self management

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Self-Management

Done by:Saad AlmowalladMuhannad Alzahrani Sultan AlomariMohammed Alkadi

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Outline DefinitionPurposeEffectivenessSelf management in respiratory casesAdvantages Problems Strategies Study

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Defining Self-Management

Self-management involves a controlling behavior and a controlled behavior

Controlling behavior what the person does now.

Managing antecedents and consequences.Controlled behavior refers to the behavior the person wants to manage in the future.

Learning new behaviors.

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Defining Self-ManagementSelf-management: Although the term "self" implies "alone", the self-management component always includes a partnership with a health care professional.

Purpose To ensuring individuals are actively engaged in self-management. to complement pharmacological care and enhance outcomes. Delivery of pulmonary rehabilitation, that assists patient self-management and provision of self-management education and support to increase self-efficacy and help patients to better manage their condition

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EffectivenessEffective self-management encompasses the ability to monitor one’s condition and to affect the cognitive, behavioral, and emotional responses necessary to maintain a satisfactory quality of life.

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considerationsAge Culture and Health Beliefs Health Literacy Access to Care Psychosocial Factors

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Advantages client related: quality of life ability to attend school/ go to workself-confidence

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Advantages health related : related to depression blood pressure hemoglobin levels painand use of medication

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Advantages health service related : planned and emergency visits to emergency departments or general practitioners cost of health care.

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Self management in respiratory

COPD and other chronic is highly prevalent and a significant cause of morbidity and mortality, impacting on quality of life and healthcare expenditure. Health promotion is therefore an important consideration. By applying specific strategies, respiratory therapists can play a major role in the promotion of self-management

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Our role :Training Training to deliver and support self-management is crucial, but insufficient as a sole intervention . Even well-designed theoretically-based training for professionals, for example including generic consultation skills as well as specific knowledge about disease self-management, may not enable the professional to implement their learning in routine practice if the organization does not nurture and support

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ProblemsBehavioral deficits refers to the failure to perform the desirable behavior.

Behavioral excess refers to the consistent performance of the undesirable behavior.

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Self-Management Strategies

Basically, self-management involves the individual:

identifying and defining the target behavior.using behavior modification procedure(s) to develop alternative behavior(s).

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Self-Management StrategiesFour steps are involved:1. Goal setting.2. Self-monitoring.3. Antecedent manipulations..4. Data collection

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1.Goal setting. • Set goals that are:

achievable.especially true early in change program.Goal achievement=conditioned reinforcer.

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2.Self-monitoring.Observing one’s own behavior.Often combined with goal setting.Produces reactivity effects.

Equipment •Intel Health-Guide (home based monitoring system).

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Equipment • Peripherals: Sphygmomanometer Pulse oximeter Scales

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Monitoring SystemWeb-based central monitoring system (Intel Health Management Suite)

• On-line interface that allows nurses to securely monitor their patient’s condition

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3.Antecedent manipulations.Involved in all self-management interventions.

Interventions Telephone consultation by the staff •Home visit by a member of the Health Choices nursing team (clinical or technical)•Liaison with patient’s GP/Specialist if indicated

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Data collection A written document that:

Activity status Level of improvement

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self-management planThe self-management plan includes all the necessary information for your patients to understand their condition and tools to manage it.The plan covers everything from breathing techniques and what questions to ask your doctor to exercise and goal setting.

( patient is his on therapist )

Study Self-management reduces both short- and long-term hospitalization in COPDM-A. Gadoury, K. Schwartzman, M. Rouleau, F. Maltais, M. Julien, A. Beaupré, P. Renzi, R. Bégin, D. Nault, J. BourbeauDOI: 10.1183/09031936.05.00093204 Published 1 November 2005

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Study AbstractThe aim of the present study was to assess the long-term impact on hospitalization of a self-management programme for chronic obstructive pulmonary disease (COPD) patients.

A multicentre, randomized clinical trial was carried out involving 191 COPD patients from seven hospitals. Patients who had one or more hospitalizations in the year preceding study enrolment were assigned to a self-management programmed “Living Well with COPDTM” or to standard care. Hospitalizations from all causes were the primary outcome and were documented from the provincial hospitalization database; emergency visits were recorded from the provincial health insurance database.

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Study Most patients were elderly, not highly educated, had advanced COPD (reflected by a mean forced expiratory volume in one second of 1 L), and almost half reported a dyspnoea score of 5/5 (modified Medical Research Council). At 2 years, there was a statistically significant and clinically relevant reduction in all-cause hospitalisations of 26.9% and in all-cause emergency visits of 21.1% in the intervention group as compared to the standard-care group. After adjustment for the self-management intervention effect, the predictive factors for reduced hospitalisations included younger age, sex (female), higher education, increased health status and exercise capacity.

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In conclusion, in this study, patients with chronic obstructive pulmonary disease who received educational intervention with supervision and support based on disease-specific self-management maintained a significant reduction in hospitalisations after a 2-year period.

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Self management for patients with chronic obstructive pulmonary disease

Marlies Zwerink1, Marjolein Brusse-Keizer1, Paul DLPM van der Valk1, Gerhard A Zielhuis2, Evelyn M Monninkhof3, Job van der Palen1,4, Peter A Frith5,6, Tanja Effing5,6,*

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Abstract Self management interventions help patients with chronic obstructive pulmonary disease (COPD) acquire and practise the skills they need to carry out disease-specific medical regimens, guide changes in health behaviour and provide emotional support to enable patients to control their disease. Since the first update of this review in 2007, several studies have been published. The results of the second update are reported here.

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Methods We searched the Cochrane Airways Group Specialised Register of trials (current to August 2011). Controlled trials (randomised and non-randomised) published after 1994, assessing the efficacy of self management interventions for individuals with COPD, were included. Interventions with fewer than two contact moments between study participants and healthcare providers were excluded.

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Results Analysis of the studies revealed that self management training improved health-related quality of life in patients with COPD compared with usual care. Also, the number of patients with at least one hospital admission related to lung disease and other causes was reduced among those who participated in a self management intervention. These patients also experienced less shortness of breath. We found trials that compared different types of self management interventions versus each other. We had hoped that these trials would help us identify the most effective components of self management. However, all interventions were different, and we were unable to draw out the key themes.The studies assessed in this review were diverse. Self management programmes differed in content and duration. Also, types of participants differed across studies. Therefore, no clear recommendations on the most effective content of self management training can be made at this time.

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Conclusion Self management interventions in patients with COPD are associated with improved health-related quality of life as measured by the SGRQ, a reduction in respiratory-related and all cause hospital admissions, and improvement in dyspnoea as measured by the (m)MRC. No statistically significant differences were found in other outcome parameters. However, heterogeneity among interventions, study populations, follow-up time and outcome measures makes it difficult to formulate clear recommendations regarding the most effective form and content of self management in COPD.

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The (cost)-effectiveness of self-treatment of exacerbations on the severity of exacerbations in COPD patients: the COPE-II study

doi:10.1136/thx.2008.112243Thorax published online 6 Sep 2009;and Job van der PalenTanja W Effing, Huib A M Kerstjens, Paul D L P M van der Valk, Gerhard A Zielhuis

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ABSTRACTCOPD is a chronic disease with high prevalence and quickly increasing incidence rates. Weevaluated the effect of self-treatment of COPD exacerbations on the severity of exacerbationsduring one year. In addition, a cost-effectiveness analysis was performed.Patients were randomly allocated to four two-hour self-management sessions, with orDuring follow up all participants kept a daily symptom diary. These provided thedata to calculate the frequency of exacerbations, the number of exacerbation days and meandaily severity scores.

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Data were analysed of 142 randomised patients (self-treatment: n=70; control: n=72).The frequency of exacerbations was identical in both study groups (mean 3.5 (SD 2.7)).31(interquartile range (IQR): 8.9-67.5); control: 40 (IQR: 13.3-88.2); p=0.064), the differencewas significant in the group of patients with a high number of exacerbation days per year(>137 (= 90th percentile of the whole study population); p=0.028). The mean severity score ofdifferences were found inhealth related quality of life. Cost-effectiveness analyses showed that applying self-treatment

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saved €154 per patient, with a trend towards a lower probability for hospitalisations(number/patient/year: self-treatment: 0.20 versus control: 0.33 (p=0.388)) and a significantreduction of health care contacts (number/patient/year: self-treatment: 5.37 versus control:6.51 (p=0.043)).

We conclude that self-treatment of exacerbations incorporated in a self-managementprogramme leads to less exacerbation days and lower costs.

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Any questions ?

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Thank you

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self management

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