# Presentation: 689393

## Chronic Disease Self-Management Programs

***Kate Lorig, RN, DrPH***
***Stanford Patient Education Center***
***1000 Welch Road, Suite 204***
***Palo Alto CA 94304***
***650-723-7935***
_*[self-management@stanford.edu](mailto:self-management@stanford.edu)*_
***Patienteducation.stanford.edu***

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## Slide 3

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## Self-Management:  What Is It?	

**Based on patient perceived problems and evidence about what makes a difference**
**Builds confidence (self-efficacy) to perform 3 tasks**
***    ******	******Disease Management***
***	******	******Role Management***
***   ******	******	******Emotional Management***
**Focus on improved health status and appropriate health care utilization**

## How Self-Management Differs From Patient Education

## How Self-Management Differs From Patient Education

## How Self-Management Differs From Patient Education

## Characteristics of Stanford Self-Management Programs

**Built on structured patient and professional needs assessments (usually focus groups)**
**Systematically use strategies to enhance self-efficacy**
***	******	******Skills Mastery***
***	******	******Modeling***
***	******	******Reinterpretation of Symptoms***
***	******	******Social Persuasion**** *

## Characteristics of Stanford Self-Management Programs

**Peer led small groups****	**
**Standardized training for leaders****	**
**Highly structured teaching protocol**
**Standardized participant materials**
**Sesame Street approach**
**Evaluated for long term outcomes**

## Chronic Disease Self-ManagementWhat Is It??

**Generic Program opened to anyone with a long term illness**
**6 week/ 2.5 hours per week**
**Taught by peer leaders**

## Chronic Disease Self-Management Program (N=945)

***Demographic Data***
**Age****	****	****	****62 years****	**
**Male****	****	****	****27%**
**Education****	****	****14 years****	**
**No. Diseases****	****	****2.2**

## Percent With Common Diseases

**Lung Disease****	****	****21%**
**Heart Disease****	****24%****	**
**Diabetes****	****	****26%**
**Arthritis****	****	****42%**

## Chronic Disease Self-Management

***6-Month Improvements in Health Outcomes***
**Self-Rated Health**
**Disability**
**Social and Role Activities Limitations**
**Energy/Fatigue**
**Distress with Health State  **
***                                                               ***

## Chronic Disease Self-Management

***Improvements in Utilization and Costs***
**Average .8 fewer days in hospital in the past six months (p=.02)**
**Trend toward fewer outpatient and ER visits (p=.14)**
**Estimated cost of intervention $100-$200**

## Tomando Control de su SaludWhat Is It??

*  *
*   ***Culturally appropriate version of the the Chronic Disease Self-Management Program developed  for Spanish speakers**

## Tomando Control de su Salud

***N=444***
**Male****	****	****	****	****17%**
**Place of birth*****	***
***	******    ******Mexico******	******	******	*****63%**
***	******    ******Central America******	******	*****21%**
**Age****	****	****	****	****58  (22-91)**** **
***	***

***Mean Education******	******	******7.5 years******	***
***	******	*****3 or less yrs****	****	****23%**
**	****	****4-6 yrs****	****	****	****30%**
**	****	****7-11 yrs****	**** ****	****	****17%**
**	****	****12 or more yrs****	****	****30%  **

**Tomando Control de su Salud**

***Insurance Status***
**	****No insurance****	****	****	****34%**
**	****MediCal or Medicare****	****35%**
**	****Private insurance****	****	****31%****	***** ***
***     ***

**Tomando Control de su Salud**

## Percent With Common Diseases

*** *****Hypertension****	****	****54%**
** ****Diabetes****	****	****	****45%**
** ****Heart disease****	****	****19%**
** ****Lung disease****	****	****17%**

## 4 Month Improvements in Health Behavior

**Minutes of exercise per week**
**Portions of vegetables eaten daily**
**Portions of fruit eaten daily**
**Number of times breakfast eaten weekly**
**Number of days of glucose testing (diabetics)**

## 4 Month Improvements in Health Status

***Self-Rated Health***
***Health Distress***
***Fatigue***
***Disability***
***Role Activity***

## 4 Month Changes in Health Care Utilization and Self-Efficacy

***MD Visits***
***ER Visits***
***Hospitalization***
***Self-Efficacy***

## Tampa V.A. Study

*244 Diabetics were randomized to the CDSMP, a weekly mailed information, or usual care*
* *
*Investigators:  Virginia Nodhturft Ed.D. RN  and Pamela Hebert Dr.PH*

## 6-Month Change in BMI and HbA1c

|  | CDSMP | Mail | Usual Care |
| --- | --- | --- | --- |
| BMI | -1.5 | +.1 | 0 |
| HbA1c | -.8 | -.4 | 0 |

## What Is the Future???

**      ****Arthritis Self-Management on-line**
**       ****Diabetes Self-Management on-line**
***Six week course for 15-20 participants***
***No real time commitment***
***  ***
*   **	**	****http://healthyliving.stanford.edu***

## What Is Needed

**  ****Self-Management Support—System Level**
**  ****Integration of Self-Management into**
**      ****Medical Care**
**  **
**         **