Chronic Disease Self Management Promotion Groups in the New ...

Chronic Disease SelfManagement Promotion Groupsin theNew Jersey Prison SystemPresented byMargaret Conrad, DNPMaria Delgado, RNUMDNJ / University Correctional HealthCare03/23/2012

Chronic DiseaseChronic diseases include: arthritis, asthma, cancer,diabetes, heart disease, hypertension, lungdisease, mental illness, multiple sclerosis,osteoporosis, obesity, Parkinson’s disease…..Chronic disease results in: amputation, blindness, pain,debilitation, disability, dependence, depression, lostphysical function, decreased mobility….death

Difference Between Acute andChronic ConditionsAcute Conditions: Chronic ConditionsBeginning Rapid Gradual, up and downCause Usually One ManyDuration Short IndefiniteDiagnosis Commonly Accurate Often uncertain, especiallyearlyTests Often Decisive Often of limited valueTreatment Cure Common Cure rareRole of theProfessionalSelect and conduct therapyTeach and AdviseRole of the Patient Follow Orders or Advice Partner of health provider,Patient responsible for dailymanagement

The FactsChronic disease is the principal cause of disabilityIs a major reason for seeking healthcareAccounts for 70% of all health care expenditures in thiscountry.Chronic disease self-management programs canimprove health benefits while reducing health care costs.

The Prison FactsThe prison population exhibits disproportionate rates ofinfectious diseases including HIV and Hepatitis C,chronic medical conditions such as asthma, diabetes,hypertension and mental illnesses, in addition toaddictions to drugs, alcohol and tobacco.The cost of medical care is growing annually by 10%,and these costs will only accelerate as the prisonpopulation ages (The Pew Charitable Trusts, 2008).

State Prisons release most inmates to the community,and about half of the population return primarily into oururban centers.This fluid relationship between the prison system and thebroader community situates correctional health care atthe forefront of many of our most pressing public healthchallenges.

The ProblemPeople with chronic diseases should receive care thatmeets national standards, both in the community andduring incarceration.Recently evidence based practice models have becomeavailable to guide the routine management of chronicdisease by achieving specific patient oriented outcomes.Currently, there are few evidence-based modelsdelivered to prison populations.

The SolutionThe Stanford University Chronic Disease Self-Management Program (CDSMP) is a cost effective selfmanagementeducation program that allowsorganizations to provide self-management supportacross multiple diseases and conditions.

Assumptions about the CDSMPProgramPatients with different chronic diseases have similar selfmanagementproblems and disease-related tasks.Patients can learn to take day-to-day responsibility fortheir diseases.Confident, knowledgeable patients practicing selfmanagementwill experience improved health status anduse fewer health resources.Source: Lorig and Holeman 2003

The Health Benefits > 6 monthsImproved self-reported healthDecreased disabilityIncreased energyDecreased fatigueLower health distressMore exercise and relaxationFewer social role limitationsGreater partnerships with cliniciansLorig, Sobel, et al., 1999; Sobel, Lorig & Hobbs, 2002

Chronic Disease Self ManagementVideo

HOW IT ALL STARTED!A grant was awarded to University CorrectionalHealthcare (UCHC) by the New Jersey Department ofHealth and Senior Services (NJDHSS) in October of2009 to implement the Stanford University ChronicDisease Self-Management Program within the prisonsystem.UCHC initiated the six-week evidence based ChronicDisease Self-Management Program (CDSMP) inJanuary, 2010

Implementing a CDSMP in theCorrectional Setting…Inmates with chronic disease attend together asa cohort.The process of how the program is taught iswhat makes it effective.The workshops are highly participative, basedon self-efficacy theory and use the processes ofskills mastery, modeling, reinterpretation ofsymptoms, and group persuasion.It is anticipated that the participants will developconfidence in their ability to manage their healthproblems.

CDSMP Course ContentContent / Week 1 2 3 4 5 6Overview of self-management and chronic health conditions PMaking an action plan P P P P P PRelaxation / Cognitive symptom management P P P P PFeedback / Problem solving P P P P PAnger / Fear / FrustrationFitness / Exercise P PBetter breathingFatigueNutritionAdvance directivesCommunicationMedicationsMaking treatment decisionsDepressionInforming the healthcare teamWorking with your healthcare professionalFuture plansPPPPPPPPPPPP

Can it Work in the CorrectionalSetting?The Answer is Yes!The success of the program depends on the mutualsupport of the participants, facilitators, providers and thesite administration.The New Jersey Department of Corrections (NJDOC)were instrumental in the success of the program.The UMDNJ Medical and Mental Health Providerssupported the program and referred inmates from thechronic disease clinics.We currently have three Master Trainers, over 45 StaffPeer Leaders and hold the six-week groups at 15different locations across the state.We also have waiting lists for both group and peer leadertrainings.

Were there Difficulties?Was it Worth it?

DATATotal participants: 391Total sites offering the CDSMP: 13Data Collection I:Pre and Post Group Surveys:Confidence in doing specific activities.Likert Scale 1-10 (totally confident)

Survey ItemsHow confident are you that you can….1. keep the fatigue caused by your distress frominterfering with the things you want to do?2. keep the physical discomfort or pain of your diseasefrom interfering with the things you want to do?3. keep the emotional distress caused by your diseasefrom interfering with the things you want to do?4. keep any other symptoms or health problems youhave from interfering with the things you want to do?

Survey Items Continued…How confident are you that you can….5. do the different tasks and activities needed tomanage your health condition so as to reduce yourneed to see a doctor?6. do things other than just taking medication toreduce how much your illness affects your everydaylife?Post Satisfaction Item:7. Overall how would you evaluate the quality of thisworkshop?

Survey ResultsQ7: Satisfaction Item

Data Collection II:DATA6 Health Care Indicators: HGA1C, BP,LDL, HDL, Weight, BMIData Source: Electronic Medical Record-EMRPre data: Prior to group start datePost data: Most current value

Health Care Indicators: FindingsBlood Pressure: No Change

Provider Feedback“This patient first came to my attention in 2007 for chronic back pain. She hadhad chronic back pain since 2004 post trauma during a fighting confrontation.It had been intermittent but had started to become persistent. Over the years Itreated her with Tylenol, muscle relaxants, Neurontin, narcotics and NSAIDS,and housing/work restrictions. She had several x-rays of the back and variousextremities. Because of the worsening of her symptoms and her inability toperform ADLs MRI was ordered that only showed a tiny left central discherniation at L5-S1. She was started on physical therapy which only proved tobe helpful for a short duration. I dreaded seeing this patient because as statedabove I exhausted all efforts to provide relief of her symptoms. I wascompletely out of ideas. To my shocking surprise she walked into my officeearlier this year with hair done, makeup on and very spirited. I felt that all myinterventions had finally worked. I commented on how great she looked whenshe burst my bubble by telling me that she attended the Chronic Disease SelfManagement course at Edna and was a new woman. She told me how theprogram changed her life and made her take ownership of her medicalproblem. She started eating differently and doing exercise.”

Inmate Feedback“It is really helpful for people to come in and give usinsight into our illnesses”“I’ve learned new ideas on how to manage my asthmaand how to set weekly goals”“Thank You for teaching us how to deal with our Chronicissues without giving up!”“Each week we learned something different aboutourselves , and family members too!”

Inmate Feedback“ This was a great motivator for me to get back into myexercise routine, and this class has been a goodinfluence for others”.“ The workshops provide me with a lot of insightfulinformation and different ways to manage my illness. Inow feel confident in my approach to life.”“ I hope you can do more of these groups for othersbecause it does provide a new prospective.”

Inmate Feedback“I can now go out in the court yard and ask howsomeone is feeling and really mean it!”“This let me know that I am not alone and other inmateshave the same problems”“This group is great! I feel the leaders are talking with usnot at us!”“This group will help me take care of myself when Ifinally get out of here. Thank You!”

Plans for the Future•Establishing a Diabetic CDSMP•Pilot Inmate Co-Led Programming•Monitoring:HospitalizationsMR007’s