Chronic disease self management the potential role of the active patient in wider engagement

1. Chronic disease self management the potential role of the active patient in wider engagement Presentation given by: Pippa Hague toSummer School 2004 Date: 4 August 2004

2. Chronic Disease Management Improving the quality of life for people living with chronic disease, reducing interventions and bringing care closer to home.

3. Young and healthy Increasingly dependant Options, convenience access Joined up health and social care Development of chronic conditions The Context for CDM Planned and systematic disease management Promoting and supporting self management Choice Taken from Sue Roberts - National Lead for Diabetes presentation to the CDM conference 18 May 2004

4. Diabetes Heart Fai lure Dement ia COPD Choice Expert patients Medicines Management Case finding and intensive case management Living with a chronic disease (SS, housing, transport, employment etc) Tertiary, primary, community, acute etc Managing the complexities ...

5. Wellness Stage 1: 80% people Low Stage 2: 15% people Resource usage Stage 3: 5% people High Time Chronic Disease Progression Adapted from Pieter Degeling presentation to NSC SHA 27 July 04

6. Chronic DiseaseManagement andShared Care Highly complex patients High risk patients Professional care 70-80% of CDM population self care

7. Health System Health Care Organization Community Resources and Policies ClinicalInformationSystems Self-Management Support DeliverySystem Design Decision Support Prepared, Proactive Practice Team Informed, Activated Patient Productive Interactions Wagner et al. Improved Outcomes Chronic Care Systems Model Health systems must take advantage of community-based programmes that enhance chronic illness care Successful self-management programmes rely on a collaborative process between patients and providers

8. Health System Health Care Organization Community Resources and Policies ClinicalInformationSystems Self-Management Support DeliverySystem Design Decision Support Prepared, Proactive Practice Team Informed, Proactive Patient Productive Interactions Wagner et al. Improved Outcomes Effective chronic illness management requires more than simply adding interventions to an existing system focussed on acute care. Basic changes in delivery system design are required for effective care management Practice teams require evidence-based protocols to guide their decisions about patient care Effective information systems can measure the success of treatment across populations and deliver reminders about care for individual Changes in the health system will only improve chronic illness care if active informed patients work together with provider teams

9. PPI CDM Choice Too many initiatives what goes where ? CDSM

10. Empowered Patients… Are patients who take responsibility for managing their condition with respect to: • Knowledge of their disease • Self monitoring • Therapeutic interventions • Diet • Exercise • Smoking • Paradoxically: this requires structured support from service providers

11. Empowered Patients… The Expert Patients Programme is a Chronic Disease Self Management programme available through the NHS Other support programmes (DAPHNE for diabetes) are becoming more widespread - focused on medicines management, but with an emphasis also on the active patient

12. But then what? Once we have let the genies out of the lamps you can’t ask them to go back in!

13. So ? People living with long term conditions have a vested interest in helping the NHS and social care get CDM right! People living with long term conditions are ideally placed to tell us where it is wrong!

14. So how do we do it ? • www.dh.gov.uk • Strengthening accountability - involving patients and the public: practice guidance • Section 11 of the Health and Social Care Act 2001