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Developing Self Management Programmes in Hywel Dda
Health Board Wales.
Claire HurlinStrategic Head Community and Chronic
Conditions ManagementOctober 2018
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Hywel Dda Health Board
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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
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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)
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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
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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?
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•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)
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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
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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
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⚫ Group A
Participants that complete at least 5 / 7 sessions of
‘COPD+’
⚫ Group B
Participants awaiting ‘COPD+’ or live out-of-area
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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)
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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”
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DSMP-Diabetes Self management Programme
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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.
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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)
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➢ 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
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”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
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• 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…
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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
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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