5. Patient involvement in the management of chronic disease Flashcards
What are the 6 quality dimensions for LTC?
Patient centred Safe Effective Efficient Equitable Timely
What is needed so that the 6 dimensions of LTC are met?
- Effective partnerships between people with LTC and proactive multi-professional care teams
- Government and local initiatives e.g. LTC Action Plan with an emphasis on self-efficacy and self-management
- Integrated services
- Evidence-based medicine and clinical guidelines supported by standards, education, practice and Managed Clinical Networks (MCNs)
- Data collection, Quality Framework, Government performance targets e.g. Health, Efficiency, Access and Treatment (HEAT) targets
What are the 5 HEAT Targets for LTC?
- T6: Reduce long term conditions admissions/bed days
- T7: Improve quality of health care experience
- T8: Increase Complex Care at home
- T10: Reduce rate of attendance at A&E
- T12: Reduce 65+ emergency bed days
What are the 3 levels of care for LTC?
Level 1= Self management
Level 2= Disease-specific care management
Level 3= Intensive care/case management
Describe level 1 of LTC care?
SELF MANAGEMENT
Collaboratively helping individuals and their carers to develop the knowledge, skills and confidence to care for themselves and their condition effectively
Describe level 2 of LTC care?
DISEASE-SPECIFIC CARE MANAGEMENT
Target: People
who have complex single need or multiple
conditions
Aim: Provide responsive, specialist services using multi-disciplinary teams
and disease-specific protocols and pathways such as the National Service Frameworks and Quality and Outcomes Framework
Describe level 3 of LTC care?
INTENSIVE CARE/CASE MANAGEMENT
Requires the identification of
the very high intensity users
of unplanned secondary care.
Care for these patients is
managed using a case management approach,
to anticipate, coordinate and join up health and social care
What are the 5 key stages where self management counts in patients with LTC?
Diagnosis Living for today Progression Transitions End of life
What are the issues associated with the diagnosis stage, and what is the impact of self management?
Issues:
Symptoms and life impact
Challenge re: place in world and situation
Impact of self management:
Coming to terms
Re-connection to self and others
Help with treatment decisions
What are the issues associated with the Living for Today stage, and what is the impact of self management?
Issues:
Skills and information for optimal wellbeing
Risk of social exclusion
Impact of self management:
Coping with journey
Facilitates inclusion and bridge building
What are the issues associated with the progression stage, and what is the impact of self management?
Issues:
Illness cycles/fluctuation Increased severity Flare-up support Possible capacity loss
Impact of self management:
Recognising and managing flare-up/early intervention/progression/
changing needs
What are the issues associated with the transitions stage, and what is the impact of self management?
Issues:
Moving between services Multiple co-morbid needs Highly stressful
Impact of self management:
Support to manage transitions
Maintaining focus on patient needs and personal control
What are the issues associated with the end of life stage, and what is the impact of self management?
Issues:
Difficult times, complex challenges -premature death, lifestyle risk factors
Symptoms + other issues
Impact of self management:
Support to manage challenges and maintain control
Address broader family and emotional needs
What is self management?
Self-management is a concept where the person takes ownership and is central
- Process of becoming empowered to manage life with LTC
- Requires individuals and health professionals working in partnership
- Concerned with problem solving, decision making and confidence
What is the role of self-management programmes?
- Self-management programmes do not conflict with existing programmes or treatment
- Designed to enhance regular treatment and condition-specific education such as pain management, cardiac rehabilitation, diabetes instruction
- Teach patients skills to co-ordinateallthe things needed to manage health and keep active
Define self-efficacy?
The belief in one’s capabilities to organise and execute the course of action required to manage prospective situations
It influences:
– the choices we make
– the effort we put in
– how long we persist when we have obstacles in our way – how we feel
People with low self-efficacy toward a task are more likely to _____ it, while those with high self-efficacy are more likely to ____ the task
People with low self-efficacy toward a task are more likely to avoid it, while those with high self-efficacy are more likely to attempt the task
Self-efficacy is based on what? (5)
Past performance Vicarious experiences Verbal persuasion Physiological cues It is not a stable trait
4 ways to encourage self-efficacy?
- Skills mastery via action planning
- Modelling
- Helping people to reinterpret meaning of symptoms – challenging health beliefs
- Social persuasion – group work
What is the EPP?
How does it aim to support people?
Expert Patient Programme
A self-efficacy programme for people living with a chronic condition
6 weeks long and is free
Strategies to support people:
- Increasing their confidence
- Improving their quality of life
- Helping them manage their condition more effectively
Topics covered in EPP course
- dealing with pain and extreme tiredness
- coping with feelings of depression
- relaxation techniques and exercises
- healthy eating
- communicating with family, friends and healthcare professionals
- planning for the future
What does KPMP stand for?
Kingdom Chronic Pain Self- Management Programme
What is the Kingdom Chronic Pain Self- Management Programme?
- Group format, 10 weekly sessions, 2-2.5 hours
- Delivered by a multidisciplinary team in primary or
secondary care settings
- Consists of education and guided practice on pain physiology, pain psychology, healthy function, problem- solving, goal-setting, changing unhelpful thinking patterns and relaxation skills.
- Use of cognitive behavioural principles to deliver components of programme
How is the outcome of self management evaluated?
- Questionnaires/interviews/ behavioural observations to monitor change
- Distress/emotional impact of pain
- Beliefs and thinking biases
- Range and level of activity
- Pain experience
- Healthcare use and work status where relevant
