Chapter 2 - Foundations of SME and SMS

Question 1

Define: Patient-centered care

Answer 1

Care provided in a manner that respects and reflects the individual’s needs, preferences and values; a patient’s values direct decisions

Question 2

Define: Self-management

Answer 2

The active participation of individuals in achieving their best health and wellness. This involves gaining the confidence, knowledge and skill to manage physical, social, and emotional aspects of life in partnership with health-care teams and community supports

Question 3

Define: Self-management education

Answer 3

A systematic intervention that involves active patient participation in self-monitoring of health parameters and/or decision making (managing).
It involves the ongoing process of facilitating the knowledge, skills and ability necessary todevelop self-care behaviours. It is recognized that a collaborative patient-provider approach with the application of problem solving skills is an essential component in this process

Question 4

Define: Self-management support:

Answer 4

A range of activities offered by organizations, communities and providers that support self-management behaviours across the lifespan and are not necessarily specific to educational processes. These may include behavioral, educational, psychosocial and/or clinical strategies

Question 5

Define: Self-management training

Answer 5

Teaching the skills necessary to manage diabetes.

Question 6

What does CCM stand for and what is it?

Answer 6

Chronic Care Model
- model that defines the relationships between various elements involved in chronic disease management
- “multifaceted, interdependent framework to improve health-care delivery from prevention to advanced management”
- need for partnerships between health systems and communities

See figure 1 in chapter 2

Question 7

Give examples of:
Delivery-system design/reorient health services

Answer 7

• Multidisciplinary teams, expanding roles of educators, case management, system navigators
• Cluster visits, shared care linking providers
• Technology support, telehealth, reminder systems

Question 8

Give examples of
Self-management/ develop person skills

Answer 8

. “Behaviorally sophisticated self-management support that gives priority to developing patients’ confidence and skills so that they can be the ultimate manager of their condition” (7)
• Delivery focused around SME
• Individual portals, websites, interactive technology

Question 9

Give examples of:
Decision Support

Answer 9

Prompted access to clinical practice guidelines, decision algorithms, etc.

Question 10

Give examples of:
Information Systems

Answer 10

• Shared clinical information among all care providers through electronic medical records, registries
• Reminders, tracking systems

Question 11

Give examples of:
Health system organization of health care

Answer 11

• Provincial strategies, funding policies
• Outcome evaluation systems, accreditation
• Standards

Question 12

Give examples of:
Strengthen community action

Answer 12

Resources available
Community supporters
Community partnerships

Question 13

Give examples of:
Build healthy public policy

Answer 13

Provincial strategies, funding policies
Outcome evaluation systems, accreditation
Standards

Question 14

Give examples of:
Create supportive environments

Answer 14

Parks available with bicycle paths
Green spaces for safe walking

Question 15

ICP and IPE

Answer 15

Interprofesional collaborative practice (ICP)
Interprofesional education (IPE)

Question 16

Compliance vs. Empowerment approach

Answer 16

Compliance - a prescription defined by the healthcare provider to follow.
Empowerment- a process designed to facilitate self-directed behaviour change

“Adults are more likely to make and maintain behaviour changes if changes are personally meaningful and freely chosen”

Question 17

Empowering interventions a include:

Answer 17

• Acceptance (unconditional, positive regard)
• Affect (exploring the emotional content of a problem)
• Autonomy (decision-making by the person with diabetes)
• Alliance (providing help and information for informed decision-making)
• Active participation (participation and active listening by both/all parties)

Question 18

4 key times when people with diabetes require assessment/reassessment and/or changes in their treatment plan:

Answer 18

1.) Diagnosis
2.) Annual Assessment
3.) Development of Complications
4.) Transition Periods (pregnancy, insulin initiation, etc)

Question 19

Goal of SME:

Answer 19

Personal engagement for informed, effective diabetes self-management

Key Principles:
(SME) interventions should:
Be collaborative and interactive
Be individualized to address a patient’s needs
Share knowledge technical skills and problem-solving
Enhance self-care training skills
Facilitate motivation and confidence to take action and Improve one’s quality of life
Be repeatedly reinforced

Question 20

5 Elements of SME

Answer 20

Assess
Educate
Collaborate
Set goals
Follow-Up

Interventions:
- monitor
- manage
- promote

Intervention areas:
- Nutrition
- Exercise
- Psychological
- Medication

Question 21

Define: self management support (SMS)

Answer 21

Diabetes self management support is defined as strategies that augment in individual Silletti to self manage their diabetes

SMS include activities that support the implementation and maintenance of behaviours for ongoing diabetes self management.
SMS also refers to the policies and people that support self-management behaviours across the lifespan, not necessarily specific to educational processes.

Question 22

Define: Health Coaching

Answer 22

(Individual or group)
Engagement, where there is, health related, education, behavior change, and support by health care professionals

Diabetes health coaching has been shown to decrease A1c by up to 0.5% compared to structured education and usual care

Question 23

Technology enabled self-management (TES) - 4 key components the most successful technologies share:

Answer 23

1.) two-way communication between patient and provider
2.) patient generated health care data analysis
3.) education
4.) feedback

Question 24

Andragogy

Answer 24

“The art and science of helping adults learn”
Malcom’s Knowles - father of adult education

Question 25

4 basic principles of adult learning

Answer 25

1. Adults relate bette to interactive learning where they discover themselves rather than lecture-style learning
2. Accumulated experiences are rich resources for learning. New learning should be referenced or connected to past experience.
3. Adults tend to have problems centred orientation to learning. Learning is goal directed as opposed to content driven.
4. Readiness to learn in adult is often related to developmental tasks. Required for a social role. People like to know “what’s in it for me” .Learning must be relevant to the situation.

Question 26

TTM

Answer 26

Trans. Theoretical model of change.
1 - precontemplation (not considering change for > six months)
2 - contemplation
3 - preparation
4 - action
5 - maintenance (doing it for >6 months)