scholarly journals The Flinders Programme of Chronic Condition Self-Management in New Zealand: survey findings

2010 ◽  
Vol 2 (4) ◽  
pp. 288 ◽  
Author(s):  
Margaret Horsburgh ◽  
Janine Bycroft ◽  
Felicity Goodyear-Smith ◽  
Dianne Roy ◽  
Faith Mahony ◽  
...  
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
Chronic Condition ◽  
Complex Interventions ◽  
Time Frame ◽  
Self Management ◽  
Management Support ◽  
Long Term Conditions ◽  
Primary Care Nurses

INTRODUCTION: The Flinders ProgramTM of Chronic Condition Self-Management in New Zealand (NZ) has been given focus as a useful and appropriate approach for self-management support and improvement of long-term condition management. AIM: To determine the use of the Flinders ProgramTM in NZ and identify barriers and enablers to its use. METHOD: A web-based survey was undertaken in June 2009 with 355 eligible participants of the 500 who had completed ‘Flinders’ training in NZ since 2005. RESULTS: 152 (43%) respondents completed the survey over a one-month time frame. Of those who responded, the majority were primary care nurses (80%; 118). Fifty-five percent (82) of survey respondents reported using some or all of the Flinders tools. Of these, 11% (16) reported using all of the tools or processes with 77% (104) of respondents having completed six or fewer client assessments utilising the Flinders tools. This indicates that respondents were relatively inexperienced with use of the Flinders ProgramTM. Barriers to implementation were identified as the time needed for structured appointments (up to one hour), funding, resistance from colleagues, lack of space and insufficient ongoing support. DISCUSSION: Despite the extent of training in the use of the Flinders ProgramTM, there is limited use in clinical practice of the tools and processes associated with the model. Without structured support for quality improvement initiatives and self-management programmes, the ability to implement learned skills and complex interventions is limited. KEYWORDS: Self-management; long-term conditions; chronic conditions; chronic illness; primary care; nurses

Self-management support? Listening to people with complex co-morbidities

2018 ◽  
Vol 16 (3) ◽  
pp. 161-172 ◽  
Author(s):  
Helen Francis ◽  
Jenny Carryer ◽  
Jill Wilkinson
Keyword(s):  
New Zealand ◽  
Early Stage ◽  
The Self ◽  
Self Management ◽  
Management Approach ◽  
Management Support ◽  
Long Term Conditions ◽  
Early Stage Disease ◽  
The Face

Objectives The study aimed to explore how people with complex, established co-morbidities experience long-term condition care in New Zealand. Despite the original conception as appropriate for people with early stage disease, in New Zealand the self-management approach dominates the care provided to people at all stages of diagnosis with long-term conditions, something reinforced through particular funding mechanisms. Methods A multiple case study followed the lives of 16 people with several long-term conditions. Data collection comprised two interviews, four weekly contacts with patients over an 18-month period and an interview with their primary health care clinicians. Results This paper reveals a cohort of tired, distracted patients struggling to manage their lives in the face of multiple conflicting challenges, with insufficient energy for the level of personal agency required to deal with the self-management approach. Discussion Participants described aspects of care received, which does meet their needs but sit outside the self-management approach, that resonate with the ideas behind current approaches to palliative care. The potential of an approach to care built upon these ideas is explored as a more compassionate, effective way of meeting the needs of people with advanced, multiple long-term conditions. Further research is warranted to explore the acceptability of such an approach.

scholarly journals A randomised controlled trial, cost-effectiveness and process evaluation of the implementation of self-management for chronic gastrointestinal disorders in primary care, and linked projects on identification and risk assessment

2018 ◽  
Vol 6 (1) ◽  
pp. 1-154 ◽  
Author(s):  
David G Thompson ◽  
Sarah O’Brien ◽  
Anne Kennedy ◽  
Anne Rogers ◽  
Peter Whorwell ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
Assessment Tool ◽  
Controlled Trial ◽  
Self Management ◽  
Gastrointestinal Disorders ◽  
Management Support ◽  
Long Term Conditions

BackgroundChronic gastrointestinal disorders are major burdens in primary care. Although there is some evidence that enhancing self-management can improve outcomes, it is not known if such models of care can be implemented at scale in routine NHS settings and whether or not it is possible to develop effective risk assessment procedures to identify patients who are likely to become chronically ill.ObjectivesWhat is the clinical effectiveness and cost-effectiveness of an intervention to enhance self-management support for patients with chronic conditions when translated from research settings into routine care? What are the barriers and facilitators that affect the implementation of an intervention to enhance self-management support among patients, clinicians and organisations? Is it possible to develop methods to identify patients at risk of long-term problems with functional gastrointestinal disorders in primary care? Data sources included professional and patient interviews, patient self-report measures and data on service utilisation.DesignA pragmatic, two-arm, practice-level cluster Phase IV randomised controlled trial evaluating outcomes and costs associated with the intervention, with associated process evaluation using interviews and other methods. Four studies around identification and risk assessment: (1) a general practitioner (GP) database study to describe how clinicians in primary care record consultations with patients who experience functional lower gastrointestinal symptoms; (2) a validation of a risk assessment tool; (3) a qualitative study to explore GPs’ views and experiences; and (4) a second GP database study to investigate patient profiles in irritable bowel syndrome, inflammatory bowel disease and abdominal pain.SettingSalford, UK.ParticipantsPeople with long-term conditions and professionals in primary care.InterventionsA practice-level intervention to train practitioners to assess patient self-management capabilities and involve them in a choice of self-management options.Main outcome measuresPatient self-management, care experience and quality of life, health-care utilisation and costs.ResultsNo statistically significant differences were found between patients attending the trained practices and those attending control practices on any of the primary or secondary outcomes. The intervention had little impact on either costs or effects within the time period of the trial. In the practices, self-management tools failed to be normalised in routine care. Full assessment of the predictive tool was not possible because of variable case definitions used in practices. There was a lack of perceived clinical benefit among GPs.LimitationsThe intervention was not implemented fully in practice. Assessment of the risk assessment tool faced barriers in terms of the quality of codting in GP databases and poor recruitment of patients.ConclusionsThe Whole system Informing Self-management Engagement self-management (WISE) model did not add value to existing care for any of the long-term conditions studied.Future workThe active components required for effective self-management support need further study. The results highlight the challenge of delivering improvements to quality of care for long-term conditions. There is a need to develop interventions that are feasible to deliver at scale, yet demonstrably clinically effective and cost-effective. This may have implications for the piloting of interventions and linking implementation more clearly to local commissioning strategies.Trial registrationCurrent Controlled Trial ISRCTN90940049.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 1. See the NIHR Journals Library website for further project information.

scholarly journals Using the patient activation measure to examine the self-management support needs of a population of UK workers with long-term health conditions

2021 ◽  
pp. 174239532110434
Author(s):  
Sally Hemming ◽  
Fehmidah Munir
Keyword(s):  
Mental Health ◽  
Patient Activation ◽  
Health Conditions ◽  
Self Management ◽  
Support Needs ◽  
Management Support ◽  
Long Term Conditions ◽  
Mental Health Conditions ◽  
Patient Activation Measure

Objectives To examine differences in patient activation and self-management support needs in a population of UK workers with long-term health conditions. Methods Demographic, health and activation information were taken from the data of participants with long-term conditions, collected via an online cross-sectional survey of workers. The 13-item British patient activation measure measured workers knowledge, skills and confidence towards self-managing. Results Three hundred and seven workers with mental health, musculoskeletal and other conditions completed the patient activation measure. Mental health conditions were most prevalent (36.8%). Workers were higher activated, however workers with mental health conditions were significantly less activated ( p = 0.006). Differences in activation by condition severity and age were revealed. Discussion This study provides insight to the activation of UK workers with long-term conditions. Whilst workers with mental health conditions need more training and education to self-manage, workers are variably activated indicating broader support needs. There is a gap for workplace self-management support. The patient activation measure is used in healthcare to improve people’s self-management and should be considered to be included in the workplace, and could form part of interventions to support workers self-management. More rigorous studies, including the patient activation measure, are needed to identify the best approaches to identifying workers self-management support needs.

scholarly journals A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

2014 ◽  
Vol 2 (53) ◽  
pp. 1-580 ◽  
Author(s):  
Stephanie JC Taylor ◽  
Hilary Pinnock ◽  
Eleni Epiphaniou ◽  
Gemma Pearce ◽  
Hannah L Parke ◽  
...  
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Systematic Reviews ◽  
Self Management ◽  
Management Support ◽  
Health Care Organisation ◽  
Long Term Conditions ◽  
Care Organisation ◽  
Overviews Of Systematic Reviews

BackgroundDespite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.AimTo undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.MethodsSelf-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.ResultsWe included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.ConclusionsSupporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.Study registrationThis study is registered as PROSPERO CRD42012002898.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

The Nexus of M-Health and Self-Care

2019 ◽  
pp. 235-259
Author(s):  
Anastasius S. Moumtzoglou
Keyword(s):  
Mobile Health ◽  
Self Care ◽  
Normal Activity ◽  
Models Of Care ◽  
Self Management ◽  
Management Support ◽  
Long Term Conditions ◽  
Concept Of Health ◽  
Health Related

Self-care emerged from the concept of health promotion in the 1970s while from 2000 onwards the term self-management gained popularity, with a greater focus on long-term conditions and the trend towards more holistic models of care. Although self-management and self-care are often used interchangeably, a distinction between the two concepts can be made. Both can be considered in terms of a continuum, with self-care at one end as “normal activity” and self-management an extension of this. Self-management support is the assistance given to patients in order to encourage daily decisions that improve health-related behaviors and clinical outcomes. The chapter envisions these concepts on a continuum with one pole representing mobile health and the other self-care. It concludes that self-management support is the nexus of mobile health and self-care.

scholarly journals Exploring determinants of self-management in adults with severe mental illness: a qualitative evidence synthesis

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S13-S13
Author(s):  
Claire Carswell ◽  
Jennifer Brown ◽  
Abisola Balogun ◽  
Jo Taylor ◽  
Peter Coventry ◽  
...  
Keyword(s):  
Mental Illness ◽  
Environmental Factors ◽  
Self Management ◽  
Qualitative Evidence Synthesis ◽  
Management Support ◽  
Long Term Conditions ◽  
Qualitative Evidence ◽  
Beliefs And Attitudes ◽  
People’S Perceptions

AimsTo systematically review and synthesise qualitative evidence about determinants of self-management in adults with SMI. The goal is to use findings from this review to inform the design of effective self-management strategies for people with SMI and LTCs.BackgroundPeople living with serious mental illness (SMI) have a reduced life expectancy by around 15–20 years, mainly due to the high prevalence of long-term physical conditions such as diabetes and heart disease. People with SMI face many challenges when trying to manage their physical health. Little is known about the determinants of self-management – managing the emotional and practical issues – of long-term conditions (LTCs) for people with SMI.MethodSix databases, including CINAHL and MEDLINE, were searched to identify qualitative studies that explored people's perceptions about determinants of self-management in adults with SMI (with or without comorbid LTCs). Self-management was defined according to the American Association of Diabetes Educator's self-care behaviours (AADE7). Determinants were defined according to the Capabilities, Opportunity, Motivations and Behaviours (COM-B) framework. Eligible studies were purposively sampled for synthesis according to the richness of the data (assessed using Ames et al (2017)'s data richness scale), and thematically synthesised.ResultTwenty-six articles were included in the synthesis. Seven studies focused on self-management of LTCs, with the remaining articles exploring self-management of SMI. Six analytic themes and 28 sub-themes were identified from the synthesis. The themes included: the additional burden of SMI; living with comorbidities; beliefs and attitudes about self-management; support from others for self-management; social and environmental factors; routine, structure and planning. Capabilities for self-management were linked to people's perceptions about the support they received for their SMI and LTC from healthcare professionals, family and friends. Opportunities for self-management were more commonly expressed in the context of social and environmental factors. Motivation for self-management was influenced by beliefs and attitudes, whilst being closely related to the burden of SMI.ConclusionThe themes identified from the synthesis suggest that capabilities, opportunities and motivations for self-management can be negatively influenced by the experience of SMI, whilst social and professional support, improved access to resources, and increased involvement in care, could promote self-management. Support programmes for people with SMI and LTCs need to account for these experiences and adapt to meet the unique needs of this population.

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