Northwest tackles chronic diseases

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Hundreds of people across northwestern Ontario are learning how to better manage their chronic diseases thanks to the North West LHIN's introduction of the Stanford School of Medicine Chronic Disease Self-Management Program.

Described as the gold standard for self-management, the program offers patients with diabetes, congestive heart failure, chronic obstructive pulmonary disease, arthritis, asthma and other chronic conditions a six-week course focusing on such topics as diet, exercise and medication management.

"We have earlier onset and a higher prevalence of many chronic diseases in the northwest, so we decided to embark on this self-management journey to help people manage their chronic conditions," said Heather Gray, senior consultant for planning and integration and lead for chronic disease prevention and management at the North West LHIN.

The LHIN held three four-and-a-half-day training sessions in Thunder Bay beginning in March 2008 for health-care providers from across the region, providing them with the skills necessary to deliver the program to patients in their communities. Approximately 75 health-care professionals graduated from the program as master trainers.

"People self-manage their chronic diseases 99 per cent of the time, so why shouldn't we help them do it better?" asked Gray. "As health-care professionals, we may be under the illusion that we're managing their chronic diseases, but we're only doing it 1 per cent of the time.

Guide on the side

"We're no longer the sage-on-the-stage, but the guide-on-the-side, supporting people to manage their chronic diseases, so there's a need to build capacity among health-care providers and a need for individuals with chronic disease to learn more about how they can cope."

Self-management takes away some of the psychological dependence on the health-care system, improves quality of life and decreases the incidence of complications which may lead to unnecessary hospitalization and trips to the emergency department, she said.

Participants in the program have found it to be a valuable experience.
"People have said ‘I've really been able to turn this around. I have the confidence to manage my chronic condition that I didn't have before,'" said Gray.  "It's really gratifying to know that it's helping them to that degree."

Tanya Shute, a social worker at St. Joseph's Care Group, led two self-management groups in August 2008, recruiting people with a variety of chronic conditions who were on long waiting lists for outpatient programs.

 "We explained to them that there was a long waiting list for the outpatient programs they applied for and asked them if they wanted to take a self-management course in the meantime," said Shute. "A number of them who did come onboard ultimately decided to take advantage of exercise programs and other services in the community and didn't feel they needed the outpatient programs anymore."

Topics

The sessions cover topics such as communicating with health-care providers and managing pain. A master trainer, Shute encourages participants to brainstorm, problem-solve and set goals themselves. When they come up with their own solutions, there's a higher rate of commitment to change and an increase in self-reported healthy behaviours, she said.

"The traditional relationship between patient and health-care provider is characterized by dependency. This program empowers you to have a collaborative partnership with your health-care provider."

Shute has also led a self-management training group for St. Joseph's Care Group staff in the hope of integrating some of the self-management support strategies into the organization's everyday practice.

Ultimately, the objective is to recruit chronic disease patients from the self-management groups to serve as trainers themselves, because "research shows that when you put it back in the lay leader's hands, it's even more successful."

An evaluation of the program in the northwest is being conducted by Patrick McGowan, a Ph.D. in Health Promotion at the University of Victoria's Centre for Aging. Questionnaires completed by participants at the conclusion of their six-week program will be used to determine the impact on their health and their ability to self-manage their chronic condition.

www.northwestlhin.on.ca
patienteducation.stanford.edu/programs