Manage Your Illness

Self-management support and communication from nurse care managers

Tue, 09 Mar 2010 17:00:58 +0000

Pain is a critical health problem, with over half of Americans suffering from chronic or recurrent pain. Many patients also experience comorbid depression. Although numerous self-management interventions have been implemented in an effort to improve pain outcomes, little attention has been devoted to the role of the provider of these services, typically a nurse care manager (NCM). Given the robust literature pointing to a link between physician-patient communication and patient outcomes, NCM-patient communication merits closer examination. Matthias and colleagues reported chronic pain patients' perceptions of the communication with NCMs in a pain self-management trial and patients' perceptions of the communication they experienced in primary care. Eighteen patients suffering from chronic musculoskeletal pain and depression participated in four focus groups designed to ascertain their perceptions of the intervention. A key emergent theme from these focus groups was the contrast in patients' perceptions of the communication with their primary care physicians versus with the NCMs. Patients reported feeling supported, encouraged, and listened to by their NCMs, whereas they tended to be dissatisfied with their primary care physicians, citing issues such as lack of continuity of care, poor listening skills, and under- or overprescribing of medication.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The results of this study underscore the importance of the NCM, particularly for patients with chronic conditions such as pain.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The study showed that you are likely to communicate better with your nurse than with your physician. This trend could be altered through the teaching and performance of self-management skills. You should then be able to communicate equally with both nurses and other health care providers.

MS Matthias et al. Self-Management Support and Communication from Nurse Care Managers Compared with Primary Care Physicians: A Focus Group Study of Patients with Chronic Musculoskeletal Pain. Pain Management Nursing, 2010;11:26-34.

An effective self-management program for multiple sclerosis

Mon, 08 Mar 2010 15:46:49 +0000

A lay-led, community-based intervention, the Chronic Disease Self-Management Course (CDSMC), is effective for a range of long-term health conditions (e.g. arthritis, heart disease). However, the perceived value and experience of the CDSMC for people with Multiple Sclerosis (MS) has not been examined. A qualitative study conducted by Barlow and colleagues addressed this omission. Ten participants with MS (7 female; age range 35 to 60 years; disease duration 4 to 19 years) were interviewed before attending the CDSMC and at 4-month follow-up. Data were analyzed using Framework Analysis. Some participants learned new self-management techniques and reported enhanced confidence (self-efficacy), whereas other participants were already confident in their self-management ability and found the CDSMC acted as a reminder of techniques previously used. Relaxation, pacing, and goal setting were particularly valuable for managing fatigue. Goal setting helped some participants to build confidence. Participants valued meeting similar others including those with different conditions. The CDSMC was an opportunity for social comparison and inspirational role modeling. Improvements to the CDSMC were suggested, including the addition of specific MS information.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: Overall, the CDSMC was viewed as a valuable source of new skills and a reminder of previously learned self-management skills, particularly in the context of managing fatigue. Gender differences emerged.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The study was reported by a solid group of investigators. It suggests that self-management may be very useful to you if you experience multiple sclerosis. Through consistent performance over time, you will develop self-efficacy with respect to your ability to help control your illness.

J Barlow et al. The experience of attending a lay-led, chronic disease self-management program from the perspective of participants with multiple sclerosis. Psychology & Health, 2009;24:1167-1180.

A three-year follow-up following multifaceted diabetes care intervention

Fri, 05 Mar 2010 16:10:21 +0000

Piatt and colleagues sought to determine if improvements observed in clinical, behavioral, and psychosocial outcomes measured at 12 months following a multifaceted diabetes care intervention were sustained at 3-year follow-up. The study was a multilevel, nonblinded, cluster design, randomized controlled trial that took place in an underserved suburb of Pittsburgh, Pennsylvania, between 1999 and 2005. Eleven primary care practices and their patients were randomly assigned to three groups: (a) chronic care model (CCM) intervention (n = 30), (b) provider education only (PROV) (n = 38), and (c) usual care (UC) (n = 51). Subjects were followed for three years. Improvements observed at 12-month follow-up in glycemic (-0.5%) and blood pressure control (-4.8 mm Hg), and the proportion of participants who self-monitor their blood glucose (86.7%-100%), were sustained at three-year follow-up in the CCM group. Additional improvements occurred in non-HDLc levels in all study groups and quality of well-being scores in the CCM intervention group. All associations remained after controlling for medication treatment intensification.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The investigators demonstrated that improvements in outcomes could be sustained over time following a multifaceted diabetes care intervention. Future research in this area is necessary to understand if improvements in outcomes can be sustained following diabetes self-management education (DSME) and what type of patient fares the best from multifaceted diabetes care interventions.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: If you have diabetes, it is imperative that you participate in a self-management program. As shown in the study, the effects can be enduring if you continue to perform the skills you are taught in self-management. The investigators should be applauded for obtaining long-term data in support of self-management.

GA Piatt et al. 3-Year Follow-up of Clinical and Behavioral Improvements Following a Multifaceted Diabetes Care Intervention: Results of a Randomized Controlled Trial. Diabetes Education, March 3, 2010.

A comparison of patient and physician assessments of weight loss

Thu, 04 Mar 2010 15:53:48 +0000

Bleich and colleagues examined concordance between patient and physician assessments of patient self-reported use of weight-management activities. They analyzed baseline data from a randomized controlled trial of patient and physician interventions designed to improve patient-physician communication (41 physicians and 274 of their patients). A majority of patients reported regular exercise (55.6%) and efforts to lose weight, such as eating less (63.1%), while physicians only perceived one-third of patients as engaging in those activities (exercise, 36.6%; weight loss, 33.3%). Kappa scores indicated small agreement between patient and physician assessments of patient self-reported use of exercise, mean kappa 0.28, and no agreement between patient and physician assessments of patient self-reported efforts to lose weight, mean kappa -0.14. Obese patients were more likely than non-obese patients to report trying to lose weight or exercising regularly (p<0.05), but physicians were less likely to perceive obese patients as engaging in those activities (p<0.05).

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: The study showed that primary care physicians differed considerably from their patients, especially obese patients, in their assessments of patient use of weight-management activities.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The findings are not surprising: both physicians and their patients were looking at the problems through different glasses. The only way that there could be some agreement is if standard criteria, agreed on by both parties, would be adopted. This is why self-monitoring is so important. Patients who keep accurate data on their weight and activities can review this information with their physicians. The data provides a standard for both parties to review. In doing so, it could also improve communication between the two groups, physicians and patients.

SN Bleich et al. Patient use of weight-management activities: A comparison of patient and physician assessments. Patient Education & Counseling, February 27, 2010.

Comparing strength training, self-management, and a combination of procedures for early osteoarthritis of the knee

Wed, 03 Mar 2010 16:40:13 +0000

McKnight and coworkers assessed the relative effectiveness of combining self-management and strength training for improving functional outcomes in patients with early knee osteoarthritis. They conducted a randomized intervention trial lasting 24 months at an academic medical center. Community-dwelling middle-aged adults (n = 273) ages 35-64 years with knee osteoarthritis, pain, and self-reported physical disability completed a strength-training program, a self-management program, or a combined program. Outcomes included five physical function tests (leg press, range of motion, work capacity, balance, and stair climbing) and two self-reported measures of pain and disability. A total of 201 participants (73.6%) completed the 2-year trial. Overall, compliance was modest for the strength training (55.8%), self-management (69.1%), and combined (59.6%) programs. The three groups showed a significant and large increase from pre- to post treatment in all of the physical functioning measures, including leg press (d = 0.85), range of motion (d = 1.00), work capacity (d = 0.60), balance (d = 0.59), and stair climbing (d = 0.59). In addition, all three groups showed decreased self-reported pain (d = -0.51) and disability (d = -0.55). There were no significant differences among the groups.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: Middle-aged, sedentary persons with mild early knee osteoarthritis benefited from strength training, self-management, and the combination program. The results suggest that both strength training and self-management are suitable treatments for the early onset of knee osteoarthritis in middle-aged adults. Self-management alone may offer the least burdensome treatment for early osteoarthritis.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The study enrolled a relatively large number of subjects and had a two-year follow-up. The next step for the investigators would be to ferret out which of three components contributed the most to the success of the study. In addition, a 69.1 compliance rate for self-management participants is actually quite high. The investigators should be encouraged to follow-up their results.

PE McKnight et al. A comparison of strength training, self-management, and the combination for early osteoarthritis of the knee. Arthritis Care & Research, 2010;62:45-53.