British Columbia Uses AHRQ Program to Assist Canadian Patients With Chronic Disease Self-Management
To help individuals take an active role in managing their chronic health conditions, the University of Victoria-Centre on Aging has put the AHRQ-funded Chronic Disease Self-Management Program (CDSMP) to widespread use throughout British Columbia. First implemented as a pilot program in 1997, the CDSMP has since become a permanent, government-funded program in three Canadian provinces.
At the conclusion of two pilot programs in 1997 and 2000, Health Canada (the country's federal health department) gave a two-year grant to the Centre on Aging to implement the CDSMP throughout British Columbia to individuals with Type 2 diabetes. It was administered through a partnership between the Centre on Aging and the Canadian Diabetes Association.
An evidence-based, patient-led program, the AHRQ-funded CDSMP was developed by Kate Lorig, RN, PhD, Professor in the Department of Medicine at Stanford University. Using an evaluation method similar to that developed by Lorig and her colleagues, the Centre on Aging measured 800 enrollees before and six months after participating in the diabetes self-management program.
Overall results were positive: Enrollees showed significant improvements both in communication with their physician and in their ability to manage their disease symptoms. They also reported less pain and fewer missed medications.
Based on these results, the British Columbia Ministry of Health Services in 2003 gave the Centre on Aging the resources to expand implementation of the CDSMP to persons experiencing chronic health conditions throughout each of province's five health regions. According to Patrick McGowan, PhD, Program Director, approximately 10,000 people have participated in the programs.
To make the program widely available, the Centre on Aging uses non-clinical, trained volunteers to teach skills. Volunteer leaders take a four-day training workshop where they learn to deliver the program. Detailed scripts are used by these leaders-who themselves have a chronic disease-to structure each discussion.
The program is conducted in two and one-half hour sessions once a week, for six consecutive weeks. Participants learn the following skills:
- Coping with pain, fatigue, and other consequences of their illness.
- Exercising to maintain strength, flexibility, and endurance.
- Communicating effectively with health professionals, family, and friends.
- Adopting healthy eating habits.
- Evaluating new treatments.
On average, program leaders are slightly younger than the average age (58) of participants. This age reflects the typical onset for many chronic diseases.
One of the strengths of the program is its ability to improve patients' self-efficacy-the skills and confidence that they can successfully manage their condition, according to McGowan. "Just being motivated isn't enough; you need the skills and ability" to manage a chronic condition.
According to government statistics, more than 15 percent of the Canadian population will be older than age 65 by 2016. With an aging population comes a higher incidence of chronic diseases, such as diabetes, congestive heart failure, and hypertension, all of which are costly to treat and can diminish one's quality of life.
As the population ages and incidence of chronic diseases accelerates, the need for proven disease self-management programs will increase. The CDSMP is "theoretically based and has been through rigorous evaluation," McGowan notes. "If we implement it in the same way, we know we're going to be effective."
For more information on the University of Victoria-Centre on Aging CDSMP, visit http://www.selfmanagementbc.ca/.
Lorig KR, Sobel DS, Stewart AL, Brown Jr BW, Ritter PL, Gonz?lez VM, Laurent DD, Holman HR. Evidence suggesting that a chronic disease self-management program can improve health status while reducing utilization and costs: A randomized trial. Medical Care 1999 37(1):5-14. (HSO6680)