Live Well: A Chronic Disease Self-Management Program

Chronic Disease Self –Management Program Fact Sheet

What is the Chronic Disease Self-Management Program?

The Chronic Disease Self-Management Program (CDSMP) is a workshop given two hours, once a week, for six weeks, in community settings such as senior centers, churches, libraries and hospitals. People with different chronic health problems attend the program together. Workshops are facilitated from a highly-detailed manual by two trained leaders, one or both of whom may be peers with a chronic health conditions themselves. Subjects covered include: 1) techniques to deal with problems such as frustration, fatigue, pain and isolation, 2) appropriate exercise for maintaining and improving strength, flexibility, and endurance, 3) appropriate use of medications, 4) communicating effectively with family, friends, and health professionals, 5) nutrition, and, 6) making informed treatment decisions.

It is the process in which the CDSMP is taught that makes it effective. Sessions are highly participative, where mutual support and success builds the participants’ confidence in their ability to manage their health and maintain active and fulfilling lives.

Does the Program replace existing programs and treatments?
The Self-Management Workshop will not conflict with existing programs or treatment. It is designed to enhance regular treatment and disease-specific education such as Better Breathers, cardiac rehabilitation, or diabetes instruction. In addition, many people have more than one chronic condition. The program is especially helpful for these people, as it gives them the skills to coordinate all the things needed to manage their health, as well as to help them keep active in their lives.

How was the Program developed?
The Division of Family and Community Medicine in the Department of Medicine at Stanford University received a five-year research grant from the federal Agency for Health Care Research and Policy and the State of California Tobacco-Related Research Project. The purpose of the research was to develop and evaluate, through a randomized controlled trial, a community-based self-management program that assists people with chronic illness. The study was completed in 1996.
The research project had several investigators: Halsted Holman, M.D., Stanford Professor of Medicine; Kate Lorig, Dr.P.H., Stanford Associate Research Professor of Medicine; David Sobel, M.D., Regional Director of Patient Education for the Northern California Kaiser Permanente Medical Care Program; Albert Bandura, Ph.D., Stanford Professor of Psychology; and Byron Brown, Jr., Ph.D., Stanford Professor of Health Research and Policy. The Program was written by Dr. Lorig, Virginia González, M.P.H., and Diana Laurent, M.P.H., all of the Stanford Patient Education Research Center. Ms. González and Ms. Laurent also served as integral members of the research team. The process of the CDSMP was based on the experience of the investigators and others with self-efficacy, the confidence one has that he or she can master a new skill or affect one’s own health. The content of the workshop was the result of focus groups with people with chronic health problems, in which the participants discussed which content areas were the most important for them.

How was the Program evaluated?
About 1,000 people with heart disease, lung disease, stroke or arthritis participated in a randomized, controlled test of the Program, and were followed for up to three years. We looked for changes in many areas: health status (disability, social/role limitations, pain and physical discomfort, energy/fatigue, shortness of breath, psychological well-being/distress, depression, health distress, self-rated general health), health care utilization (visits to physicians, visits to emergency department, hospital stays, and nights in hospital), self-efficacy (confidence to perform self-management behaviors, confidence to manage disease in general, confidence to achieve outcomes), and self-management behaviors (exercise, cognitive symptom management, mental stress management/relaxation, use of community resources, communication with physician, and advance directives).

What were the results?
Subjects who took the Program, when compared to those who did not, demonstrated significant improvements in exercise, cognitive symptom management, communication with physicians, self-reported general health, health distress, fatigue, disability, and social/role activities limitations. They also spent fewer days in the hospital, and there was also a trend toward fewer outpatient visits and hospitalizations. These data yield a cost to savings ratio of approximately 1:10. Many of these results persist for as long as three years.

HOW CAN MY FACILITY OFFER THE PROGRAM?
Leaders' trainings are 4 days. Each trainee receives a detailed leader's manual, a copy of the textbook Living a Healthy Life with Chronic Condition and relaxation audio tape. This training is FREE!
(Tuition for this program at Stanford is $1,200 for health professionals and $600.00 for non-health professionals with chronic conditions.)

TRAINING INFORMATION
Free, but mandatory, Informational Session will be held on October 8, 2010 at 10 a.m. at Creamery Brook located at 36 Vina Lane, Brooklyn, CT. To register please call Laura Crews at Senior Resources – Agency on Aging 860-887-3561 x129 or 800-690-6998 (in CT only). Or by email: ljcrews@seniorresourcesec.org

4 Day Training Dates

November 15th, 16th 22nd and 23rd
from 8:30 a.m. – 4 pm.