8. COMMISSION RESOURCES TO SUPPORT PEOPLE TO MANAGE THEIR CONDITIONS
Background
Self management interventions vary considerably in their objectives, content, method of delivery, duration and target population. Educational programmes teaching practical self-management skills are more effective than the provision of information alone. Self-management education has been associated with improved knowledge, coping behaviour, adherence, self-efficacy, symptom management, enhanced quality of life and some evidence of a reduction in healthcare utilisation.
Evaluation of the Expert Patient Programme ( EPP), a UK lay led self management course based on the Chronic Disease Self-Management Program developed by Kate Lorig at Stanford University produced mixed findings. ( http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_080680 ) Participants valued the generic course for poorly recognised conditions that are not well supported, but many felt that they would have benefited more from a condition specific course. Most studies of condition-specific education programmes have involved people with asthma, diabetes or arthritis. Success factors include longer interventions (twelve weeks or more); higher intensity programmes; regular review by health professionals; focus on specific rather than general educational topics; participative rather than didactic teaching methods; multi-component approaches, and involvement of family or carers.
EPP participants also valued the social support generated through sharing of information and experiences, practical exchange of ideas and solutions and a reduction in social isolation. Community and voluntary groups provide emotional, psychological and peer support for people living with specific conditions or in similar circumstances. Peer-led interventions are effective in promoting confidence, engagement and participation in local communities and are a useful source of information, advocacy, education and support for carers and family. They are well rated by people living with long term conditions, but professional support appears to be critical for sustaining effect.
NHS, community and voluntary organisations are working together to deliver a range of educational, support, rehabilitation and enablement programmes. The Self Management Fund will enhance our capacity to tailor these supports to an individual's preference, culture, level of comprehension, skill, educational needs and learning style and to ensure that people with long term conditions are actively involved in planning and delivery of self management support.
Sharing resources and experience
- The Patient Activation Measure can be used to help gauge readiness to join a self management support programme.
Contact: Professor Craig White, National Clinical Lead for Self Management at craig.white@scotland.gsi.gov.uk - The Scottish Diabetes Group has directed funding for centres to provide Dose Adjustment For Normal Eating ( DAFNE) structured education courses for Type 1 diabetes. The Scottish Diabetes Education Network ( http://www.diabetes-education.net/index.php?link=about ), with Diabetes UK Scotland, supports diabetes educators to develop appropriate resources and national standards for delivery of diabetes education.
- Lothian - Community Physiotherapy services with Chest, Heart and Stroke Scotland are delivering a 6 weeks exercise programme to help people cope with breathlessness, improve their muscle strength and fitness and stop smoking.
Contact: carol.lumsden@nhslothian.scot.nhs.uk - The Pain Association developed a programme in collaboration with the Chronic Pain and Low Back Pain services in Forth Valley. The annual uptake for the intensive seven week programme is around 400 people. The programme is complemented by local self-management groups in Stirling and Falkirk. This model, now extended to Tayside and Lanarkshire, addresses many of the recommendations in NHS Quality Improvement Scotland's GRIPS report.
Contact: http://www.painassociation.com, Tel: 0800 783 6059 - Grampian cooking courses offer practical support for people with diabetes to learn how to cook healthily.
Contact: fphilip@nhs.net ( MCN Administrator) - The Thistle Foundation's Lifestyle Management courses build on participants' own recovery strategies. The 10 week courses are designed around a framework of planned discussions, safe and appropriate exercise and therapeutic relaxation. They are about building confidence, boosting self esteem through experiencing small successes and benefiting from the supportive environment in the Thistle Foundation facilities. http://www.thistle.org.uk/