1 / 31

Jayna M. Holroyd-Leduc, MD FRCPC Associate Professor, Division of Geriatrics University of Calgary

Evidence-based Self-management : Translation of Knowledge into a Self-management Tool for Patients with Urinary Incontinence. Jayna M. Holroyd-Leduc, MD FRCPC Associate Professor, Division of Geriatrics University of Calgary. Disclosure Slide. No Conflicts of Interest to Disclose

yowell
Download Presentation

Jayna M. Holroyd-Leduc, MD FRCPC Associate Professor, Division of Geriatrics University of Calgary

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Evidence-based Self-management:Translation of Knowledge into a Self-management Tool for Patients withUrinary Incontinence Jayna M. Holroyd-Leduc, MD FRCPC Associate Professor, Division of Geriatrics University of Calgary

  2. Disclosure Slide • No Conflicts of Interest to Disclose • Project Funding Sources • University of Toronto Dean’s Fund New Staff Competition • CIHR Operating Grant

  3. Learning Objectives 1) To explain the concept of self-management 2) To discuss the value of evidence-based self-management tools for patients 3) To identify that knowledge can be translated for direct use by patients

  4. Self-Management A process whereby persons function on their own behalf in the areas of: • Health promotion • Disease prevention • Disease management Is decisions and actions taken by an individual to cope with and improve a health issue Bhuyan BMC Public Health 2004; Health Canada 2006

  5. Self-Management • Estimated 65-85% of all health care is provided by individuals or family without professional intervention Bhuyan BMC Public Health 2004 • Important component of chronic disease management • Can lower health service use by 7-17% • Low cost way of providing health care Fries Health Aff 1998; Tsai Am J Manag Care 2005

  6. Self-Management Works through 2 mechanisms: 1) Providing information 2) Improving personal self-efficacy (the belief that by personal behaviour one may affect health) Fries Health Aff 1998

  7. Self-Management To be effective it requires: 1) Access to relevant health information 2) Goal setting 3) Organization of resources 4) Implementation of problem-solving strategies Clark J of Aging & Health 1991

  8. Self-Management • Role for the professional health care system to facilitate self-management • Direct translation of knowledge to patients using evidence-based self-management tools

  9. Why Self-Management for Urinary Incontinence? • In the next 20 years >4 million Canadian women will suffer from urinary incontinence • Incontinence is associated with significant morbidity: • Poor quality of life and poor self-rated health • Depression and social isolation • Decline in ADLs

  10. Why Self-Management for Urinary Incontinence? • Majority with incontinence report the issue is of great concern • Only 25% feel it is being adequately addressed by their health care provider • Despite available evidence-based treatment options, less than 50% of incontinent women have talked to a health care provider Tannenbaum CMAJ 2005; Holroyd-Leduc JAMA 2004

  11. Development and Evaluation of an Evidence-based Self-management Tool for managing Urinary Incontinence Risk Factors

  12. Development of the Tool • Funded through University of Toronto Dean’s Fund New Staff Competition • Used evidence from a systematic review to determine modifiable risk factors Holroyd-Leduc JAMA 2004 • Conducted Focus Group of Health care providers to determine risk factors to include in tool • Conducted literature review of behavioural strategies to modify chosen risk factors

  13. Development of the Tool • Drafted the tool • Conducted 2 Patient Focus Groups to critique tool • Vetted final tool through 2 Health care Experts • Translated the tool into French

  14. The Developed Tool • Paper-based tool • Grade 6 reading level • Requires no instruction for use

  15. The Developed Tool • Includes 6 risk factors and associated change strategies: • Pelvic floor muscle exercises • Caffeine intake • Excess weight • Constipation • Vision and hearing problems • Smoking • Outlines how to monitor symptoms • voiding diaries pre- and post-change

  16. Evaluation of the Tool • CIHR-funded grant • Conducted at 2 sites • University of Calgary (English) • University of Montreal (French and English) • Interrupted-time series design • 6 month study (3 pre- and 3 post-intervention) • Targeted enrolment of 100 (50 per site)

  17. Evaluation of the Tool • Included • Women > 50 years with • Any type of incontinence • Minimum of 2 episodes/week

  18. Evaluation of the Tool Exclusions • Received treatment within past 2 years • Started on incontinence meds within past 6 months • Related complications requiring further investigation • Cognitive impairment (MMSE <24/30) • Unable to communicate in English • Would not consent to participate

  19. Evaluation of the Tool Hypotheses • Usage rate would be 75% or higher • Usage of the tool would result in an increase in Self-Efficacy • Improvement in Self-Efficacy would correlate with decrease in leakage episodes and improved Quality of Life

  20. Evaluation of the Tool Primary Outcome: Successful usage of the tool (targeted > 75%) Secondary Outcomes: • Impact on self-efficacy (Geriatric Self-efficacy Index for UI) • Change in leakage episodes (Bladder diaries) • Change in Quality of Life (Urogenital Distress Inventory-6 and Incontinence Impact Questionnaire-7)

  21. Evaluation of the Tool Analyses: Primary Outcome (Usage Rate) • Percentage and 95%CI Secondary Outcomes • Linear mixed effects modelling

  22. Results -Demographics

  23. Results - Usage Rates

  24. Results- Risk Factors Modified

  25. Results – Self Efficacy • Geriatric Self-Efficacy Index for Urinary Incontinence • 15 items • Min score 0 – Max score 150 • Higher score = better self efficacy • Significant Improvement

  26. Results – Quality of Life • Urogenital Distress Inventory -6 (UDI-6) • Evaluates symptom distress • Scored out of 100 • Higher score = more distress • Significant improvement

  27. Results – Quality of Life • Incontinence Impact Questionnaire – 7 (IIQ-7) • Evaluates life impact of incontinence • Scored out 100 • Higher scores = more impact • Non-significant Improvement

  28. Results – Impact of Self Efficacy on QoL • There was a positive relationship between Self Efficacy and Quality of Life • Improvement in Urogenital Distress (non-significant) • decrease of 0.09 (0.3-+0.01) in UDI-6 for every 1 pt increase in Self Efficacy Index • Improvement in Incontinence Impact • decrease of 0.2 (0.1-0.4) in IIQ-7 for every 1 pt increase in Self Efficacy Index

  29. Results- Difficulty with Tool Difficulty understanding information in the tool: 10 % (6-18%) Difficulty understanding the directions in the tool: 10% (5-17%)

  30. Bottom Line • Self-Management is an important part of health care • Evidence-based self-management tools can be effective for improving chronic diseases • Tools should be developed using • High quality evidence (e.g. systematic reviews) • Input from health care experts and end-users

  31. Co-Investigators Sharon Straus Cara Tannenbaum Kevin Thorpe Dave Davis Heidi Schmaltz Heather Armson Research Assistants Barbara Artiuch Julie Michaud Data-base Support Jean Gagnon Special Thanks To

More Related