Lorig KR, Sobel DS, Ritter PL, Laurent D, Hobbs M. Effect of a self-management program on patients with chronic disease

Stanford University School of Medicine, Calif, USA.
Effective clinical practice: ECP 11/2000; 4(6):256-62.
Source: PubMed

ABSTRACT For patients with chronic disease, there is growing interest in "self-management" programs that emphasize the patients' central role in managing their illness. A recent randomized clinical trial demonstrated the potential of self-management to improve health status and reduce health care utilization in patients with chronic diseases.
To evaluate outcomes of a chronic disease self-management program in a real-world" setting.
Before-after cohort study.
Of the 613 patients from various Kaiser Permanente hospitals and clinics recruited for the study, 489 had complete baseline and follow-up data.
The Chronic Disease Self-Management Program is a 7-week, small-group intervention attended by people with different chronic conditions. It is taught largely by peer instructors from a highly structured manual. The program is based on self-efficacy theory and emphasizes problem solving, decision making, and confidence building.
Health behavior, self-efficacy (confidence in ability to deal with health problems), health status, and health care utilization, assessed at baseline and at 12 months by self-administered questionnaires.
At 1 year, participants in the program experienced statistically significant improvements in health behaviors (exercise, cognitive symptom management, and communication with physicians), self-efficacy, and health status (fatigue, shortness of breath, pain, role function, depression, and health distress) and had fewer visits to the emergency department (ED) (0.4 visits in the 6 months prior to baseline, compared with 0.3 in the 6 months prior to follow-up; P = 0.05). There were slightly fewer outpatient visits to physicians and fewer days in hospital, but the differences were not statistically significant. Results were of about the same magnitude as those observed in a previous randomized, controlled trial. Program costs were estimated to be about $200 per participant.
We replicated the results of our previous clinical trial of a chronic disease self-management program in a "real-world" setting. One year after exposure to the program, most patients experienced statistically significant improvements in a variety of health outcomes and had fewer ED visits.

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    • "Several studies have highlighted that higher PE positively influences disease management leading to improvement of health behaviors [32] [33] [34] [35] "
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    ABSTRACT: Asthma self-management has been recognized as an essential factor for the improvement of asthma outcomes and patients' quality of life (WHO, 2013). Likewise, empowerment and health literacy have been noted as important elements for the management of chronic diseases. To study the influence of health literacy and empowerment on asthma self-management. This cross-sectional study used a self-reported questionnaire assessing health literacy, judgment skills, empowerment, and asthma self-management; 236 patients were recruited from medical offices in Switzerland and Italy. Judgment skills (B=2.28, p<0.001) and empowerment (B=0.19, p<0.05) have a significant and positive influence on several asthma self-management practices such as use of medicines, timely medical consultation, and asthma triggers control whereas health literacy (B=-0.15, p<0.175) appeared to have a negative effect on self-management practices. However, this was not significant. These findings suggest that empowered patients with adequate judgment skills carry out key self-management tasks more appropriately, which in turn will potentially result in better asthma control. This study recommends that both empowerment and judgment skills should be addressed in patient education as they serve as essential motivators to engage patients in these behaviors. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Patient Education and Counseling 04/2015; 98(7). DOI:10.1016/j.pec.2015.03.003 · 2.20 Impact Factor
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    • "The researcher discussed diabetes management strategies and evaluated and updated the action plan with the participants at each intervention visit. This problem-based, patient-focused approach was consistent with nursing case management and diabetes self-management interventions (Lorig, Ritter, & Gonzales, 2003; Lorig et al., 2001). The collaborative action plan included the identified health issues and behavior change strategies to manage diabetes. "
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    ABSTRACT: Introduction: The study purpose was to evaluate the feasibility of a chronic disease self management/case management intervention for adults experiencing homelessness and diabetes and the ability to retain subjects. Methods: Participants with type 2 diabetes were recruited at a homeless clinic and a subset received the intervention. Analysis included calculating a retention rate and evaluating the intervention implementation process. Results: Of the nine participants, five were retained for 12 weeks and two of three participants completed the full intervention. Conclusions: Study retention is feasible for adults experiencing homelessness. Further intervention refinement is needed to address relevancy of content and time constraints.
    Journal of Community Health Nursing 10/2014; 31(4):238-48. DOI:10.1080/07370016.2014.958406 · 0.48 Impact Factor
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    • "When tested on patients with chronic disease it has a test re - test reliability of r ¼ 0 . 92 ( Lorig et al , 2001 ) . ( 3 ) Rapid Assessment of Physical Activity ( RAPA ) Questionnaire : A 9 - item assessment tool used to measure the physical activity of adults . "
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    ABSTRACT: Purpose: To evaluate a program in support of chronic disease self-management (CDSM) that is founded on a health coaching (HC) approach, includes supervised exercise and mindfulness-based stress reduction components and is delivered within a private practice physiotherapy setting. Methods: An explanatory mixed method design, framed by theory-based program evaluation, was employed to evaluate an eight-week group-based program. Standardized self-rated and performance measures were evaluated pre- and post intervention. Additionally, participant focus groups were conducted following the intervention period. An inductive thematic approach was undertaken to analyze the qualitative data. Findings: Seventeen participants (N = 17) completed the study. Improvements were seen in both self-report and performance outcomes. Participants explained how and why they felt the program was beneficial. Six themes were generated: (1) group dynamic; (2) learning versus doing; (3) holism and comprehensive care; (4) self-efficacy and empowerment; (5) previous solutions versus new management strategies; and (6) healthcare provider support. Conclusions: This study established that a group program in support of CDSM founded on a HC approach demonstrated potential value from participants as well as favorable outcomes. A pragmatic randomized control trial is required to determine efficacy of this intervention.
    Physiotherapy Theory and Practice 07/2014; 31(1):1-10. DOI:10.3109/09593985.2014.930769
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