncertainty about consequences, severity, emergency room services, primary care options, finances, and psychologic concerns. The second round generated 52 idea statements reflecting uncertainty about self-management, causation, diagnosis and treatment plan, trust in the provider and institution, accessibility, and alternative care options. DiscussionFactors that contribute to uncertainty and decision-making about ED use are both intrinsic (ie, cause, symptom severity) and extrinsic (ie, finances, accessibility). These domains can inform approaches to measure the uncertainty that patients experience, and to design and test interventions for nurses and other providers to help manage patient uncertainty during acute illness.

The increasing burden of asthma in South African children: A call to action

Background. Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, as well as airway reversibility. The burden of asthma in children is increasing in low- and middle-income countries and remains under-recognised and poorly managed. Objectives. To quantify the burden of asthma in the South African (SA) population and identify the risk factors associated with disease severity in the local context. Methods. The SA Childhood Asthma Working Group (SACAWG) convened in January 2017 with task groups, each headed by a section leader, constituting the editorial committee on assessment of asthma epidemiology, diagnosis, control, treatments, novel treatments and self-management plans. The epidemiology task group reviewed the available scientific literature and assigned evidence according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system. Conclusions. Asthma in children remains a common condition, which has shown an increasing prevalence in urban and rural populations of SA. Of concern is that almost half of children in urban communities experience severe asthma symptoms, and many asthmatics lack a formal diagnosis and thus access to treatment. Exposure to tobacco smoke and living in highly polluted areas increase the severity of wheezing in young children.

The diagnosis of asthma in children: An evidence-based approach to a common clinical dilemma

Background. Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, as well as airway reversibility. The diagnosis of asthma in young children is limited by the inability to perform objective lung function testing in this group of patients and the wide variety of conditions that can phenotypically present with asthma-like symptoms. Objectives. To provide an evidence-based approach for clinicians to accurately diagnose asthma in young children and to assess the level of control to guide therapeutic decisions. Methods. The South African Childhood Asthma Working Group (SACAWG) convened in January 2017 with task groups, each headed by a section leader, constituting the editorial committee on assessment of asthma epidemiology, diagnosis, control, treatments, novel treatments and self-management plans. The asthma diagnosis and control task groups reviewed the available scientific literature and assigned evidence according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system, providing recommendations based on current evidence. Conclusions. Asthma in young children should only be diagnosed if all other causes of wheezing have been considered and excluded, and if there is a response to a therapeutic trial and worsening with withdrawal of asthma medication. Asthma control should be assessed at each visit to guide therapeutic decisions.S Afr Med J 2018

Model construction of self-management behavior in senile patients with chronic heart failure based on AMOS

Objective To build a model of self-management behavior for senile patients with chronic heart failure (CHF) based on Bandura's self-efficacy theory and Clark's chronic disease self-regulation model aged CHF patients and to provide scientific evidence for formulating self-management interventions and plans for senile CHF patients. Methods Totally 881 CHF patients were investigated in 30 hospitals from 6 districts of Shanghai from December 2014 to March 2016. The statistical software AMOS 21.0 was used to conduct the path analysis, include various influencing factors, and build systematically an equation model demonstrating the internal mechanism of self-management behaviors. Results The score of self-management of aged CHF patients was (50.2±9.8) . Self-concept, per capita income, heart function grading, avoidance as response, self-care ability, quality of life, resignation as response and education level were included into the multiple regression equation of self-management, and these variables accounted for 20.8% of the total variation. The structural equation model demonstrating the influencing factors of self-management for senile CHF patients fit better, and all path coefficients reached a significant level, suggesting that self-efficacy had only indirect effect on the self-management of senile CHF patients, while self-concept, per capita income, heart function grading, avoidance as response, self-care ability, quality of life, resignation as response and education level had both direct and indirect effect on their self-management. Conclusions The self-management of senile CHF patients remains at a medium and low level on the whole, and symptom management is the worst. This study has constructed a model demonstrating the internal mechanism of self-management behaviors in senile CHF patients, suggesting that medical staff should take targeted and systematic interventions according to the general condition of patients and their self-efficacy and self-concept to help improve their self-management level. Key words: Heart failure; Agde; Self-management; Structural equation model

Quadrupling Inhaled Glucocorticoid Dose to Abort Asthma Exacerbations

BackgroundAsthma exacerbations are frightening for patients and are occasionally fatal. We tested the concept that a plan for patients to manage their asthma (self-management plan), which included a temporary quadrupling of the dose of inhaled glucocorticoids when asthma control started to deteriorate, would reduce the incidence of severe asthma exacerbations among adults and adolescents with asthma.MethodsWe conducted a pragmatic, unblinded, randomized trial involving adults and adolescents with asthma who were receiving inhaled glucocorticoids, with or without add-on therapy, and who had had at least one exacerbation in the previous 12 months. We compared a self-management plan that included an increase in the dose of inhaled glucocorticoids by a factor of 4 (quadrupling group) with the same plan without such an increase (non-quadrupling group), over a period of 12 months. The primary outcome was the time to a first severe asthma exacerbation, defined as treatment with systemic glucocorticoids or an unscheduled health care consultation for asthma.ResultsA total of 1922 participants underwent randomization, of whom 1871 were included in the primary analysis. The number of participants who had a severe asthma exacerbation in the year after randomization was 420 (45%) in the quadrupling group as compared with 484 (52%) in the non-quadrupling group, with an adjusted hazard ratio for the time to a first severe exacerbation of 0.81 (95% confidence interval, 0.71 to 0.92; P=0.002). The rate of adverse effects, which were related primarily to local effects of inhaled glucocorticoids, was higher in the quadrupling group than in the non-quadrupling group.ConclusionsIn this trial involving adults and adolescents with asthma, a personalized self-management plan that included a temporary quadrupling of the dose of inhaled glucocorticoids when asthma control started to deteriorate resulted in fewer severe asthma exacerbations than a plan in which the dose was not increased. (Funded by the Health Technology Assessment Programme of the National Institute for Health Research; Current Controlled Trials number, ISRCTN15441965.)

Reaching out to diabetic soles: Outreach foot care pilot project.

Objectives:To assess the effectiveness of outreach foot care services as a tool for engagement with isolated vulnerable seniors. To improve foot health of diabetic seniors, thus avoiding expensive and potentially life-threatening diabetic complications.Methods:Four validated tools are used to gather data: InLow 60-second Diabetic Foot Screen©, Short Diabetes Knowledge Instrument for Older and Minority Adults, Brief Healthcare Questionnaire (Patient Health Questionnaire-9), and the Health-Related Quality of Life Questionnaire.Results:Five monthly visits to 20 participants resulted in multiple co-morbidities being identified, improvements in foot status and diabetic knowledge realized, and determinants of health addressed. Seniors needed support and resources to engage in diabetes self-management.Conclusion:The importance of regular foot care as a key element of any self-management plan for diabetes cannot be understated, nor can increasing social services spending to include coverage for foot care thereby avoiding expensive healthcare. Using foot care as a tool for engagement conferred access to vulnerable seniors who ultimately benefited from healthcare and social interactions with a provider.

Supporting patients self-managing respiratory health: a qualitative study on the impact of the Breathe Easy voluntary group network.

Self-management strategies are designed to improve lung and respiratory health through structured self-management plans with regular practitioner reviews. Strategies have not, however, focused upon how patient support groups and advocacy networks can help with the management of these conditions; therefore, it is unknown what impact they may have on patient self-management. A qualitative study was designed to help understand what impact the British Lung Foundation's Breathe Easy (BE) groups have on patients managing their lung and respiratory conditions.A semistructured telephone interview schedule was developed to study the network. Topics covered included: perceptions about the BE groups; current referrals systems and integration pathways; benefits of attending the BE groups; and integration of the BE groups into the respiratory pathway.Key themes explored included: shared patient experience and peer support; patient self-management and self-education; attendance of healthcare professionals; and the impact of integrating BE groups into the respiratory pathway.BE networks were shown to support self-care initiatives for people attending the groups, and members expressed a social and educational benefit. BE networks were working with the local National Health Service to become an integral part of the respiratory pathway, yet there was evidence of resistance from the health service in incorporating the networks.

Accuracy of physical activity recognition from a wrist-worn sensor

Purpose: The EU-funded project “selfBACK” (http://www.selfback.net/) will utilise continuous objective monitoring of physical activity (PA) by a wrist-mounted wearable, combined with self-monitoring of symptoms and case-based reasoning. Together these will provide personalised self-management plans to people with low back pain via a novel digital health intervention. The purpose of this study was to determine the accuracy of PA recognition via wrist-mounted sensors compared to thigh-mounted sensors. Thigh or hip-mounted sensors have previously been shown to be the most accurate placement for single sensor-based PA monitoring. However, long-term adherence may be greatly enhanced with a less obtrusive wrist-worn sensor. It was therefore important to compare both locations.

Improving service user self-management: development and implementation of a strategy for the Richmond Response and Rehabilitation Team.

Community rapid response and rehabilitation teams are used to prevent avoidable hospital admissions for adults living with multiple long-term conditions and to support early hospital discharge by providing short-term intensive multidisciplinary support. Supporting self-management is an important service intervention if desired outcomes are to be achieved. A Care Quality Commission inspection of the Richmond Response and Rehabilitation Team in 2014 identified that self-management plans were not routinely developed with service users and reported this as requiring improvement. This quality improvement project aimed to develop and implement a self-management strategy for service users and for 90% of service users to have a personalised self-management plan within 3 months. The quality improvement intervention used the Plan-Do-Study-Act model comprising: (1) the development of a self-management plan, (2) staff education to support service users to self-manage using motivational interviewing techniques, (3) piloting the self-management plan with service users, (4) implementation of the self-management plan and (5) monthly audit and feedback. Evaluation involved an audit of the number and quality of self-management plans developed with service users and a survey of staff knowledge and confidence to support service users to self-manage. Following implementation of the intervention, the number of self-management plans developed in collaboration with service users increased from 0 to 187 over a 4-week period. Monthly audit data confirmed that this improvement has been sustained. Results indicated that staff knowledge and confidence improved after an education intervention. Quality improvement methods facilitated development and operationalisation of a self-management strategy by a community rapid response and rehabilitation team. The next phase of the project is to evaluate the impact of the self-management strategy on key service outcomes including self-efficacy, unplanned and emergency hospital admissions and early discharges.

A Qualitative Study Exploring Models of Supportive Care in Men and Their Partners/Caregivers Affected by Metastatic Prostate Cancer.

To explore the experiences of patients with metastatic prostate cancer and their partners/caregivers, as well as an interprofessional team, with a nurse-led multimodality supportive care intervention. . Qualitative study. . National Health Service (NHS), Tayside, Scotland. . 19 patients, 7 partners/caregivers, and 7 interprofessional members from four hospitals in NHS, Tayside, Scotland. . 33 semistructured interviews were conducted to explore patients' and partners/caregivers' experiences of supportive care, and a framework approach was used to analyze the data. . Men and their partners/caregivers experienced a range of unmet physical, psychological, and informational supportive care needs. The participants in the intervention group reported overall high satisfaction with the use of holistic needs assessments and self-management plans, with a decrease in unmet needs compared to the standard of care over time. The prostate cancer specialist nurse was perceived as the hub of survivorship care. Members of the interprofessional team perceived benefit in the nurse-led multimodal supportive care intervention. . An emphasis needs to be placed on personalizing care, with supportive care interventions targeted to individual needs. . Care can be improved by incorporating holistic needs assessment to target specialized interventions for optimized, individualized care plans. An intervention seminar encouraged self-management and self-efficiency, leading to greater satisfaction for participants.

Implementing Respiratory Integrated Care: the Future for COPD Diagnosis and Management?

Ireland has the highest rate of admissions for COPD in the Organisation for Economic Co-operation and Development (OECD) countries.1 Part of the explanation for this may reside in lack of resources for diagnosis and management in the community. An integrated model of care was developed as part of the Clinical Care programme for chronic disease management. The first respiratory integrated care post commenced in April 2016 providing the services of a clinical nurse specialist (CNSp) and/or a respiratory specialist physiotherapist to both primary and secondary care. Caseload comprised of patients with asthma and COPD. Challenges and successes were documented in a diary, patient outcomes recorded on an excel spreadsheet. Patients are selected and booked in by G.P practice. The CNSp assesses patients and records notes directly onto G.P software. The specialist consultant in secondary care then reviews this assessment and assists CNSp in accurately reporting on the patients’ spirometry results. From the first clinic July 19th to 30th of September 2016 patient statistics were collated, 45 patients were reviewed by the CNSp. Of these 22 had asthma and 15 COPD, 20 had the GP diagnosis confirmed, 10 had new diagnosis of asthma and 7 COPD, 3 had an alternative diagnosis found. Three patients were unable to perform spirometry for varying reasons, 2 patients had respiratory disease ruled out. All patients received health advice to support the self-management of their condition including inhaler technique and emergency self-management plans. Preliminary feedback from G.Ps and patients has been very positive. Challenges identified were difficulty with electronic communication between primary & secondary care and lack of overall IT set-up/planning for the programme. Respiratory integrated care (RIC) provides accurate diagnosis with evidence based cohesive management in primary care. More collaboration and communication is required to streamline this service further.

Self-management behaviour and support among primary care COPD patients: cross-sectional analysis of data from the Birmingham Chronic Obstructive Pulmonary Disease Cohort

Self-management support for chronic obstructive pulmonary disease (COPD) patients is recommended by UK national guidelines, but extent of implementation is unknown. We aimed to describe self-management behaviour and support among COPD patients and explore behaviour associated with having a self-management plan. We undertook cross-sectional analysis of self-reported data from diagnosed COPD patients in the Birmingham COPD Cohort study. Questionnaire items relevant to self-management behaviour, knowledge of COPD, receipt of self-management plans and advice from healthcare professionals were examined. Multiple regression models were used to identify behaviour associated with having a self-management plan. One-thousand seventy-eight participants (676 males, 62.7%, mean age 69.8 (standard deviation 9.0) years) were included. The majority reported taking medications as instructed (940, 94.0%) and receiving annual influenza vaccinations (962, 89.2%). Only 400 (40.4%) participants had self-management plans, 538 (49.9%) reported never having received advice on diet/exercise and 110 (42.7%) current smokers had been offered practical help to stop smoking in the previous year. General knowledge about COPD was moderate (mean total Bristol COPD Knowledge Questionnaire score: 31.5 (standard deviation 10.7); max score 65), corresponding to 48.5% of questions answered correctly. Having a self-management plan was positively associated with self-reported adherence to medication (odds ratio 3.10, 95% confidence interval 1.43 to 6.72), attendance at a training course (odds ratio 2.72, 95% confidence interval 1.81 to 4.12), attendance at a support group (odds ratio 6.28, 95% confidence interval 2.96 to 13.35) and better disease knowledge (mean difference 4.87, 95% confidence interval 3.16 to 6.58). Primary care healthcare professionals should ensure more widespread implementation of individualised self-management plans for all patients and improve the lifestyle advice provided.

A Model of Consultation in Prostate Cancer Care: Evidence From a Systematic Review.

There has been an evolution of various consultation models in the literature. Men affected by prostate cancer can experience a range of unmet supportive care needs. Thus, effective consultations are paramount in the delivery of supportive care to optimize tailored self-management plans at the individual level of need. The aim of this study is to critically appraise existing models of consultation and make recommendations for a model of consultation within the scope of clinical practice for prostate cancer care. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement Guidelines. Electronic databases were searched using a wide range of keywords and free text items to increase the sensitivity and inclusiveness of the searches. Findings were integrated in a narrative synthesis. A total of 1829 articles were retrieved and 17 papers were included. Beneficial features ranged across a number of models that included a person-centered consultation, shared management plans, and safety netting. None of the reviewed models of consultation are suitable for use in prostate cancer care because of a range of limitations and the clinical context in which models were developed. A Cancer Care Consultation Model was informed from critical appraisal of the evidence and expert clinical and service user comment. Further research is needed to empirically test consultation models in routine clinical practice, specifically for advanced cancer specialist nurses. The Prostate Cancer Model of Consultation can be used to structure clinical consultations to target self-management care plans at the individual level of need over the cancer care continuum.

Type 2 Diabetes Mellitus in Children and Adolescents: An update

Childhood type 2 Diabetes Mellitus (DM) has increasingly been reported worldwide. It is commonly associated with childhood obesity.It may be presented with classical manifestation of DM such as polyuria, polydipsia, weight lossor acute complications like Diabetic ketoacidosis (DKA), Hyperglycemic Hyperosmolar State (HHS) or features of insulin resistance syndrome. Many a cases it may remain asymptomatic and hence undiagnosed.So,overweight children and adolescents who met screening criteria such as family history of type 2 DM, signs of insulin resistance, and high risk ethnics should undergo screening. Emphasis should be given on early diagnosis and optimum management plan to avoid grave consequences of it in early part of life. Diagnosis of type 2 Diabetes Mellitus in children should be done on the basis of standard diagnostic criteria such as American Diabetic Association (ADA) criteria. Both non-pharmacological and drug management are important equally. Multidisciplinary team approach including self-management plan is mandatory for obtaining optimal therapeutic goals of type 2 DM in children and adolescents. Lifestyle modification, dietary intervention, weight reduction, patient education, psychological support, and oral anti diabetic drugs and insulin therapy should be included in comprehensive diabetic management plan. Complications of type 2 DM should be minimized by all means with strict glycemic control and management of co-morbidity if any. Emphasis should also be given on prevention of type 2 DM by adopting a healthy lifestyle characterized by healthy eating behavior, regular physical activity and subsequent modest weight loss that can prevent the progression of impaired glucose tolerance to clinical diabetes mellitus.J Bangladesh Coll Phys Surg 2017; 35(1): 24-30

Personalised asthma action plans for adults with asthma.

Personalised asthma action plans for adults with asthma.

How chronic disease affects children's views on being ill and healthy: a comparative study

Understanding children's views of illness and health is vital to a child-centred approach in patient education and care. Paediatric healthcare providers should incorporate children's views of health and illness to enable children and their families to participate in self-management plans and achieve better health outcomes. However, there is limited scientific knowledge regarding the views of children with specific diseases. This comparative study investigated whether and in what ways the experience of having different chronic diseases influenced children's views of being ill and healthy. The participants were 82 children aged 8-13 years diagnosed with a chronic disease (31 had asthma, 27 had diabetes and 24 had cancer). A group of 81 healthy children participated as a comparison group. The 'draw-and-write' technique was used to collect the children's views, and the data were analysed using a previously validated coding system (inter-rater agreement of 93%) and subsequently quantified for the examination of any differences in relation to illness. Statistically significant differences were found in all dimensions of the children's conceptions of health and illness according to whether they had a chronic condition (effect sizes calculated with Cohen's d ranged from 0.35 to 1.22). Globally, the chronically ill children expressed a narrower definition of being healthy and ill than their healthy peers. Moreover, the comparison among the children with asthma, diabetes and cancer showed differences that seemed to reflect their specific experiences with their type of chronic disease and the associated treatments (effect sizes calculated with Eta-squared ranged from 0.07 to 0.25). This study's findings can be used to guide education and clinical services tailored to ill children suffering from different chronic conditions.

Using Digital Health Technology to Prevent and Treat Diabetes.

This year's article on health information technology (HIT) illustrates the use of digital technology to prevent and treat diabetes by enabling consumer engagement, behavior change, and impact analytics. It provides a snapshot of current thinking about digital technology's capabilities and capacity to deliver personalized interventions at scale. Early results are promising. A growing number of digital programs are clinically proven to improve health and lower the cost of care. And pioneering health-care organizations are offering these programs to members and patients as part of their new models for value-based care. Their success will drive other organizations—payers, providers, and employers—to make similar investments in health. In the modern health-care world, experts agree that “value” will be created by enabling health, not just delivering care. With today's epidemic of diabetes, patients who use digital health technologies can benefit greatly from both short-term health improvements and long-term health self-management. The foundations have been laid with evidence-based programs. Now, more health-care organizations must embrace this population management strategy for health. As adoption increases, the next technology challenge will arise: consumer engagement at scale. This engagement will be digital: content-rich programs filled with social support to activate, educate, and engage consumers. Most of the articles included in this and prior ATTD Yearbook articles address the specifics of digital interventions once the person enrolls. But before enrollment, consumers must engage. And to engage consumers, one must understand their reasons for engaging and their expectations for results. These insights fall into the realm of digital marketing, rather than the domain of clinical programs. Using a multidisciplinary approach, digital engagement will be the next variable to solve in the equation for scalable digital health. Not for a lack of trying, we have been unable to find noteworthy articles presenting best practices for consumer engagement from outreach to enrollment. But the future looks quite bright for the science of marketing digital health interventions. Increasingly, “big data” is providing scientists, innovators, entrepreneurs, educators, health-care providers, and administrators with the insights they need to predict consumer interests and personalize experiences throughout the entire behavior change process—from outreach to outcomes. Over the coming year, we will continue to search the health-care landscape to bring more innovations in digital health and diabetes prevention, from consumer engagement to population impact.

Experiences of Living with Dyspnea Among Taiwanese People with Chronic Obstructive Pulmonary Disease: A Qualitative Study

Purpose: Dyspnea is the primary complaint among patients with chronic obstructive pulmonary disease (COPD) and is a subjective physical experience responsible for considerable distress in patients. However, to date, research has tended to focus on measuring the severity of dyspnea, with few studies considering the subjective experiences among people living with COPD. The current study explored the experiences of living with dyspnea among patients with COPD. Methods: In this qualitative descriptive study, we examined 12 purposively sampled outpatients with COPD from the Pulmonary Medicine Department. One-on-one in-depth interviews were conducted to collect information. Data reduction, data display and conclusion drawing that three-step method was adopted to analyze the data. Results: Based on interview data analysis, 6 themes were devised regarding the dyspnea experiences of participants: (a) internal urgent situation signal resulting from a life-threatening incapability to respire; (b) triggering and straining; (c) constraints in life caused by insufficient inhalation; (d) immediate self-rescue strategies; (e) awareness of maintain health in daily life; and (f) coexistence with the disease and redefine self-concept. Conclusions: As COPD progresses, people living with COPD experienced discomfort and developed self-rescue strategies by identifying the risk factors for dyspnea as well as measures for symptom deterioration. Most participants experienced loss of activity or physical functions in their daily lives, prompting them to begin reposition themselves. To maintain the existing functions of the patients is the main goal for both medical staffs and patients. The findings of this study can serve as a reference for medical teams to devise self-management plans for patients with COPD.

Health psychology: supporting the self-management of long-term conditions.

This article considers how knowledge of health psychology can help nurses support patients in managing their long-term conditions. The concept of 'self-management' is defined and the need for self-efficacy-the patient's confidence in their ability to manage-and social support is highlighted. Patients' 'illness perceptions', or beliefs about the nature of their condition, also have an impact on their self-management. This is discussed in particular relation to adherence to treatment. A distinction is made between intentional and non-intentional non-adherence. Understanding of the many factors, other than lack of knowledge, that influence self-management success will help nurses and patients work together to develop an effective self-management plan.