supporting people to self manage their long term condition(s)
TRANSCRIPT
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Supporting people to self manage their long term condition(s).
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Session Outline• Hear what has helped people to manage
their long term condition.
• Share practical tips in relation to supporting people to manage their condition
• Identify what interventions have helped to support people on their self management journey.
• Reflection - what action is needed to make this happen for you/your organisation?
• Take home messages – key points to take away with you
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Self Management Support
Self management support is the assistance that caregivers give to people with long term conditions in order to encourage daily decisions that improve health related behaviours and clinical outcomes. It can be viewed in two ways:
• A portfolio of tools and techniques that help patients choose healthy behaviours
• A fundamental transformation of the patient caregiver relationship into a collaborative partnership”
Bodenheimer T, McGregor K and Sharifi C (2005) Helping patients manage their chronic conditions California Healthcare Foundation, Oakland, USA
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4
‘a person-centred approach in which the individual is empowered and has ownership over the management of their life and conditions. The role of the health and social care professionals, services and treatment is to support the person’s journey towards living well in the presence or absence of symptoms’
Gaun Yersel! The Self Management Strategy for Long Term Conditions in Scotland 2008
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Self Management Support
What does it look like to you?
What are the challenges?
What do you/we need to change?
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My self management journey
Ann Jackson from Marsden, West Yorkshire
Steve Donaldson from Ayrshire and Aaron
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The Self Management Journey
Most people do not become confident self-managers overnight. They embark on a journey where self management may not be seen as important and confidence levels vary.
4 Stages:• Beginning the journey• Finding a way• Travelling• Staying on track
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Beginning the Journey
Does not see self management as an important part of living with a long term condition
Finding a Way
Recognises their role in managing health and well-being but has low confidence in their ability
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Travelling
Recognises their role in managing health and well-being but has low confidence in their ability.....trying some skills, looking for ideas
Staying on Track
High confidence for many skills and can problem solve new challenges
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Self Management Support
Patients cannot do it alone. They need support, information and skills to develop their self management capabilities
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Agenda Setting
http://personcentredcare.health.org.uk
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Agenda Setting
It is important that:
• the patient and clinician jointly agree the agenda otherwise the clinician might not know what changes the person is willing to make
• patients who succeed in making one health behaviour change will apply that learning to other areas
http://personcentredcare.health.org.uk
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Setting & Negotiating the Agenda
Role Play:
Sam is a person living with a long term condition and is visiting his / her GP.
(medications are fictional)
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Goal Setting
http://personcentredcare.health.org.uk
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Goal Setting• Though goal setting is a collaborative
process between the individual and clinician, behavioural change and better health care outcomes are more likely if the patient sets the goals.
• This is because the goal(s) will be relevant and important to them, at the time and take account of their situation.
• Follow up of goals
http://personcentredcare.health.org.uk
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Goal Setting: Importance & Confidence
Exploring importance and confidence can help clarify significance of change to the patient and increase importance and confidence levels. For example..
http://personcentredcare.health.org.uk
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Goal Setting - SMART
Goals should be SMART
• Specific - What are you going to do?• Measurable - How much and how often will you
do it?• Appropriate - How important is this to you? (0-
10 scale)• Realistic - How confident are you? (0-10 scale)• Time Based - When will you do it?
http://personcentredcare.health.org.uk
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Goal Follow Up
Self Management Programme
• weekly goal follow up• Peer support and encouragement• Learning how to set SMART goals• Peer supported problem solving
Post Self Management Programme
• Reunion sessions (Support Network)• Peer support groups• Health practitioners?
http://personcentredcare.health.org.uk
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Reflection from Ann & Steve
• Confidence • Agenda Setting • Goal Setting• Goal Follow up
http://personcentredcare.health.org.uk
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1. Flexible and relevant patient self management support options necessary
2. Identify and fully utilise volunteer patient ‘champions’ from the start.
3. Commitment from influential leaders vital (Clinical and Managerial)
Top Tips for Implementing Self Management Support
http://personcentredcare.health.org.uk
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Take Home Messages
What 3 key messages will you take from the session?
Think about what is needed in your locality / field of work to make Self Management Support a reality?
http://personcentredcare.health.org.uk
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Questions
http://personcentredcare.health.org.uk
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Session Outline• Hear what has helped people to manage
their long term condition.
• Share practical tips in relation to supporting people to manage their condition
• Identify what interventions have helped to support people on their self management journey.
• Reflection - what action is needed to make this happen for you/your organisation?
• Take home messages – key points to take away with you
http://personcentredcare.health.org.uk