Transcript Co-creating Health - Health Foundation

Improving Outcomes by
Helping People Take
Control
The theory and practice of
Co-creating Health
Why support self-management?
Life with a long term condition: the person’s perspective
Interactions with the service: planned or unplanned
Care planning: A system of regular
scheduled appointments, providing
proactive structured support
Problem solving: Time
limited consultation/s
providing
motivational support
Care pathways:
providing
specific
interventions
NB : People may also be accessing a wide variety of other support e.g. from within their
communities
What is supported
self-management?
“Self management support can be viewed in two
ways: as a portfolio of techniques and tools that
help patients choose healthy behaviours; and a
fundamental transformation of the patientcaregiver relationship into a collaborative
partnership.”
Bodenheimer T, MacGregor K, Shafiri C (2005). Helping Patients Manage
Their Chronic Conditions. California: California Healthcare Foundation.
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Co-creating Health
Achieve measurable
improvements in the
quality of life of people
living with long term
conditions and improve
their experience of
health services by
embedding self
management support
within mainstream
health services.
©The Health Foundation
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The Chronic Care Model
The problems:
• Lack of care coordination
• Lack of active follow-up
• Patients inadequately trained to
manage their illnesses
‘Overcoming these deficiencies
will require nothing less than a
transformation of health care, from
a system that is essentially reactive
- responding mainly when a person
is sick - to one that is proactive and
focused on keeping a person as
healthy as possible.’
Developed by the MacColl Institute
ACP-ASIM Journals and Books
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The Chronic Care Model
‘Overcoming these deficiencies
will require nothing less than a
transformation of health care, from
a system that is essentially reactive
- responding mainly when a person
is sick - to one that is proactive and
focused on keeping a person as
healthy as possible.’
Understanding
have role; confident
and capable in role
Developed by the MacColl Institute
ACP-ASIM Journals and Books
Supporting
people on
their journey
of activation
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The evidence
Evidence for supporting self management grows every year.
•
Research is up to date
•
Internationally, studies are consistently positive
•
Research has used a range of methodologies.
•
Studies are from small to large scale.
It shows that supporting self-management can improve:
•
self confidence / self efficacy
•
self management behaviours
•
quality of life
•
clinical outcomes
•
patterns of healthcare use
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Active support works best
Research shows that more
active support focused on
self-efficacy (confidence)
and behaviour works best
to improve outcomes.
Information and
knowledge alone are not
enough.
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Active support works best
Approaches that focus on
whether people are
ready to change work
well.
Source: Prof Judy Hibbard, University of Oregon
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Examples of improvement
•
Self monitoring and agenda setting reduce hospitalisations, A&E visits,
unscheduled visits to the doctor and days off work or school for people with
asthma (Gibson et al 2004).
•
Goal setting for older women with heart conditions reduces days in hospital
and overall healthcare costs (Wheeler et al 2003).
•
Telephone support may improve self care behaviour, glycaemic control,
and symptoms among vulnerable people with diabetes (Piette et al 2000).
•
Motivational interviewing improve self efficacy, patient activation, lifestyle
change and perceived health status (Linden et al 2010).
•
Individual education and group sessions improve symptoms for people
with high blood pressure (Boulware et al 2001).
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The Co-creating Health model
©The Health Foundation
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The Three Enablers
Becoming an active partner
Making change
Maintaining change
Agenda setting
– Identifying issues and problems
– Preparing in advance
– Agreeing a joint agenda
Goal setting
– Small and achievable goals
– Builds confidence and momentum
Goal follow-up
– Proactive – instigated by the system
– Soon – within 14 days
– Encouragement and reinforcement
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An Integrated Approach
Advanced
Development
Programme
Service
Improvement
Programme
Patient
Clinician
Self-management
Programme
Who
Service
Programme
Role change
Focus
From passive patient
to self-management
Activation and
partnership: confidence
and skills
From expert who
cares to enabler who
supports selfmanagement
Building the
knowledge, skills and
attitudes needed to
provide effective selfmanagement support
From cliniciancentred services to
services that have
self-management
support as their
organising principle
Embedding the 3
enablers into everyday
practice by building
them into systems and
care pathways
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Self Management Programme
outcomes
Skills developed ....
•
Setting the agenda
•
Setting goals
•
Problem solving
•
Develop the confidence
•
Understand their condition
•
Develop skills
“I used to go to the doctor only when they summoned
me, and then say ‘What are you going to do to fix my
problem?’. But now I’m saying like, ‘I’m not sure
these particular painkillers are working the way we
hoped, can we try something else? What could I do
myself? ’ “
Person living with a
long-term condition
... producing statistically significant changes in:
• positively engagement with life
• constructive attitude/approach towards condition
• more positive emotional well being
• using self-management skills and techniques
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Practitioner Development
Programme outcomes
Practice positively influenced:
•
•
•
•
•
•
patients’ confidence to self manage
agenda setting
setting own goals
collaborative problem solving
goal follow up
patients’ experience
“It’s a change from the traditional approach
where say ‘You need to do this”, and the
patient says “you’re the boss”, but doesn’t
actually do it. We used to wonder why that
wasn’t working”
Community matron
“Now I use agenda setting with my patients and I start by
asking ‘what do you want us to do today?’ Patients
appreciate this different approach because you are giving
them the power. You work out the goals and the steps
together and they are empowered to carry on and work on it
on their own. So you may need to see them a bit more at
first, but in the long run you need to see them less often.”
Clinician tutor
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Service Improvement Programme
Outcome
Primary Drivers
Secondary
Drivers
Organisational
Changes
The 3 Enablers
Patient Confident
in Self
Management
Pre-visit
changes
Agenda Setting
Goal Setting
Goal Follow Up
During visit
changes
Post-visit
changes
Adapted from Robert Lloyd and Richard Scoville, Better Quality through Better Measurement
I
M
P
R
O
V
E
M
E
N
T
A model for all long-term
conditions
Diabetes
COPD
The Whittington Hospital and
Haringey and Islington PCTs
Addenbrokes and
Cambridgeshire PCT
Guys & St Thomas and
NHS Arran and Ayrshire
Southwark PCT
A model for
all LTCs
Depression
Chronic Pain
SW London MH Trust and
Wandsworth PCT
Torbay Care Trust and PCT
Calderdale and Huddersfield
Trust and Kirkees PCT
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Improving lives in chronic pain?
Pre and 6 Months Post Self-Management Programme scores for Pain
intensity, Pain Interference, Pain Activation and Pain Self Efficacy
60
Pre SMP
Outcome measure Score
50
6 Months Post SMP
40
30
20
10
0
P intensity
p = 0.01
P Interference
p = 0.02
PAM
PSEQ
p = 0.001
p = 0.05
Conclusion
‘I’d like to thank
you both for giving
me back the life I
thought I’d lost, its
made me realise I
was holding
myself back’
Person living with a
long-term condition
©The Health Foundation
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