Self-management: Why bother Self-management: What’s it as long as Methods

Self-management: Why bother Self-management: What’s it as long as  Methods

Self-management: Why bother Self-management: What’s it as long as Methods

Ragsdale, Sachiyo, Managing Editor has reference to this Academic Journal, PHwiki organized this Journal Which outcomes of self-management matter to patients, family/carers, health professionals in addition to commissionersDr Sara Demain, Associate Professor 2Self-management in addition to “patient empowerment”

Columbia College Chicago US

This Particular University is Related to this Particular Journal

Self-Management What is it“individuals making the most of their lives, coping with difficulties in addition to making the most of what they have. It includes managing or minimising the way conditions limit individuals’ lives as well as what they can do to feel happy in addition to fulfilled, to make the most of their lives despite the condition.” (Department of Health, 2008)5What outcomes matterPeople with LTCsFamilies in addition to friendsHealth professionalsSelf-management: Why botherBetter healthHappier patientsLower costsPanacea or snake-oil

7Self-management: What’s it as long as Stroke self-management13 trials of Stroke SM15 concepts measured43 outcome measuresMostly “clinical”SM: VOICED StudySelf-Management: Valued Outcomes; Investigating ConsEnsus in addition to Difference SMVOICEDEffective Self-management

AimsTo underst in addition to -What outcomes each stakeholder wants SM to achieveHow they would recognise successful SM in addition to successful SM supportIdentify consensus in addition to disparity11MethodsPhase 1 – Systematic review. Boger et al; PLOS-One.Phase 2 – Qualitative data gatheringPhase 3 – DelphiMethods 3 conditions: diabetes, stroke, colorectal cancer3 centres: Southampton; Leeds; London + 50 mile radius (urban in addition to rural)+ NHS Engl in addition to commissioning policy makers

MethodsFocus groups in addition to interviewsPeople’s underst in addition to ing of: SM in addition to SM supportdesired outcomeswhat was the point of SM What would constitute a good / bad ‘self-manager’ How could SM support be evaluatedDeductive thematic analysis – coding schema developed from SRSample (n= 166) 89 people with LTC Diabetes (38); Colorectal Cancer (19); Stroke (40)35 friends in addition to family Diabetes (14); Colorectal cancer (10); Stroke (11)20 HCP Diabetes (3); Colorectal cancer (3); Stroke (6); Generic (8)22 Commissioners CCG (17); CSU (1) NHS Engl in addition to (4)Findings

CommissionersFocus on process measures & healthcare utilisation ‘’ the economic impact looking at the emergency admission rate, bed days, [impact on] ambulatory care services, emergency admissions, emergency readmissions, rehabilitation, residential home ’’ (comm 11)Focus on patient responsibility‘’I think we have gone far too much down the path of the nanny state, where everything is done as long as people, in addition to I think we are trying to bring it back to a point where patients have to realise that actually ultimately they are the ones that control their lives’’ (comm 20)CommissionersAlso value person centred care in addition to ‘soft’ outcomes – confidence, wellbeing, etcThe best outcome as long as me , [the] “Why are we doing it” is that there’s an increase in terms of people feeling more supported in addition to confident to manage their condition’’ (comm 17)But don’t know how to measure these ‘Well because of the personalisation [agenda] now outcomes are difficult to measure because they’re personalised. So if somebody says, “I want to go fishing,” well how do you measure that [or] if somebody wants to start knitting You can’t’’. (comm 10)HCPBiomarkers are important measures of health in addition to complianceat a rather narrow level, you can look at their biochemical parameters, so we’ve got the measures of blood glucose which – HBa1C, you can tell whether they’re taking their cholesterol medications, you can look at their blood pressure, you can look at their weight. And those are very important end points. They’re not really – they’re not the whole story at all’’ (HCP, DM)Driven by government in addition to commissioning targets in addition to clinical guidelines

Targets can hinder person centred outcomesI’ve got one person with diabetes who refused to be weighed but it’s not about it being my target, it’s about that person in addition to how do we deal with that issue, And then there’s the feeling that we’ve become ‘our income is dependent on achieving those targets’, so that’s produced another feeling, in addition to dynamic.” Patient choice in addition to controlhe said he didn’t even want to take any of his drugs. So I said, “Right, let’s take you off your drugs then.” Because he probably wasn’t taking them at home; he didn’t want to take them. He’s just emptying them. And then once we got back to basics I said, “What would you be willing to take” So he told me what he was willing to take, so I prescribed that in addition to we gradually got him back on all his drugs in addition to his diabetes was really well controlled within a year”Patients in addition to families Want more support, in as long as mation in addition to tailored adviceHCP need to take responsibility as long as SM tooFamilies – how to get patients to do what they should.Patients – how to adapt treatments to live well in addition to feel normal

’without the help I haven’t got a clue in addition to that went on as long as years because I just couldn’t in addition to nobody was telling me anything useful that was actually practical in addition to fitted in with a life; that you could sustain ongoing, yes you could do it as long as a month or two but then actually, I have got a life!! (patient)Nick’s self- management wish-list .I don’t want to be blamed or dictated with a broken record, I want the professionals to be listening in addition to learning from me, to feel like I’m listened to in addition to involved in addition to that my experience in addition to knowledge has some value in addition to respect, not that I’m right, but that they’ll listen to it. And that the people I’m talking to underst in addition to the challenges that we’ve got, that it’s ‘not just that easy; that it is difficult’ in addition to that they give us options in addition to flexible responses, in addition to not just the same old thing, kind of, “Go back in addition to do it again”. And the thing that matters most to me, that’s crucial to me, is to feel that what I’m doing makes a difference because if I don’t feel it makes a difference I won’t do it. I can’t sustain doing it as long as decades unless I know it makes a difference.SummaryComplex range of outcomes – often in tension

Ragsdale, Sachiyo Gilbert Lifestyle Managing Editor

Next steps National Delphi survey: Identifying outcome priorities as long as stakeholdersStakeholder events – discuss tensions in addition to ways as long as wardWork on measurement in addition to evaluation of SM27Patient in addition to family views priority

Self-Management VOICED StudyWebsite: @SMVOICEDEmail: Posters: 59 in addition to 60

Ragsdale, Sachiyo Managing Editor

Ragsdale, Sachiyo is from United States and they belong to Gilbert Lifestyle and they are from  Mesa, United States got related to this Particular Journal. and Ragsdale, Sachiyo deal with the subjects like Domestic Lifestyle (Regional)

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