Archive for February, 2016

Chronic Disease Self-Management Program (Better Choices, Better Health® Workshop)

February 5, 2016

The Chronic Disease Self-Management Program is a workshop given two and a half hours, once a week, for six weeks, in community settings such as senior centers, churches, libraries and hospitals. People with different chronic health problems attend together. Workshops are facilitated by two trained leaders, one or both of whom are non-health professionals with chronic diseases themselves.

Subjects covered include: 1) techniques to deal with problems such as frustration, fatigue, pain and isolation, 2) appropriate exercise for maintaining and improving strength, flexibility, and endurance, 3) appropriate use of medications, 4) communicating effectively with family, friends, and health professionals, 5) nutrition, 6) decision making, and, 7) how to evaluate new treatments.

Each participant in the workshop receives a copy of the companion book, Living a Healthy Life With Chronic Conditions, 4th Edition, and an audio relaxation CD, Relaxation for Mind and Body.*

It is the process in which the program is taught that makes it effective. Classes are highly participative, where mutual support and success build the participants’ confidence in their ability to manage their health and maintain active and fulfilling lives.

Does the Program replace existing programs and treatments?

The Self-Management Program will not conflict with existing programs or treatment. It is designed to enhance regular treatment and disease-specific education such as Better Breathers, cardiac rehabilitation, or diabetes instruction. In addition, many people have more than one chronic condition. The program is especially helpful for these people, as it gives them the skills to coordinate all the things needed to manage their health, as well as to help them keep active in their lives.

How was the Program developed?

The Division of Family and Community Medicine in the School of Medicine at Stanford University received a five year research grant from the federal Agency for Health Care Research and Policy and the State of California Tobacco-Related Diseases office. The purpose of the research was to develop and evaluate, through a randomized controlled trial, a community-based self-management program that assists people with chronic illness. The study was completed in 1996.

The research project had several investigators: Halsted Holman, M.D., Stanford Professor of Medicine; Kate Lorig, Dr.P.H., Stanford Professor of Medicine; David Sobel, M.D., Regional Director of Patient Education for the Northern California Kaiser Permanente Medical Care Program; Albert Bandura, Ph.D., Stanford Professor of Psychology; and Byron Brown, Jr., Ph.D., Stanford Professor of Health Research and Policy. The Program was written by Dr. Lorig, Virginia González, M.P.H., and Diana Laurent, M.P.H., all of the Stanford Patient Education Research Center. Ms González and Ms Laurent also served as integral members of the research team.

The process of the program was based on the experience of the investigators and others with self-efficacy, the confidence one has that he or she can master a new skill or affect one’s own health. The content of the workshop was the result of focus groups with people with chronic disease, in which the participants discussed which content areas were the most important for them.

How was the Program evaluated?

Over 1,000 people with heart disease, lung disease, stroke or arthritis participated in an randomized, controlled test of the Program, and were followed for up to three years. We looked for changes in many areas: health status (disability, social/role limitations, pain and physical discomfort, energy/fatigue, shortness of breath, psychological well-being/distress, depression, health distress, self-rated general health), health care utilization (visits to physicians, visits to emergency department, hospital stays, and nights in hospital), self-efficacy (confidence to perform self-management behaviors, confidence to manage disease in general, confidence to achieve outcomes), and self-management behaviors (exercise, cognitive symptom management, mental stress management/relaxation, use of community resources, and communication with physician).**

What were the results?

Subjects who took the Program, when compared to those who did not, demonstrated significant improvements in exercise, cognitive symptom management, communication with physicians, self-reported general health, health distress, fatigue, disability, and social/role activities limitations. They also spent fewer days in the hospital, and there was also a trend toward fewer outpatients visits and hospitalizations. These data yield a cost to savings ratio of approximately 1:4. Many of these results persist for as long as three years.*** Studies by others have reported similar results (see our bibliography).

How can my facility offer the Program?

Trainings for representatives of health care organizations are 4½ days. There are 4-5 trainings scheduled at Stanford University each year. Click “Training” on the menu to learn more.

NOTES

Seidel can be ordered from Bull Publishing.

**A complete report on the measures used and their psychometric properties can be found in Outcome Measures for Health Education and Other Health Care Interventions, by Lorig, Stewart, Ritter, González, Laurent and Lynch, Sage Publications, 1996.

***Outcome data reported in (more citations in our bibliography):

Lorig KR, Sobel DS, Stewart AL, Brown Jr BW, Ritter PL, González VM, Laurent DD, Holman HR. Evidence suggesting that a chronic disease self-management program can improve health status while reducing utilization and costs: A randomized trial. Medical Care, 37(1):5-14, 1999.

Lorig KR, Ritter P, Stewart AL, Sobel DS, Brown BW, Bandura A, González VM, Laurent DD, Holman HR. Chronic Disease Self-Management Program: 2-Year Health Status and Health Care Utilization Outcomes. Medical Care, 39(11),1217-1223, 2001.

In HMO setting: Lorig KR, Sobel DS, Ritter PL, Laurent D, Hobbs M. Effect of a Self-Management Program on Patients with Chronic Disease. Effective Clinical Practice, 4(6),256-262, 2001.

http://patienteducation.stanford.edu/programs/cdsmp.html

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Speaking Out About Speech Challenges

February 3, 2016

Posted by Lisa O’Neill Hill – 29 Jan 2016

Montana resident Jerri Thueson had a stroke two years ago when she was 49. It affected her right side and her ability to speak.

“I could barely make a whole sentence,” she said.

Thueson went to speech therapy and found other ways to tell people what she was thinking or what she needed. She practiced using an app on her iPad.

Speech challenges after stroke are common, and there are different types:

Aphasia: A survivor with aphasia may have trouble understanding language, talking or may have a hard time coming up with the words he wants to say. Sometimes people with aphasia use the wrong words; it can also affect reading and writing. It does not affect intelligence.

Dysphagia: A stroke can cause swallowing problems, which can cause challenges with speech and with eating. Dysphagia can happen because of weakness and a lack of coordination between the muscles in the mouth and throat.

Dysarthria: This happens when muscles in your lips, tongue vocal folds or diaphragm don’t work the way they need to for clear speech.  A survivor’s speech might be slurred, mumbled, slow or choppy and can be difficult to understand.

Regardless of what kind of speech issue you’re having, there are things you can do.

“One of the things that seems to be overlooked is that there are ways that people can still communicate,” says Kathy Newkirk, a speech language pathologist in California. “Even if a person can’t talk, they might be able to write a message so you can understand or they can point to something on a chart.”

Apps for your phone or iPad can be particularly helpful, she says.

Newkirk recommends getting into speech therapy as soon as possible. If it’s not offered, ask for it. Speech therapy should begin as soon as a doctor clears a patient for therapy.

Every survivor is different, she says. For some, getting back to pre-stroke speech can take years; others come back much quicker. It’s important for caregivers to be involved and be supportive.

“Motivation is a huge issue as is family support. It kind of does come down to the extent they are willing and able to practice and work for it,” Newkirk says. “The brain is sometimes forming new connections. It does take a lot of effort.”

Thueson’s advice to stroke survivors struggling with speech challenges?

“Do therapy. Don’t give up. Plan to stick with it and go to a support group. Mainly, don’t give up.”

http://www.strokesmart.org/Speech-Challenges