Developing Self Management Programmes in Hywel Dda

Health Board Wales.

Claire HurlinStrategic Head Community and Chronic

Conditions ManagementOctober 2018

Hywel Dda Health Board

Some Facts

⚫ Number of people aged 65 and over are projected to have

increased by 32% from 2010 in 2026

⚫ Wales has a higher proportion of reported limiting long-term

illness (23%) compared with England (18%), Scotland and

Northern Ireland (20%)

⚫ One third of adults report having at least one chronic condition

⚫ Three quarters of over 85 year olds report having a limiting

long-term illness

⚫ Intensive users of inpatient services have on average 3

chronic conditions

⚫ By 2030 Wales will have an increase of 10.38% of people with

a diagnoses of diabetes which equates to 39,444 people

Self Management

⚫ ....... includes all the actions taken by people to

recognise, treat and manage their own healthcare

independently of, or in partnership with the

healthcare system.

(supporting self management National Voices 2014)

What does the evidence say?⚫ Cost effective

Self management programmes save on average £452 /patient/year

⚫ Reduces burden on professional time

Peer-led self management

⚫ It works

– Improves clinical outcomes

– Improves clinical symptoms

– Improves quality of life.

⚫ Supports patient participation at all levels

– Improves interactions between clinicians and patients

– Voluntary roles

– £1 invested around £6.50 of social value created

COPD-Chronic Obstructive Pulmonary Disease

⚫ COPD Self Management for Life

⚫ EASE-Self-reported outcomes of a self-

management programme for Chronic

Obstructive Pulmonary Disease:

A focus group study

⚫ COPD+ and COMPACT

COMmunity based Pulmonary rehabilitation

progrAmme for patients with mild to moderate

Chronic obsTructive pulmonary disease?

•Why MRC 1 and 2

⚫ Earlier you start the better the outcome?

⚫ COPD Self Management for Life

⚫ Most would like course when diagnosed1

⚫ Creation of COPD+

1. EASE report (SU)

COPD+ Licenced with Self Management UK

⚫ 9 weeks –pre test

– 7 weeks (1 hr exercise, break, 1 ½ hrs education)

– post test

⚫ Introduced to Breathe Easy

⚫ Sign up to NERS 16 week programme

Week 2 - 8 education sessions:

⚫ What is self management?

⚫ What is COPD?

⚫ Balancing Life with COPD

⚫ Goal setting

⚫ Planning for action

⚫ Physical activity and COPD

⚫ Pursed lip breathing

⚫ Sleep

⚫ Handling challenging and

unhelpful emotions

⚫ Managing our

breathlessness

⚫ Socialising with COPD

⚫ Managing our medication

⚫ Being positive

⚫ Managing COPD

exacerbations or setbacks

⚫ Group A

Participants that complete at least 5 / 7 sessions of

‘COPD+’

⚫ Group B

Participants awaiting ‘COPD+’ or live out-of-area

Conclusions

⚫ Both groups typical of Pre-Pulmonary Rehabilitation

and comparable at baseline (Controls slightly higher

ISWT)

⚫ COPD+ was safe and popular

⚫ At 9 weeks: COPD+ was associated

- improved CAT (statistically & clinically relevant)

- improved EQ-5D (statistical, clinical)

- no change BORG

- improved ISWT (statistically & clinically relevant)

Participants comments:

“A great course, really enjoyable and fun”

“.. well presented in a relaxed informative way.

It has given me more confidence because of

my achievements”

“A benefit to help with my condition”

DSMP-Diabetes Self management Programme

Diabetes Self Management Education

Stanford University DSMP – delivered for

2½ hours/week for six weeks, in

community settings by lay person tutors.

Study aims

• Assess the feasibility of conducting a

large pragmatic randomised control trial

to assess the effectiveness of the

DSMP in a Welsh population;

• To explore a range of factors that could

be used to improve the delivery of the

DSMP.

Protocol & outcome measures

• DSMP Questionnaire

Stanford evaluation Tools

• Diabetes Empowerment

Scale-Short Form (DES-

SF)

• Summary of Diabetes Self

Care Activities (Diabetes

Care 23:943–950, 2000)

• Health Questionnaire

• EQ-5D-3L

• Focus groups & patient

letters

• HbA1c (DCA 2000

Analyser)

➢ 12.4% enrolled over the 7-

month period (August 2014 -

February 2015)

➢ 41% participants attended the

final six-month data collection

➢ appointments were kept to 10-

minute slots

➢ Questionnaires took between

10 and 30 minutes to complete

➢ Questions with poorest

response rates were testing

blood sugars and foot care

485 eligible patients

identified centrally

Diabetes Self Management Education

”With the excellent tutors breaking it down into bite size pieces over the six weeks I was able to understand how I could take control of my diabetes. I would highly recommend this course”

“I found the course extremely informative and helpful and the lecturers

delivered the course in a very professional way. As the lecturers

themselves had diabetes, it made the whole progress seem as if these

people knew exactly how we were feeling and that these problems could

be solved”

Patient Letters…

Diabetes Self Management Education

• DSMP Self-efficay: greatest improvement in DSMP

• Diabetes Empowerment Scale-Short Form (DES-SF): DSMP Increased

vs no change

• Summary of Diabetes Self Care Activities (Diabetes Care 23:943–950,

2000): DSMP increased vs unchanged or decrease

• DSMP Health Questionnaire: greatest reduction in DSMP depression

• EQ-5D-3L: DSMP health score increased vs unchanged

• Focus groups & patient letters: Positive

• HbA1c (DCA 2000 Analyser): 0.1% increase in DSMP & 0.6% in control

Observations…

Outcomes

➢ Findings indicate benefit of DSMP on outcomes

➢ Tutors felt confident delivering material

➢ Tutors were well received

➢ DSMP will form part of tiered approach to patient

education

Information

leaflet Film

packageXPERT

DSMP

Technology

Gwelwch y ffilmiau hyn am diabetes fel rhan o’ch triniaeth.

Please watch these films about diabetes as part of your treatment.

Click this link for prediabetes: www.medic.video/h-pre

For Type 2: www.medic.video/h-type2

For Type 1: www.medic.video/h-type1

For Gestational: www.medic.video/h-gest

Gwelwch y ffilmiau hyn am COPD fel rhan o’ch triniaeth.

Please watch these films about COPD

as part of your treatment.

Click this link www.medic.video/h-copd

www.medic.video/h-exercise

Many thanks

Any questions?

Claire.hurlin@wales.nhs.uk