Self-management for chronically ill older people

Summary: Many chronically ill older patients in the Netherlands have a combination of more than one chronic disease. There is, therefore, a need for self-management programs that address general management problems, rather than the problems related to a specific disease. The Chronic Disease Self-Management Program (CDSMP) seems to be very suitable for this purpose. In evaluations of the CDSMP that have been carried out in the United States and China, positive effects were found on self-management behaviour and health status. However, the CDSMP has not yet been evaluated in the Netherlands. Therefore, the aim of this study was to evaluate the short-term and longer-term effects of the CDSMP among chronically ill older people in the Netherlands. One hundred and thirty-nine people aged 59 or older, with a lung disease, a heart disease, diabetes, or arthritis were randomly assigned to an intervention group (CDSMP) or a control group (care-as-usual). Demographic data and data on self-efficacy, self-management behaviour, health status and health care utilization were collected at three measurement moments (baseline, after 6 weeks, and after 6 months). The patients who participated on average rated the program with 8.5 points (range 0-10), and only one dropped out. However, our study did not yield any evidence for the effectiveness of the CDSMP on self-efficacy, self-management behaviour or health status of older patients in the Netherlands. Yet, a significant effect was found between the intervention and the control group with regard to use of home care, but this effect could not be attributed to the intervention. Positive subjective evaluations made by the participants might indicate that other general self-management skills or abilities were addressed, and this may have positively influenced subjective well-being. Therefore, it was investigated whether the CDSMP addressed other self-management skills, in addition to self-efficacy, and whether these skills affected the subjective well-being of chronically ill older people in the Netherlands. However, no effectiveness of the CDSMP was found on any other self-management abilities than self-efficacy, or on subjective well-being. It is possible that the content of the intervention was too implicit with regard to these other self-management abilities. It might also be that we included patients who had little room for improvement. To conclude, the patients who participated were very enthusiastic, which was also indicated by very high mean attendance (5.6 out of 6 sessions) and the fact that there was only one dropout. Therefore, it seems too early to conclude that the program is not beneficial for these patients. Samenvatting Nederlands: Een manier om oudere chronisch zieken te helpen, is ze actief te betrekken bij de dagelijkse zorg voor hun aandoening. Dit kan onder meer gebeuren door middel van zogeheten zelfmanagementinterventies. Amerikaanse onderzoekers stelden dat het CDSMP (Chronic Disease Self-Management Program) een positieve invloed heeft op zelf-effectiviteit, zelfmanagement, zorggebruik en gezondheidsgerelateerde variabelen. Promovendus Henrike Elzen onderzocht of dit ook in Nederland het geval is. Er werden geen positieve effecten gevonden op bovengenoemde terreinen. De patienten uit de voor dit onderzoek samengestelde interventiegroep waren echter wel zeer enthousiast over de methode. Daarom acht Elzen het te vroeg om te stellen dat de interventie onbruikbaar is voor oudere chronisch zieken in Nederland.