educating future health care professionals to support ... · pdf fileeducating future health...

FLINDERS UNIVERSITY

ADELAIDE i AUSTRALIA

FLINDERS HUMAN BEHAVIOUR

& HEALTH RESEARCH UNIT

Educating future health care professionals to support people with chronic conditions

to live better and live longer

A chronic condition self-management support tertiary education curriculum framework

31st October 2007

Flinders Human Behaviour and Health Research Unit (FHBHRU) in collaboration with

Department of General Practice, School of Medicine (Flinders University) and the Spencer Gulf Rural Health School, the Centre for Allied Health Evidence and the School of Nursing and Midwifery (University of South

Australia)

Project Team

Assoc. Professor Malcolm Battersby Alison Martin

Cassandra Hood Ellie Lawrence-Wood

Dr Sharon Lawn Associate Professor Gary Misan

Dr. Marie Heartfield Professor Richard Reed

Dr. Jill Beattie Dr. Saravana Kumar

Professor Karen Grimmer-Somers

This project was funded by a grant from the Australian Government Department of Health and Ageing as part of the joint Australian, State and Territory Governments’ Australian Better Health Initiative.

© Flinders Human Behaviour & Health Research Unit, Flinders University Curriculum Framework 31st October 2007

2


3

Table of Contents

1. Introduction .......................................................................................................................................................4

2. Background........................................................................................................................................................5

3. Theoretical concepts and rationale for chronic condition self-management ...............................................6

3.1 Context................................................................................................................................................6 3.2 Benefits of chronic condition self-management .................................................................................6 3.3 Summary of the evidence base for chronic condition self-management ............................................7 3.4 Key features for optimal practice in self-management .......................................................................7 3.5 Implementation of self-management support ...................................................................................11

4. Philosophy ........................................................................................................................................................11

5. Nationally Agreed Definitions ........................................................................................................................11

5.1 Context..............................................................................................................................................11 5.2 Definitions ........................................................................................................................................12

6. Chronic condition self-management support tertiary education principles ..............................................14

6.1 Purpose .............................................................................................................................................14 6.2 The Principles ...................................................................................................................................14

7. References ........................................................................................................................................................16


4

1. Introduction This curriculum framework was developed after extensive auditing and consultation with medical, nursing and allied health schools, and professional, accreditation and registration bodies, on course content and curriculum delivery issues involving the teaching of chronic condition self-management support (CCSMS) in the tertiary education setting in Australia. Results showed that whilst CCSMS education was considered important by the vast majority of schools and the knowledge of theoretical elements of CCSMS was usually being taught, very few schools were teaching or assessing the skills and attitudes that would ensure a new graduate is competent in providing CCSMS in clinical practice. The definitions of self-management as used in this initiative are detailed below. ‘Self-management’ is a process that includes a broad set of attitudes, behaviours and skills directed toward managing the impact of the condition(s) on all aspects of living. It includes, but is not limited to self-care, and it may also encompass prevention. The following are believed to contribute to this process: • Having knowledge of the condition and/or its management • Adopting a self-management care plan agreed and negotiated in partnership with health professionals,

significant others and/or carers and other supporters • Actively sharing in decision-making with health professionals, significant others and/or carers and other

supporters • Monitoring and managing signs and symptoms of the condition • Managing the impact of the condition on physical, emotional, occupational and social functioning • Adopting lifestyles that address risk factors and promote health by focusing on prevention and early

intervention • Having access to, and confidence in the ability to use support services.

‘Self-management support’ is what health professionals and the health system do to assist the person with a chronic condition to manage their condition(s). It includes a health system that provides ready access to appropriate systems of self-management support that are: • Evidence-based • Adequately resourced with staff who are adequately trained, culturally sensitive to the person’s needs and

who support the belief in the person’s ability to learn self-management skills.

The development of a framework to guide the integration of chronic condition self-management into undergraduate or entry level medical, nursing and allied health professional curricula project (conducted by Flinders University and University of South Australia in 2007) was funded through the Australian Better Health Initiative: A joint Australian, State and Territory government initiative. The project team was led by the Flinders Human Behaviour and Health Research Unit (Flinders University) in collaboration with consultants representing general practice, nursing and allied health from Flinders University and the University of South Australia. The team was advised by members of the project’s national reference group, which included representatives from: • the Committee of Deans of Australian Medical Schools • the Council of Deans of Nursing and Midwifery


5

• the Australian Council of Pro-Vice Chancellors and Deans of Health Science • the Australian Nursing and Midwifery Council • Allied Health Professions Australia • the Consumer’s Health Forum • representatives with recognised, relevant expertise in the application of a variety of self-management

approaches in clinical and community settings in Australia; and • representatives from a range of States and Territories across Australia. This framework is one of the outcomes of the project. It aims to provide a structure to support education authorities/discipline regulatory bodies to understand, incorporate and implement chronic condition self-management support into the Australian health education system and support educators to: • add value to health professional education (in areas such as chronic condition management, chronic

condition self-management support and interprofessional education) • ensure a higher quality of graduate from medicine, nursing and allied health • ensure that curricula continues to remain up to date with contemporary policy and practice • advance the development of a future workforce equipped to support health care systems to change to better

meet the needs of people with chronic conditions

2. Background Chronic diseases pose increasing problems for quality of life and burden of disease in developed and developing countries (World Health Organisation (WHO), 2002). In Australia, chronic diseases such as asthma, diabetes, depression, arthritis and cardiovascular disease are the main cause of death and disability and the major consumer of health care expenditure (Australian Government Department of Health and Ageing, 2004). Internationally, and in Australia, healthcare systems are under substantial pressure from rising medical costs, such that chronic disease now contributes over 70% of the disease burden in Australia ($34 billion annually) – and this is expected to increase to 80% by 2020 (National Health Priority Action Council, 2006). The number of people affected by chronic disease, currently estimated at 2.5 million Australians, is expected to increase to 3.5 million by 2016 (Australian Government Department of Health and Ageing, 2004). Nearly half of lifetime health care system expenditure is incurred during the senior years (Alemayehu & Warner, 2004), with most of the costs (90%) compressed into the last seven years of life (Fries, 1980). An increasingly ageing population in most developed countries (12% in 2002 to 26% in 2051 over 65 years in Australia) means that health systems will need to tailor care models to cope with the increased economic and social burden (Australian Institute of Health and Welfare, 2002). The Australian Government, and State and Territory governments have a major focus on chronic disease through the National Chronic Disease Strategy and associated National Service Improvement Frameworks and the Blue Print for Chronic Disease Surveillance (Australian Government Department of Health and Ageing, 2006). Activities such as the Australian Better Health Initiative (ABHI) arising from the Council of Australian Government (COAG) National Reform Agenda recognise chronic condition self-management (CCSM) and CCSMS as important strategies in reducing the impact of chronic disease. Two key concepts involved in reducing the impact of chronic disease (and integral to health promotion, disease prevention and early intervention) are active ‘self-management’ and ‘collaborative care’ (Australian Government Department of Health and Ageing, 2006). Over recent years Australian governments have made major policy shifts towards CCSM which is being promoted and supported at all levels of the health care system. See Table 1: Comparison of Traditional and Collaborative Care in Chronic Illness.

Taken from Bodenheimer, T., Lorig, K., Holman, H., and Grumbach, K. (2002). Patient Self-management of Chronic Disease in Primary Care. JAMA, 288(19), 2469-2475.

3. Theoretical concepts and rationale for chronic condition self-management

3.1 Context CCSM is not a new concept to medical, nursing or allied health professionals in Australia. On the contrary, many of these practices are well understood and widely accepted - after all, people have been self-managing their own health since the dawn of time. However, there are many opportunities available to improve the CCSMS currently provided across health care settings. For example, the CCSMS practices of health care professionals across disciplines (e.g. in assessing a person’s capacity to self manage, and/or in having the necessary clinical/professional knowledge, attitudes and skills to support people to live with complex life issues and chronic conditions) are not consistently performed to an adequate standard in Australia at present. The ability of a person to engage in or take up self-management can be compromised by co-morbidity (e.g. mental illness, chronic pain, obesity, and arthritis), drug or alcohol use, physical or intellectual disability, family difficulties, socio-cultural or economic factors. A national curriculum framework provides an opportunity to advance CCSMS related educational practices that will have a sustainable impact on the work quality of many health care professional graduates, and the health and wellbeing of many Australians.

3.2 Benefits of chronic condition self-management Current literature supports the notion that self-management will improve wellbeing and strengthen self-determination and participation in health care, while also reducing health care utilisation and health care costs (Bodenheimer, Lorig, Holman & Grumbach, 2002; Mortimer & Kelly, 2006). There is also evidence to show that clinical outcomes are improved in a number of chronic diseases and that CCSM is applicable across a broad range of conditions. It is seen as a sustainable, low cost intervention, with wide applicability and which may have a substantial public health effect (Lorig et al., 2001). Self-management support complements, rather than substitutes for, traditional health care consumer education.


6


7

3.3 Summary of the evidence base for chronic condition self-management The face validity and evidence for the benefits of self-management are well accepted (Wagner, Austin & Von Korff, 1996). Chronic condition self-management has evolved to embrace related concepts such as patient centered care (Glasgow, Orleans, Wagner, Curry & Solberg, 2001) and health behaviour change (Rollnick, Mason & Butler, 1999), which are evidence based and central to all health professional practice. Recent reviews and meta-analyses of self-management research have shown positive outcomes for a range of diseases and self-management interventions directed both at clinician and individual level (Newman, Steed & Mulligan, 2004). Warsi, Wang, LaValley, Avorn, and Solomon (2004) suggest that disease-specific self-management programs are effective for asthma and diabetes. A meta-analysis of generic programs (Newbould, Taylor & Bury, 2006) also identified significant improvements in self-management in diverse populations and conditions. There has also been proven effectiveness of CCSM in randomised controlled trials with some populations. For example in osteoarthritis there has been decreased pain, depression and visits to physicians (Lorig, Chastain, Ung, Shoor & Holman, 1989), improvements in perception of control, health behaviours and health status (Barlow, Williams & Wright, 2000) and improved quality of life (Hopman-Rock & Westhoff, 2000). Ethnic minorities (Hussain-Gambles, Atkin & Leese, 2004), the mentally ill and other vulnerable groups have been under represented in self-management research. Arguably, their exclusion potentially limits the scope of knowledge and learning and perpetuates their disadvantage. Newman et al. (2004) also demonstrate a number of positive qualitative outcomes across diabetes, arthritis and asthma, but note that sustainability of self-management gains once the person ceases involvement in courses remains an issue. This lends support to the need for CCSMS training across the future health care workforce to reinforce the goals achieved and skills attained by individuals. Self-management support has been shown to improve physiological measures of disease, quality of life, health status and health service use (Dennis et al, 2007). Glasgow, Davies, Funnell, and Beck (2003) note that formal self-management group programs are only one strategy in providing self-management support. A person’s optimal self-management may require the repeated provision of information and skill development over many years, rather than just a single referral to a self-management program. This again lends support to the need for CCSMS training of individual health care workers in our future workforce to ensure that CCSMS can be provided in a sustainable way across the lifespan. It is not known whether generic models are more or less effective than disease-specific interventions. However, both generic and disease-specific CCSM programs have a number of germane elements that can form core components of curricula for the future health care workforce. These are outlined in the next section.

3.4 Key features for optimal practice in self-management The WHO (2002) articulates a range of innovative care elements for chronic conditions and provides several international examples of innovative programs. Its emphasis is on reorienting health care systems via a range of building blocks for action that: • Support a paradigm shift; • Manage the political environment; • Build integrated health care; • Align sectoral policies for health; • Use health care personnel more effectively; • Centre care on the individual and family; • Support individuals in their communities; and • Emphasize prevention. Informed, activated individuals need prepared, proactive practice teams and agencies which together need collaborative social, economic and political systems that address the social determinants of health inequity through effective education and training systems and resource management.


8

The efficacy of CCSM depends on the quality of the collaboratively developed, integrated care plan across these areas and the quality of the relationships that underlie the transactional process of care giving and care receiving. This includes the development of a health professional’s belief and trust in a person’s ability to self-manage and may require a cultural shift in service philosophy. Although self-management is critical across the chronic condition continuum from prevention to palliation, there are critical points in the longitudinal process at which people develop a chronic condition. At these points some interventions to engage people into a collaborative process of care management will likely be more effective than at other times. Self-management support may need to be customized for culturally and linguistically diverse (CALD) group and Indigenous Australians, as concepts of control, autonomy, and community may be interpreted differently dependent on cultural and socioeconomic context. Elements for optimal CCSM: Individual elements occur at the individual interaction level and include prepared, informed, and motivated individuals, significant others, carers, families, health care teams, and community partners. Practice elements occur at the level of health care organization and include community health and wellbeing programs, promotion of continuity and coordination of services, quality leadership and incentives, adequate organization and equipping of health care teams, support for self-management and prevention, and effective information systems. Further meso-level elements occur at the level of community and include raising awareness and reducing stigma, better outcomes through better leadership and support, mobilizing and coordinating resources, and complementary functions between services. System elements occur at the policy environment level and include the provision of effective leadership and advocacy, integrative policies, consistent financing, effective development, training and allocation of human resources, population-based legislation and regulatory frameworks that reduce the burden of chronic conditions, and strengthen partnerships between the various government sectors. Figure 1 illustrates the relationship between a population and individual approach to CCSM across the three areas of system (macro-level), practice (meso-level) and the individual (micro-level) as well as those influencing factors that cross all areas such as the social determinants of health (Lawn, Battersby & Pols, 2005). Figure 2 provides a diagrammatic representation of the potential ideal relationship between elements of self-management leading to optimal self-management by the individual (Lawn et al., 2005); Level 1 being the Chronic Care Model (Wagner et al., 2001), Level 2 being practice level CCSM (Battersby, et al 2007) and Level 3 being the individual attributes of self-management (Battersby et al 2003). Each level is interconnected.

Figure 1: Individual and population health approach to self-management


9

Figure 2: Framework for regional, organisational and individual self-management


10

© Flinders Human Behaviour & Health Research Unit, Flinders University Curriculum Framework 31 October 2007

11st

People with chronic conditions wish to live effective lives in spite of their symptoms and/or limitations; to make the most of their lives with least disability and optimum health outcomes. The health professional assists the person with a range of tasks that promote effective self-management. Assistance is based on the person’s goals, wishes and capacities and supports the person’s participation in the key skills of problem-solving, decision-making, and confidence-building. This is achieved by addressing the three key tasks of role, emotional and medical self-management. Self-management employs a person-centred, holistic approach that builds on the

3.5 Implementation of self-management support In order for self-management support strategies to be effectively disseminated among relevant professionals, and used effectively, the health care workforce within this country will need to embrace and advocate self-management practice. The Australian Better Health Initiative (ABHI) includes a measure to encourage patient self management of chronic disease by providing training for health professionals, including GPs, in teaching self management skills (Zwar, et al., 2006). This framework provides information to help ensure that self-management principles are consistently implemented in the routine clinical practices and activities of the future health care workforce. Greater self-management of health in general is also an increasing focus of organisations and individuals in our communities. Various strategies and policies aimed at improving health at a population level, or specific to certain conditions or demographic groups, are reliant on people incorporating these approaches into their lifestyles and self-care regimes. Prevention or management of chronic conditions typically requires health behaviour changes. However, where prevention and self-management recommendations involve a person changing long-term behaviours, such as dietary or sedentary habits, or taking up new behaviours, such as exercise, medications, or blood testing procedures, adherence is a potential problem (WHO, 2003). This report states that “patients need to be informed, motivated and skilled in the use of cognitive and behavioural self-regulation strategies if they are to cope effectively with the treatment-related demands imposed by their illness” (WHO, 2003, p.35). The importance of a multidisciplinary approach towards individual adherence to prevention and management of health behaviours associated with chronic conditions has been identified by the WHO (2003). This has been acknowledged due to the need for multiple behaviour changes typically required by people in health self-management or illness prevention strategies. The development of interprofessional support for chronic condition self-management is also seen as imperative to cope with these trends.

4. Philosophy The philosophical assumptions underpinning CCSMS are that a person with a chronic condition is the expert in managing their life. The health professional has expert knowledge about the condition. Best health outcomes are achieved when the health professional works in partnership with the person and their significant others and/or carers to manage their chronic conditions.

5. Nationally Agreed Definitions

5.1 Context CCSM in its broadest context is about how the person with a chronic condition manages their symptoms and the emotional and daily role consequences associated with the condition. Set within a cultural context that recognises and respects the beliefs and values of the person, it acknowledges the social, psychological, biological and spiritual factors that impact on self-management. Successful self-management is enhanced when the health professional and the system share responsibility and work together with that person to support better health and wellbeing as defined by the individual.


12

person’s capacity, strengths, resilience and dignity. CCSM involves the identification of issues, setting of goals, and commitment to actions. Hence progress and outcomes are measurable and can be reviewed over time regarding process and impact, by the person, health care professionals, significant others and/or carers and other supporters.

5.2 Definitions These definitions are provided to support the development of a common language and to facilitate communication between health professionals and people living with chronic conditions. They were based on definitions provided by the ‘Center for the Advancement of Health’, adapted with a variety of national and international sources, reviewed and agreed upon with expert input and finalised in an Australian national consensus process as part of the project The development of a framework to guide the integration of chronic condition self-management into undergraduate or entry level medical, nursing and allied health professional curricula project (conducted by Flinders University and University of South Australia in 2007).

Glossary of nationally agreed terms and meanings

Term Meaning Action plan The specific steps required to achieve a goal. Care plan A structured, comprehensive plan developed by the person and their significant others

and/or carers and health professional(s), defining problems, goals, actions, time frames and accountability of all involved, to prevent complications and deterioration of chronic conditions.

Chronic condition & Chronic disease

The term chronic condition encompasses disability and disease conditions that people live with over extended periods of time (i.e. more than 6 months). Chronic disease is a subset of chronic conditions and refers to a specific medical diagnosis. It may be more likely to have a progressively deteriorating path than other chronic conditions.

Chronic condition self-management

Self-management is a process that includes a broad set of attitudes, behaviours and skills directed toward managing the impact of the condition(s) on all aspects of living. It includes, but is not limited to self-care (see below) and it may also encompass prevention. The following are believed to contribute to this process:

− Having knowledge of the condition and/or its management − Adopting a self-management care plan agreed and negotiated in partnership

with health professionals, significant others and/or carers and other supporters − Actively sharing in decision-making with health professionals, significant

others and/or carers and other supporters − Monitoring and managing signs and symptoms of the condition − Managing the impact of the condition on physical, emotional, occupational

and social functioning − Adopting lifestyles that address risk factors and promote health by focusing on

prevention and early intervention − Having access to, and confidence in the ability to use support services

Chronic condition self-management support

The process of providing multi-level resources in health care systems (and the community) to facilitate a person’s self-management. It includes the social, physical and emotional support given by health professionals, significant others and/or carers and other supports to assist a person in managing their chronic condition. Self-management support is what health professionals and the health system do to assist the person with a chronic condition to manage their condition(s). It includes a health system that provides ready access to appropriate systems of self-management support that are:


13

− Evidence-based − Adequately resourced with staff who are adequately trained, culturally

sensitive to the person’s needs and who support the belief in the person’s ability to learn self-management skills

Collaborative care Collaborative care is person centred practice that promotes the active participation of each health professional in providing quality care. It respects goals and values for a person and significant others and/or carers and other supports, provides mechanisms for continuous communication among caregivers, optimises caregiver participation in decision-making (within and across disciplines) and fosters respect for the contributions of all health professions.

Decision support Decision support is any process or structure that assists the person with a chronic condition and/or a health professional to make informed decisions based on existing evidence. It includes knowledge support and computer-based decision support systems as well as decision aids for health care professionals and/or the person with a chronic condition(s). These decision support aids help the person reflect on their own values (around their condition and benefits/harms of intervention/management), taking into account the evidence and their own situation.

Empowerment Empowerment is having the right and the confidence to make one’s own decisions. Empowerment in the self-management context refers to the person with the chronic condition, but also significant others and/or carers. People are empowered by learning skills and abilities to gain effective control over their lives versus responsibility resting with others. Empowered people are confident, assertive, equal partners in decision-making with others.

Interprofessional education

Inter-professional education occurs when two or more professions learn with, from and about each other to improve collaboration and the quality of care

Person-centred care Person-centred care places the individual (significant other and/or carer etc) as the focus of any health care provision. The focus is on the needs of the person rather than the needs of the systems or professionals. The person feels understood, valued and involved in the management of their chronic condition.

Resilience Resilience is the person’s capacity to ‘soldier on’, to ‘bounce back’, to cope psychologically and to overcome the negative impact of a chronic condition in spite of its presence.

Self-care Self-care encompasses all the decisions and actions people take which affect their health and wellbeing. Examples include the daily activities that a person performs to manage their life, such as eating, drinking, taking medication, exercising, hygiene practices or measuring medical tests (e.g. blood sugar, weight, and blood pressure). Declining health care advice or using trial and error in everyday living may be elements of self-care.

Self-efficacy Self-efficacy is the belief in one’s ability to succeed at chosen tasks; to achieve set goals. It is the sense of confidence that one can effect change.

Self-help Self-help is a process involving accessing information, knowing where to go and who to contact to gain information, education or support in relation to perceived problems. It may include attending self-help groups or accessing self-help information (e.g. books, email network groups, internet etc)

Self-management care plan

A self-management care plan is a care plan (see above definition) which identifies and focuses on specific self-management goals and tasks.

Shared care Shared care is both systematic cooperation, about how systems agree to work together, and operational cooperation at local levels between different groups of health professionals.

Symptom action plan A written care plan (see above) which enables a person to respond proactively to changes in signs and symptoms of their chronic condition.

© Flinders Human Behaviour & Health Research Unit, Flinders University Curriculum Framework 31 October 2007

14st

6. Chronic condition self-management support tertiary education principles

6.1 Purpose It is important that the emerging health care workforce is prepared to embrace and advocate self-management practices and that education encompasses best practice CCSMS which is being progressively embedded at all levels of the Australian health system. The aim of the principles is to provide medical, nursing and allied health schools with a foundation to promote best practice in the area. By comparing an individual curriculum against the principles, educators may choose to take the opportunity to: audit their discipline curriculum against nationally agreed CCSMS education principles review, update and adapt curricula content and delivery to better reflect current best practice, and

ensure it remains relevant to the future health workforce initiate the planning of a process to develop curriculum for a greater focus on teaching CCSMS

skills and practice consider what resources, capacity and workforce development issues will need to be addressed to

enhance CCSMS education.

6.2 The Principles

Vision All Australians with chronic conditions and their carers will receive care from health professionals competent in providing self management support.

Core Principles 1. All health professional graduates will be competent in supporting people to self-manage their

chronic condition(s). 2. Health professional education will ensure that graduates are equipped to:

conduct their practice so that the person with the chronic condition and their carers are central to the process of care, ensuring they feel understood, valued and involved in efforts to support their self-management

work in interprofessional teams that support chronic condition self-management understand and base their chronic condition self-management support on the biopsychosocial,

cultural and economic context of the person and their carers

Operational Principles 1. Consumers are involved in the design, conduct and evaluation of chronic condition self-

management support education. 2. The agreed national chronic condition self-management definitions and terms are used. 3. Students are exposed to a range of chronic condition self-management models of consumer

education. 4. Students understand the influence of the health care system on chronic condition self-management. 5. Chronic condition self-management support education incorporates interprofessional learning. 6. Students learn chronic condition self-management support in interprofessional practice settings. 7. There are identified individuals competent in chronic condition self-management support to

champion development and delivery of chronic condition self-management support education. 8. Chronic condition self-management support education is integrated across all years of the

curriculum. 9. Chronic condition self-management support competencies are explicitly assessed.


15

10. The effectiveness of the chronic condition self-management support education is explicitly evaluated.


16

7. References Alemayehu, B., & Warner, K.E. (2004). The Lifetime Distribution of Health Care Costs. Health Services Research, 39(3), 627-642. Australian Government Department of Health and Ageing. (2004). Chronic Condition Self-Management - Managing ongoing conditions in partnership with your health care provider. Retrieved May 17, 2007, from http://www.health.gov.au/internet/wcms/Publishing.nsf/Content/chronicdisease-sharing.htm. Australian Government Department of Health and Ageing. (2006). COAG Health Services - Promoting Good Health, Prevention, and Early Intervention. Australian Institute of Health and Welfare. (2002). Chronic Diseases and Associated Risk Factors in Australia, 2001, (AIHW Cat. No. PHE 33). Canberra: Australian Institute of Health and Welfare. Barlow, J., Williams, B., & Wright, C. (2000). Patient Education for People with Arthritis in Rural Communities: The UK Experience, Patient Education and Counseling, 1451: 1-10. Battersby, M., A. Ask, M. Reece, M. Markwick and J. Collins (2003). "The partners in health scale: The development and psychometric properties of a generic assessment scale for chronic condition self-management." Australian Journal of Primary Health 9(2&3): 41-52. Battersby, M., M. Von Korff, J. Schaefer, C. Davis, E. Ludman, S. M. Greene, M. Parkerton and E. H. Wagner (2007) (in submission). "Evidence-based Principles for Implementing Self-management Support in Primary Care." Bodenheimer, T., Lorig, K., Holman, H., & Grumbach, K. (2002). Patient self-management of chronic disease in primary care. Journal of American Medical Association, 288(19), 2469-2475. Dennis, S., Zwar, N., Harris, M., Griffiths, R., Roland, M., Hasan, I., & Powell Davies, G. (2007). Chronic disease in primary care: what works. Program and Abstracts from 2007 General Practice and Primary Health Care Research Conference, Sydney, Australia. Fries, J.F. (1980). Aging, natural death, and the compression of morbidity. New England Journal of Medicine, 303(3), 130-135. Glasgow, R.E., Orleans, T.C., Wagner, E.H., Curry, S.J., & Solberg, L.I. (2001). Does the Chronic Care Model Serve Also as a Template for Improving Prevention? Milbank Quarterly, 79(4), 579-612. Glasgow, R., Davies, C., Funnell, M., & Beck, A. (2003). Implementing practical interventions to support chronic illness self-management. Joint Commission Journal on Quality and Safety, 29(11), 563-574. Hopman-Rock, M., & Westhoff, M. (2000). The Effects of a Health Educational and Exercise Program for Older Adults with Osteoarthritis of the Hip or Knee. Journal of Rheumatology, 27, 1947-1954. Hussain-Gambles, M., Atkin, K., & Leese, B. (2004). Why Ethnic Minority Groups Are Under-Represented in Clinical Trials: A Review of the Literature. Health and Social Care in the Community, 12(5), 382-388. Lawn, S., Battersby, M.W., & Pols, R.G. (2005). National Chronic Disease Strategy – Self Management. Report to the Commonwealth Department of Health and Ageing. Adelaide: Flinders Human Behaviour and Health

http://www.health.gov.au/internet/wcms/Publishing.nsf/Content/chronicdisease-sharing.htm


17

Research Unit, Flinders University. Lorig, K.., Chastain, R.L., Ung, E., Shoor, S., & Holman, H.R. (1989). Development and Evaluation of a Scale to Measure Perceived Self-Efficacy in People with Arthritis. Arthritis and Rheumatism, 32(1), 37-44. Lorig, K.., Ritter, P., Stewart, A., Sobel, D., William Brown, B., Bandura, A., Gonzalez, V., Laurent, D., & Holman, H. (2001). Chronic Disease Self-Management Program: 2-Year Health Status and Health Care Utilization Outcomes. Medical Care, 39(11), 1217-1223. Mortimer, D., & Kelly, J. (2006). Economic evaluation of the Good Life Club intervention for diabetes self-management. Australian Journal of Primary Health, 12, 5-14. National Health Priority Action Council. (2006). National Chronic Disease Strategy, Australian Government Department of Health and Ageing, Canberra. Newbould, J., Taylor, D., & Bury, M. (2006). Lay-led self-management in chronic illness: a review of the evidence. Chronic Illness, 2(4), 249-261. Newman, S., Steed, L., & Mulligan, K. (2004). Self-management interventions on chronic illness. Lancet, 364, 1523-1537. Rollnick, S., Mason, P., & Butler, C., (1999). Health Behaviour Change: A Guide for Practitioners. Edinburgh: Churchill Livingstone. Wagner, E.H., Austin, B.T, & Von Korff, M.R. (1996). Organizing Care for Patients with Chronic Illness. The Milbank Quarterly, 74(4), 511-542. Warsi, A., Wang, P.S., LaValley, M.P., Avorn, J., & Solomon, D.H. (2004). Self-management Education Programs in Chronic Disease. Archives of Internal Medicine, 164(9/23), 1641-1649. World Health Organisation. (2002). Innovative Care for Chronic Conditions: Building Blocks for Action: Global Report. Geneva: World Health Organisation. World Health Organisation. (2003). Adherence to long-term therapies: Evidence for action. Edited by Eduardo Sabate. Geneva: World Health Organisation. Zwar, N., Harris, M., Griffiths, R., Roland, M., Dennis, S., Powell Davies, G., & Hasan, I. (2006). A systematic review of chronic disease management. Australian Primary Health Care Research Institute, School of Public Health and Community Medicine, UNSW.

educating future health care professionals to support ... · pdf fileeducating future health...

Documents