Self Management Programs: Better Choices, Better Health Powerful Tools for Caregiviers. Marie Mulroy May 12, 2105

Transcription

1 Self Management Programs: Better Choices, Better Health Powerful Tools for Caregiviers Marie Mulroy May 12, 2105

2 ONCE A CHRONIC DISEASE IS PRESENT, ONE CANNOT NOT MANAGE, THE ONLY QUESTION IS HOW. (Bateson 1980, Lorig, 2003)

3 Chronic Care Model Community Resources and Policies Self- Management Support Health System Health Care Organization Delivery System Design Decision Support Clinical Information Systems Informed, Activated Patient Productive Interactions Prepared, Proactive Practice Team Improved Outcomes

4 Individuals with Chronic Disease Have significant reduced productivity Live with less income Accomplish less normal activities Spend more time in bed sick Tend to feel less in contol of their lives

5 Some Evidence-Based Programs SELF-MANAGEMENT Chronic Disease Self-Management Tomando Control de su Salud Chronic Pain Self-Management Diabetes Self-Management Program PHYSICAL ACTIVITY Enhanced Fitness & Enhanced Wellness Healthy Moves Fit & Strong Arthritis Foundation Exercise Program Arthritis Foundation Walk With Ease Program Active Start Active Living Every Day MEDICATION MANAGEMENT HomeMeds FALL RISK REDUCTION Stepping On Tai Chi Moving for Better Balance Matter of Balance DEPRESSION MANAGEMENT Healthy Ideas PEARLS CAREGIVER PROGRAMS Powerful Tools for Caregivers Savvy Caregiver NUTRITION Healthy Eating DRUG AND ALCOHOL Prevention & Management of Alcohol Problems

6 BETTER CHOICES BETTER HEALTH Stanford s Chronic Disease Self Management Program

7 What Is it? Stanford Based Program 2.5 hours/week Six weeks Community workshop Led by two trained co-leaders

8 Who Should Attend People with at least one chronic condition A family member, friend or caregiver of someone with a chronic condition

9 Chronic Disease Self Management Assumptions: Patients with different chronic diseases have similar self-management problems and disease-related tasks. Patients can learn to take day-to-day responsibility for their diseases. Confident, knowledgeable patients practicing self-management will experience improved health status and use fewer health resources. Source: Lorig and Holeman 2003

10 Self Managing with a Chronic Disease Involves: Taking care of your illness (using medicines, exercise, diet, technology, physician partnership) Carrying out normal activities (employment, chores,social life) Managing emotional changes (anger, uncertainty about the future, changed expectations and goals, and depression)

11 Better Choices, Better Health Program Content Week Week Week Week Week Week Overview of self-management and chronic health conditions Using your mind to manage symptoms Getting a good night s sleep Making an action plan Feedback and problem-solving Dealing with difficult emotions Physical activity and exercise Preventing falls Making decisions Pain and fatigue management Better breathing Healthy eating Communication skills Medication usage Making Informed treatment decisions Dealing with depression Working with your health care professional and system Weight management Future plans

12 Participant s Learn How to Manage the Symptom Cycle... Shortness Of Breath Fatigue Poor Sleep Symptom Cycle Physical Limitations Pain Depression Stress/Anxiety Difficult Emotions

13 Using the Self-Management Tool Box Problem Solving Medications Breathing Techniques Physical activity Decision Making Sleep Using Your Mind Action Planning Weight Management Healthy Eating Working with Health Professionals Understanding Emotions

14 Participants Report Fewer participants indicated that health issues were interfering with their daily Activities More participants made list of questions to take to their providers appointments Increase in individual s confidence in being able to handle their diseases More Participants were stretching and incorporating strength training A doubling of people who reported walking three times a week Source: Oct.2014 SNHAHEC Report

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16 Powerful Tools For Caregivers Is designed to provide caregivers the tools to increase their self-care Increase their confidence to handle difficult situations, emotions, Thrive-- not just survive as caregivers

17 What Is it: Stanford Based Program 2.5 hours/week or 90 minutes/week Six weeks Community workshop Led by two trained co-leaders

18 Overview of Program Caregiver s self-care behaviors Management of Emotions Self-Efficacy Use of Community Resources 18

19 Powerful Tools for Caregivers Empower family caregivers to take better care of themselves by teaching them how to: reduce stress improve caregiving confidence establish balance in their lives communicate their needs make tough decisions locate helpful resources

20 Who Is It For? Family Spouses/partners Adult children of aging parents Whether care receiver is living: At home alone, with others or with caregiver At home or in a facility In same town or across the country

21 Six Week Content Taking Care of You Identifying and Reducing Personal Stress Communicating Feelings, Needs and Concerns Communicating in Challenging Situations Learning from Our Emotions Master Caregiving Decisions

22 Program Content Workshop Overview You are Not Alone Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Challenges of Caregivers Managing Self-Care Principles Using Community Resources Managing the Stress of Caregiving Identifying Signs and Sources Identifying What You Can Change Stress Reducers - Taking Action Using Positive Self Talk Breathing for Relaxation Benefits of Good Communication How Best to Express Yourself I and You Messaging Progressive Muscle Relaxation Being Assertive - Not Agressive Assertive Communication - DESC AIKIDO Communication Style Community with the Memory Impaired

23 Workshop Overview Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Listening to Our Emotions Dealing With Anger Dealing with Guilt Dealing with Depression Guidelines for Managing Emotions Progressive Muscle Relaxation Understanding the Transition Process The Family Meeting Using the Power of Optimism Setting Future Goals Shoulder Lifts - Relaxation

24 Powerful Tools for Caregivers class participants report they: Are better at caring for themselves, Have fewer feelings of anger, guilt and depression, Have increased confidence and ability to cope with the demands of caregiving, and Are more likely to use community services.

25 For the Caregiver What they have in common Both are Six Week Programs Co-lead by two lay or professional leaders Caregivers can go to either Chronic Disease Self Management and Powerful Tools for Caregivers Action Plans begin and end both of the programs Several Communication techniques overlap

26 Summary The disease doesn t matter these are general tips which help everyone Chronic Disease like wolves travels in packs so most are handling several chronic diseases Both programs are complementary to regular clinical treatments For Caregivers both programs offer ways to help without stress Both programs are designed to improve the quality of life for those living or caring for someone with chronic disease

27 Thank You Contact Information: Marie Mulroy

28 Living Well with Chronic Disease Community Clinical Linkages Jason Aziz, MS,CSCS CDC National Diabetes Prevention Program Coordinator Concord Hospital

29 Background Diabetes is one of the most prevalent chronic diseases of our generation. It represents our culture s most pressing public health issues. The focus on prevention is paramount. In Clinical settings, historically, treatment, has been the focus.this is changing. In Community settings, prevention, is the focus.

30 Diabetes Prevention Type 2 Diabetes can be prevented. In 2002 in the NE Journal of Medicine, research demonstrating this was published. Lifestyle change actually outperformed metformin in preventing or delaying Type 2 NIDDM! Intensive lifestyle change that lasts is imperative. For the NDPP: 16 weeks, 1x/week, then for 6 additional months, 1x/month Weekly body mass measures and self report of PA Two primary measures: Body Mass AND PA (min/week)

31 Source Populations The population of individuals ideal for this programming is all around us. The Community Clinical linkage is powerful Advantages: Physician referrals, access to lab results, closes the continuum of care, breaks barriers Disadvantages: Stigmas with overly-clinical approach. Non-compliance rates in Community settings. Community Clinical combination is ideal blend!

32 Therapeutic Treatment Algorithm Pts who have had an HbA1C HbA1C > 6.4% HbA1C: [ %] HbA1C < 5.7% Diabetes Self Management CDC NDPP MY UTOPIA!

33 Promotional Flyer Mondays; 12-1pm Concord Hospital s Center for Health Promotion 49. S Main St Concord In the Fall: Wednesday evenings 5:30-6:30pm Concord Hospital s Center for Health Promotion 49. S Main St Concord

34 Questions? Contact Info: Jason Aziz; MS, CSCS x4258

35 NE Journal of Medicine Article REDUCTION IN THE INCIDENCE OF TYPE 2 DIABETES WITH LIFESTYLE INTERVENTION OR METFORMIN N Engl J Med, Vol. 346, No. 6, February 7, 2002,

36 DSME or DSMT Diabetes Self Management Education or Training by Liz Kennett RN BSN CDE DSME is a Foundation of Care

37 DSME What is it? Ongoing processes of facilitating Knowledge skill abilities necessary for diabetes self care American Diabetes Association, Standards of Medical Care in Diabetes 2015

38 DSME What is it? Supports informed decision making, self-care behaviors, problem-solving and active collaboration with health care teams to improve Clinical outcomes Health status Quality of Life in a cost effective manner American Diabetes Association, Standards of Medical Care in Diabetes 2015 Quality of Life $

39 As recommended by the American Diabetes Association1 DSME Should be provided at diagnosis and as needed thereafter Effectiveness should be measured and monitored Should address psychosocial issues such as emotional well being which impacts positive diabetes outcomes Should be adequately reimbursed because DSME can result in cost savings DSME can result in Improved outcomes 1Clinical Diabetes, Volume 33, Number 2 Spring 2015

40 DSME is defined by National Standards American Diabetes Association Standards of Medical Care in Diabetes Needed for both American Diabetes Association and American Association of Diabetes Educators Recognition National Standards Require That your administration is behind you That the Diabetes Community has input A position to coordinate the program and instructors who are RNs, RDs, pharmacists or CDEs A Formal Curriculum Individualized Assessment of the client with diabetes Ongoing Support Client meeting his/her personalized goals Quality Improvement

41 DSME assures that we are giving the right information about Diabetes Not outdated and sometimes obsolete information Current information Required by the national standards Verified through ADA or AADE Recognition Often provided by Certified Diabetes Educators Rigorous exam process Continuing Education in Diabetes

42 Why does DSME make a difference? Based on individual assessment of the client What s their life story Family history of diabetes? Did the family member develop complications? What is their greatest concern? Can I continue in my occupation? interstate truck drivers Will my insurance pay for my medication? What do I do if my copays are too high And then, there are the need to knows Meter but can they use the preferred insurance product? Insulin Pens desirable product but prior authorization is needed

43 Diabetes Educator in a DSME Work with the PCP for authorization for insulin pen use

44 Educator in a DSME Program will Get creative

45 DSME is measured Many programs use the AADE 7 Self Care Behaviors Allows the patient to make individualized measurable behavior change in Eating Habits Being Active Monitoring Taking medications Problem-solving Reducing Risks Healthy Coping Outcome measures Reduces costs in Medicare patients by $135/mo. 1 Improves clinical outcomes such as A1C, lower self-reported weight gain, improved quality of life lower costs 2 1Diabetes Self Management Education/Training Toolkit Diabetes Care, Standards of Medical Care in Diabetes 2015, S20-21

46 DSME is always looking to improve the quality of education1 By recognizing that our clients need follow-up support That our education is culturally sensitive That our education is age appropriate That it addresses psychosocial issues such as depression and competing demands on time That as Diabetes Educators, We always look at health literacy 2 We always look at numeracy 1 Diabetes Care, American Diabetes Association Standards of medical Care in Diabetes-2015, Ferguson MO, et al. Diabetes Educator, 2015

47 Where does NH stand with recognized DSME programs? Do we have enough recognized programs for our population with diabetes? Do we have enough certified educators for our population?

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49 Parts of the state are under-served If clients are referred, they may have to drive long distances to participate in DSME services. Further complicated because Medicare restricts Medical Nutrition therapy by Registered Dietitians on the same day as DSME. Unfortunately No

50 Barriers to Increasing Number of Programs Difficulty keeping administrative support because of low revenues Reimbursement by Medicare is low; client may have high co-pays and deductible and decline the service Cost of recognition $800- $1000 Record-keeping process is time-consuming but necessary. Prescribers don t always refer Clients choose not to participate

51 How can we jump the barriers? Explore providing Recognition Program Training in NH Explore satellite programs Already recognized program allows a smaller site to join them May be successful if facilities have other contractual relationships May ease the financial and record-keeping burden Educate prescribers and clients about the benefits of DSME Pass national legislation for CDEs to be Medicare Providers Allow CDEs to move to less costly facilities

52 Adequate number of CDEs for NH??? No Not just a NH problem but a problem throughout the US Department of Health and Human Services and Granite State Diabetes Educators conducted Diabetes Educator Survey Results will be shared at Stakeholder s Meeting Preview of a few facts Aging group of professionals; many are working as Diabetes Educators part time

53 Gathering ideas to increase the number of CDEs Stakeholders Meeting to discuss survey and brainstorm Engage current CDEs to participate in a mentoring program for CDE want-to-be s Entice nursing, nutrition, and pharmacy students to think about a career helping those with diabetes and becoming a CDE

54 We can do this. We must do this. Our clients with diabetes are depending on us!!

55 Questions Will be addressed during the discussion Thank you

56 NH Tobacco Helpline Teresa Brown Treatment Specialist Tobacco Prevention and Control Program

57 Understand the science of quitting-2as & R to QuitWorks-NH Physiological Psychological NH Tobacco Helpline Services

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62 2006 Surgeon General Report The Health Consequences of Involuntary Exposure to Tobacco Smoke NO SAFE LEVEL of exposure Over 4,000 chemicals in the smoke including carcinogens Smoke (gas) cools to a solid and forms a layer on walls, clothes, furniture, etc

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64 6,000 research articles Dose-response Multiple medications Counseling Quitlines are effective

65 What type/s Dual use is common How much (packs per day/tins per day) How early in the morning? In the middle of the night? E-cigarettes used Exclusively In combination with other tobacco products

66 On a scale of 1-10 Willing to talk about quitting Willing to set a quit date in the next 30 days Willing to use nicotine replacement therapy Offer to DIRECTLY refer patient to QuitWorks-NH A Quit-Coach will call them within 2 days Call is from a # Up to 5 counseling calls are available at no cost and around their schedule over the phone If no offer INDIRECT referral

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69 Teresa Brown

70 Better Breathers Clubs May 12, 2015

71 Better Breathers Clubs Lung disease is increasing COPD is the third leading cause of death in the U.S. Almost 13 million people have been diagnosed, but as many as another 12 million may have the disease and not know it. Medical costs continue to rise 71

72 Better Breathers Clubs Increasing concern that more emphasis needs to be placed upon helping patients manage chronic diseases to improve their quality of life. One of the strategies for managing chronic disease is patient education and support. Research has shown that support groups do positively impact disease management. Better Breather Clubs are support groups for people with chronic lung disease and their loved ones. 72

73 Better Breathers Clubs Purpose: to offer patient-centered, and community-based educational opportunities and support to persons with chronic lung disease and their families, friends and support persons Goal: to improve the quality of life and functional status for members by providing disease-specific education and emotional connection which may help prevent exacerbation, thereby reducing the health, economic and social burden of lung disease. 73

74 Better Breathers Clubs People living with COPD or other chronic lung disease often feel alone and isolated the Better Breathers Club provides a venue for them to come together for support and socialization as well as education. Learn new skills to manage their condition Support each other Family members and caregivers are invited Clubs meet regularly (monthly) for 1-2 hours Facilitator oversees and coordinates the meeting, communication, finds speakers to address topics 74

75 American Lung Association of the Northeast Can Provide For the Facilitator Online BBC Facilitator Training Better Breathers Facilitator Manual BBC Brochures, Flyers COPD Management Plans Educational materials on COPD Club information listed on ALANE s website, Better Breathers Clubs page 75

76 Interested? Want to learn more? Contact: Lee B. Gilman, MS CHES American Lung Association of the Northeast New Hampshire

77 Our Credo We will breathe easier when the air in every American community is clean and healthy. We will breathe easier when people are free from the addictive grip of tobacco and the debilitating effects of lung disease. We will breathe easier when the air in our public spaces and workplaces is clear of secondhand smoke. We will breathe easier when children no longer battle airborne poisons or fear an asthma attack. Until then, we are fighting for air. 77