Choice, Risk, and Accountability

1. Choice, Risk, and Accountability Jim Phillips & Bob Sang [How] Can Expert Patients Help Provide Solutions for PCTs’ Priority Challenges? www.expertpatients.nhs.uk

2. Improving Effectiveness is Key PREVENTION PROMOTION INTERACTION RECOVERY INFORMED EQUITABLE ACCESS BETTER OUTCOMES IMPROVED EFFICIENCY www.expertpatients.nhs.uk

3. So, “Why Bother?” • Section 11 • “Choice” • The Evidence ……. www.expertpatients.nhs.uk

4. Confident, knowledgeable patients have fewer hospitalisations and enjoy improved health status www.expertpatients.nhs.uk

5. Benefits of self management/self care evidence from around the world • Doctor visits reduced by 30 to 40% • Reduction in outpatient visits by 17% • Hospital length of stay reduced by 50% • Angina attacks reduced by 50% • Improved health risk scores for heart attacks and diabetes • Improved health status, such as increased fitness, improved mobility • Reduction in stress and anxiety • Days off work reduced by 50% • Increase in medicine compliance to 85% Average cost: savings ratio = 1 : 1.5 to 10 (Lorig KR, Sobel DS, Effective Clin Practice 2001;4:256-262) i.e. for every £100 spent, savings = £150 to £1000 net of risks Above figures supplied by Department of Economic and Operational Research (EOR) DoH. A a range of studies are listed in appendix slides. There is a further discussion on self management research and evidence on the Expert Patients Programme web site. www.expertpatients.nhs.uk

6. The key findings so far – EPP emerging trends • 10% more take medicine as prescribed • 30% of the people showed significant reduction in feeling of depression • 30% showed reduction in feeling of “lacking in energy” • felt intensity of pain, breathlessness, tiredness and depression less for 20 to 30% of the people • increase in confidence levels for 30 to 50% of the people that they would not let pain, breathlessness, tiredness or depression interfere with their lives • 9% fewer visits to GPs These are emerging findings from the internal audit of the Expert Patient program being carried out by the DoH and are based on the first PCTs to join the pilot at 4 month follow up a. Whilst provisional and not part of a RCT they clearly show a trend in line with the evidence base from the US and Kaiser Permanente. A full write up of these will be provided on the Expert patients web site. www.expertpatients.nhs.uk

7. The key findings so far- EPP the emerging trends • 6% fewer visits to A&E • 9% fewer visits to outpatients • 15% increase in visits to pharmacists • 17% reduction in number of days off work (by 204 days) • 6% increase in number of people using health information • 30% increase in number of people feeling better prepared for consultations with care professionals. These are emerging findings from the internal audit of the Expert Patient program being carried out by the DoH and are based on the first PCTs to join the pilot at 4 month follow up a. Whilst provisional and not part of a RCT they clearly show a trend in line with the evidence base from the US and Kaiser Permanente. A full write up of these will be provided on the Expert patients web site. www.expertpatients.nhs.uk

8. Living with Chronic Disease3 Key Tasks • Managing the illness • Taking medications • Changing diet and exercise • Managing symptoms of pain, fatigue, insomnia, shortness of breath, etc. • Making best use of health care available • Managing daily activities and roles • Maintaining roles as spouse, parent, employment, etc. • Managing the emotional changes • Managing anger, fear, depression, anxiety, etc. From Expert Patients Program leaders manual www.expertpatients.nhs.uk

9. person and professional in partnership • Be aware of the possible social/psychological/physical impact of condition • Identify lifestyle and psychological barriers to managing condition • Identify behaviour changes needed (diet, exercise) • determine the areas in which changes are possible • Identify system determinates- CHOICE • develop care plan and goals based on persons ability to engage. www.expertpatients.nhs.uk

10. Expert Patient Empowering Doctor • good listener • clear communicator • works in partnership • resource facilitator • monitors condition • outward focused • problem solver • validates patients experience • honest • nurturers respect • good listener • clear communicator • works in partnership • resource finder • monitors condition • outward focussed • problem solver • maintains physical and emotional well being • partner in care • confident www.expertpatients.nhs.uk

11. 20% care managed by health system 25% decrease in professional care 80% of symptoms and care are self managed 5% increase in self managed care www.expertpatients.nhs.uk Kemper D et al 1992. see also Williams JD, Danaher K, 1978

12. Improved efficiency Attitudes Beliefs Moods Health Behavior Change Health Outcomes confidence to engage Effectiveness Adapted from Lorig K, Arthritis and Rheumatism. 1989;32:91-95 www.expertpatients.nhs.uk

13. “Everyone else – the professionals, my children and my friends – feel they’re being very open and up-front referring to me as disabled and discussing how I’m going to cope not doing the things I used to. I’d like people to concentrate on what I can do and explore with me (rather than for me) the possibilities for what things I can improve - not how they are going to deteriorate.” Participant on expert patient course www.expertpatients.nhs.uk

14. Background – supporting evidence see in particular the work of Lorig K, Fries J and Barlow J www.expertpatients.nhs.uk

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