self-management education
DESCRIPTION
Canadian Diabetes Association 2013 Clinical Practice Guidelines. Self-Management Education. Chapter 7 Helen Jones, Lori D Berard, Gail MacNeill , Dana Whitham , Catherine Yu. Self-Management Education (SME). A systematic intervention that involves active patient participation - PowerPoint PPT PresentationTRANSCRIPT
Self-Management Education
Chapter 7
Helen Jones, Lori D Berard, Gail MacNeill, Dana Whitham, Catherine Yu
Canadian Diabetes Association 2013 Clinical Practice Guidelines
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association
Self-Management Education (SME)
A systematic intervention that involves
active patient participationin self-monitoring and/or
decision-making
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association
Key Points
1. Diabetes self-management education (SME) improves health parameters
2. SME should teach behaviours as well as knowledge and technical/problem-solving skills
3. SME should be patient-centred, tailored to the individual, use a variety of teaching methods and be regularly reinforced
2013
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association
Knowledge is Power
• Empowering patients through self-management education improves:
– A1C– Quality of life– Weight loss– Cardiovascular fitness
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association
Basic Knowledge and Skills
• Monitoring health parameters (including self-monitoring blood glucose [SMBG])
• Healthy eating• Physical activity• Pharmacotherapy and medication adjustment• Hypo-/hyperglycemia prevention/management• Prevention and surveillance of complications • Problem identification and solving
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association
Not Just Knowledge: Work on Behaviour!
• Cognitive-behavioural interventions improve self-management and metabolic outcomes
• They may involve:– Cognitive re-structuring– Problem-solving– Cognitive-behavioural therapy (CBT)– Stress management– Goal setting– Relaxation
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association
How should SME be delivered?
Interdisciplinary team and/or peer-education
Personal contact with healthcare workers
Combination of group and individual sessions
Combination of didactic and interactive
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association
SME must be Reinforced Regularly
• Booking follow up sessions• Patient-educator contact between sessions• Automated or technology-based reminders
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association
Diabetes Education… Improved!
• Collaborative and interactive• Patient-centred and individualized• Knowledge and technical skills, but also problem-
solving skills• Repeatedly reinforced• Educational, psychological, and behavioural
interventions and a variety of teaching methods
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association
Steps to SuccessEvaluate and
support long-term self-management
Implement a realistic plan for skills training
Collaborate on decisions and goals for action
Make informed consideration of self-care options
Assess & identify personal self-care needs
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association
Recommendation 1
1. People with diabetes should be offered timely diabetes education that is tailored to enhance self-care practices and behaviours [Grade A, Level 1A ].
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association
Recommendation 2
2. All people with diabetes who are able should be taught how to self-manage their diabetes [Grade A, Level
1A].
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association
Recommendation 3
3. SME that incorporates cognitive-behavioural educational interventions, such as problem-solving, goal setting, and self-monitoring of health parameters, should be implemented for individuals with diabetes [Grade B, Level 2].
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association
Recommendation 4
4. Interventions that increase patient participation and collaboration in healthcare decision-making, should be used by providers [Grade B, Level 2].
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association
Recommendation 5
5. For people with type 2 diabetes, SME interventions should be offered in small-group and/or one-on-one settings, since both may be effective [Grade A, Level 1A].
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association
Recommendation 6
6. In both type 1 and 2 diabetes, interventions that target families’ ability to cope with stress or diabetes-related conflict should be included in educational interventions when indicated [Grade B, Level 2].
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association
Recommendation 7
7. Technologically based home blood glucose monitoring systems may be integrated into SME interventions in order to improve glycemic control [Grade C, Level 3].
2013
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association
Recommendation 8
8. Culturally-appropriate SME, which may include peer or lay educators, may be used to increase diabetes-related knowledge, self-care behaviours, and decrease A1C [Grade B, Level 2].
2013
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association
Recommendation 9
9. Adding literacy and numeracy sensitive materials to a comprehensive diabetes management and education program may be used to improve knowledge, self-efficacy, and A1C outcomes for patients with low literacy [Grade C, Level 3].
2013
guidelines.diabetes.ca | 1-800-BANTING (226-8464) | diabetes.caCopyright © 2013 Canadian Diabetes Association
CDA Clinical Practice Guidelines
http://guidelines.diabetes.ca – for professionals
1-800-BANTING (226-8464)
http://diabetes.ca – for patients