Top tips for embedding chronic condition self-management support into practice

2010 ◽  
Vol 16 (4) ◽  
pp. 334 ◽  
Author(s):  
Sharon Lawn
Keyword(s):  
Health Services ◽  
Chronic Condition ◽  
Positive Impact ◽  
Organisational Change ◽  
Self Management ◽  
Service Improvement ◽  
Management Support ◽  
Postgraduate Students ◽  
Leadership Support ◽  
Clear Vision

Organisational change aimed at service improvement continues to be a challenging process for many health services, managers and teams. Current imperatives to develop service models responsive to the growing demands of chronic conditions on health systems suggest that reflection on core change principles is warranted. Dominant themes for progress in embedding chronic condition self-management (CCSM) support into practice settings arose from content analyses of case studies from health professionals who have attempted to implement CCSM support into their health services after undertaking specific training (The Flinders Program of CCSM). This included in-depth interviews with 10 trainers accredited to deliver training in this CCSM care planning approach to the workforce, formal reflections from 47 postgraduate students (currently in the health workforce) enrolled in a dedicated CCSM program at Flinders University and a consensus forum with accredited trainers. Emergent themes were then considered in the context of existing organisational change and CCSM literature. Long understood principles of effective change management continue to be important, including leadership support, clear vision, team cohesion, effective people management and shared values. However, interdependence of these and other factors seems to be most important. Organisational change that builds capacity for CCSM support is possible, given a clearer understanding of where efforts will have the most positive impact on change.

scholarly journals Between knowing and doing person-centredness: A qualitative examination of health professionals’ perceptions of roles in self-management support

2019 ◽  
pp. 136345931988908
Author(s):  
Marika Franklin ◽  
Karen Willis ◽  
Sophie Lewis ◽  
Anne Rogers ◽  
Lorraine Smith
Keyword(s):  
Health Professionals ◽  
Chronic Condition ◽  
Social Representations ◽  
Self Management ◽  
Clinical Aspects ◽  
Management Support ◽  
Health Capital ◽  
Clinical Interactions ◽  
Depth Interviews ◽  
Unrealistic Expectations

Self-management is a contemporary model of chronic condition care that places expectations on, and roles for, both patients and health professionals. Health professionals are expected to form partnerships with their patients, and patients are expected to be active participants in their own care. In these new roles, control and responsibility for self-management are shared between people with chronic conditions and their health professionals. We still have limited knowledge about how these new roles are enacted in self-management support. In this article, we examine how health professionals perceive the roles of patients and professionals in chronic condition self-management, drawing on Bourdieu’s concepts of field, doxa and capital. In this qualitative study, 32 in-depth interviews were conducted with 11 health professionals in Sydney, Australia. Data were analysed thematically. Three themes were derived. First, there was incongruence between how participants characterised and enacted their roles. Second, participants compartmentalised clinical and non-clinical aspects of self-management support. Finally, the roles of health professionals entwined with emotions and judgements of patienthood revealed that the provision of self-management support was linked to a fit between individuals’ cultural health capital and the expectations governing the field. We argue that ‘taken for granted’ assumptions about self-management and self-management support must be challenged to mitigate negative social representations and unrealistic expectations placed on patients and health professionals, particularly those patients with less capital, who are more marginalised within clinical interactions.

An evaluation of the self-management support capacity of providers of chronic condition primary care

2012 ◽  
Vol 18 (2) ◽  
pp. 112 ◽  
Author(s):  
Tracy E. Cheffins ◽  
Julie A. Twomey ◽  
Jane A. Grant ◽  
Sarah L. Larkins
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health Professionals ◽  
Chronic Condition ◽  
Health Care Services ◽  
Readiness To Change ◽  
Structured Interview ◽  
Self Management ◽  
Management Support ◽  
Primary Health

Self-management support (SMS) is an important skill for health professionals providing chronic condition management in the primary health care sector. Training in SMS alone does not always lead to its utilisation. This study aimed to ascertain whether SMS is being used, and to identify barriers and enablers for SMS in practice. Health professionals who underwent SMS training were invited to participate in a semi-structured interview. A response rate of 55% (14 of 24) was achieved. All interviewees rated their understanding of the principles of SMS as moderate or better. In relation to how much they use these principles in their practice, several (5 of 14) said minimally or not at all. The tools they were most likely to use were SMART goals (8 of 14) and decision balance (5 of 14). Core skills that were being used included problem solving (11 of 14), reflective listening (13 of 14), open-ended questions (12 of 14), identifying readiness to change (12 of 14) and goal setting (10 of 14). The most important barriers to implementing SMS were current funding models for health care, lack of space and staff not interested in change. The most highly rated enabling strategies were more training for general practitioners and more training for practice nurses; the lowest rated was more training for receptionists. The increasing prevalence of chronic conditions due to ageing and lifestyle factors must be addressed through new ways of delivering primary health care services. Self-management support is a necessary component of such programs, so identified barriers to SMS must be overcome.

scholarly journals Collaborative Chronic Care Model Implementation within Outpatient Behavioral Health Care Teams: Qualitative Results from a Multisite Trial using Implementation Facilitation

2020 ◽  
Author(s):  
Jennifer L Sullivan ◽  
Bo Kim ◽  
Christopher Miller ◽  
A. Rani Elwy ◽  
Karen Drummond ◽  
...  
Keyword(s):  
Mental Health ◽  
Information Systems ◽  
Clinical Information ◽  
Self Management ◽  
Clinical Information Systems ◽  
Work Role ◽  
Community Resources ◽  
Management Support ◽  
Outpatient Mental Health ◽  
Leadership Support

Abstract Background: This paper reports on a qualitative evaluation of a hybrid II stepped-wedge trial using implementation facilitation to implement team-based care in the form of the Collaborative Chronic Care Model (CCM) in interdisciplinary outpatient mental health teams. The objective of this study was to compare the alignment of sites’ clinical processes with the CCM elements at baseline (Time 1) and after 12 months of implementation facilitation (Time 2) from the perspective of providers.Methods: We conducted semi-structured interviews to assess the extent to which six CCM elements were in place: work role redesign, patient self-management support, provider decision support, clinical information systems, linkages to community resources, and organizational/leadership support. Interviews were transcribed and a priori CCM elements were coded using a directed content analysis approach at Time 1 and 2. We sought consensus on, and compared, the extent to which each CCM element was in place at Times 1 and 2.Results: We conducted 27 and 31 telephone interviews at Times 1 and 2, respectively, with outpatient mental health providers at nine participating sites. At Time 1 and Time 2, three CCM elements were most frequently present across the sites: work role redesign, patient self-management support, and provider decision support. The CCM elements with increased implementation from Time 1 to Time 2 were: work role redesign, patient self-management support, and clinical information systems. For two CCM elements, linkages to community resources and organizational/leadership support, some sites had increased implementation at Time 2 compared to Time 1, while others had reductions.Conclusions: Sites increased the extent of implementation on several CCM elements. The most progress was made in the CCM elements where sites had CCM-aligned processes already in place at Time 1. Teams made progress on elements they could more easily control, such as work role redesign. Our results suggest that maximizing the benefits of CCM-based outpatient mental health care may require targeting resources and training toward specific CCM elements—especially in the use of clinical information systems and linking with community resources. Trial Registration: Clinical Trials NCT02543840Registered 7 September 2015.

Better knowledge, better health: piloting an education intervention in chronic condition self-management support

2011 ◽  
Vol 17 (1) ◽  
pp. 4 ◽  
Author(s):  
Jennifer M. Newton ◽  
Leah Falkingham ◽  
Lyn Clearihan
Keyword(s):  
General Practice ◽  
Pilot Study ◽  
Chronic Condition ◽  
Self Management ◽  
Learning Needs ◽  
Management Support ◽  
Management Skills ◽  
Allied Health Professionals ◽  
Lifestyle Risk ◽  
Risk Modification

Chronic condition self-management and lifestyle risk modification education is paramount for General Practice registrars. A multi-dimensional learning package ‘Better Knowledge, Better Health’ was developed and piloted to improve General Practice registrars’ understanding of their role in supporting chronic condition self-management in patients with osteoarthritis. This pilot study was supported by the Australian Better Health Initiative. Pre-training learning needs analysis with a new intake of General Practice registrars (n = 40) indicated high levels of confidence in supporting patients in chronic condition management and lifestyle risk modification, and locating and interacting with local resources and allied health professionals. Conversely, interviews with General Practice Supervisors (n = 13) found most would not identify chronic condition self-management skills as priorities for registrar learning. Supervisors were also not familiar with core principles of chronic condition self-management, in particular application of motivational interviewing to behaviour change. Disparities between General Practice Supervisors’ perceptions of the importance of chronic condition self-management and lifestyle risk modification education and levels of access to learning opportunities in chronic condition self-management for registrars are discussed. Difficulties in implementing a pilot study within tight timeframes are also explored.

scholarly journals Self-management support from the perspective of patients with a chronic condition: a thematic synthesis of qualitative studies

2015 ◽  
Vol 19 (2) ◽  
pp. 194-208 ◽  
Author(s):  
Jolanda Dwarswaard ◽  
Ellen J.M. Bakker ◽  
AnneLoes van Staa ◽  
Hennie R. Boeije
Keyword(s):  
Chronic Condition ◽  
Qualitative Studies ◽  
Self Management ◽  
Management Support ◽  
Thematic Synthesis

scholarly journals Toward consensus on self-management support: the international chronic condition self-management support framework

2016 ◽  
pp. daw030 ◽  
Author(s):  
Susan L. Mills ◽  
Teresa J. Brady ◽  
Janaki Jayanthan ◽  
Shabnam Ziabakhsh ◽  
Peter M. Sargious
Keyword(s):  
Chronic Condition ◽  
Self Management ◽  
Management Support

scholarly journals Chronic condition self-management support: proposed competencies for medical students

2009 ◽  
Vol 5 (1) ◽  
pp. 7-14 ◽  
Author(s):  
Rene G. Pols ◽  
Malcolm W. Battersby ◽  
Martha Regan-Smith ◽  
Mignon J. Markwick ◽  
John Lawrence ◽  
...  
Keyword(s):  
Medical Students ◽  
Chronic Condition ◽  
Self Management ◽  
Management Support

scholarly journals Using e-health tools and PROMs to support self-management in patients with inflammatory bowel disease

2021 ◽  
Vol 30 (7) ◽  
pp. 394-402
Author(s):  
Pearl Avery
Keyword(s):  
Disease Activity ◽  
Positive Impact ◽  
Activity Index ◽  
Digital Health ◽  
Outpatient Setting ◽  
Self Management ◽  
Small Scale ◽  
Service Improvement ◽  
Improvement Project ◽  
Patient Reported

Background: The use of digital health or e-health is growing. The potential positive impact on IBD care from supported self-management using these tools emerged from a literature review carried out in preparation for a service improvement project. A patient-reported outcomes measure (PROM) with validation across IBD sub-types was already available for use. This internationally recognised tool has potential for use with existing or new e-health systems. Aims: In order to test the concept of using PROMs to support practice and follow up a small-scale pilot study was designed. The aim of the study was to understand if empowering patients to undertake supported self-management could lead in turn to improved flow through outpatient services. Methods: An audit was carried out of PROMs looking at quality of life (QoL) as well as disease activity using an electronic platform in real time at the point of patient contact. The disease activity indices used were the Harvey Bradshaw Index and the Simple Clinical Colitis Activity Index, due to the author's familiarity with these tools. Results: Of the 15 participants, 10 reported themselves as ‘well’ or ‘well with questions’ all participants reported an acceptance of supported remote self-management using e-health. Conclusion: This evaluation led to PROMs being captured on a tablet in the outpatient setting in the pre-pandemic period. Allowing patients to use the PROM as a tool in the outpatient setting has led to longitudinal data being added to the e-health system for each individual. Well patients could be managed remotely, freeing capacity in outpatient clinics.

Chronic condition self-management support for Aboriginal people: Adapting tools and training

2018 ◽  
Vol 26 (4) ◽  
pp. 232-237
Author(s):  
Malcolm Battersby ◽  
Sharon Lawn ◽  
Inge Kowanko ◽  
Sue Bertossa ◽  
Coral Trowbridge ◽  
...  
Keyword(s):  
Chronic Condition ◽  
Aboriginal People ◽  
Self Management ◽  
Management Support ◽  
And Training

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

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