Catherine Viljoen , BA ( Human Kinetics and Ergonomics ) ( RU ), BSc ( med ) ( Hons ) Exercise Science ( Biokinetics ) ( UCT )

Aimée Wesso , BSc ( Sport and Exercise Science ) ( UWC ), BHons ( Biokinetics ) ( US ), MBA ( University of Ljubljana )

There is little doubt that the management of chronic disease goes beyond medicine prescription . Managing chronic conditions is a daily effort which is reliant on a patient ’ s behaviour at home as much as , if not more than , time spent in a healthcare practitioner ’ s office . Since patient behaviour affects symptoms , health outcomes and quality of life , self-management is an important aspect of patient care .

Treatment adherence , healthcare utilisation and lifestyle management is often overwhelming for patients with chronic physical or mental health conditions . While medical care and education provide patients with knowledge and skill , selfefficacy plays a major role in the success of any treatment intervention . Many patients already know the lifestyle changes that are necessary to improve their health , but are unable or feel unable to implement these changes . It is an individual ’ s ‘ level of activation ’ that determines the successful self-management of chronic diseases .

THE ROLE OF PATIENT ACTIVATION IN SELF- MANAGEMENT

Patient activation is described across three elements , namely an individual ’ s knowledge , skill , and confidence for managing their health and health care ( Hibbard et al 2005 ). Patients with ‘ low levels ’ of activation are less likely to play an active role in staying healthy and lack the confidence to manage their own health . As a result , they are less likely to seek help when they need it , to follow their doctor ’ s advice and unable to manage their health when they are no longer being treated . By understanding the elements of patient activation , both healthcare practitioners and funders can support patients by empowering them to negotiate the obstacles they may encounter while trying to achieve three important selfmanagement skills : 1 . Taking care of a health condition , 2 . Carrying out daily activities , and 3 . Managing their emotional changes .

A HEALTHCARE ENVIRONMENT WHICH SUPPORTS SELF-MANAGEMENT

Medscheme recognises the important role that family practitioners ( FP ), and other healthcare practitioners in the primary care setting , play in coordinating patient care and facilitating self-management . It is well known that a good relationship between patients and family practitioners is vital to ensuring that patients become active partners in the management of their condition ( s ). We also understand the limitations which time constraints place on FP consultations . This makes it challenging for providers to effectively communicate and educate patients on self-management .

Understanding the barriers evident on both the provider and patient side , Medscheme has embarked on a core strategy to facilitate beneficiary activation and to empower the FP as the coordinator of care . Key features of this strategy are :

• Providing FPs with the time necessary to actively engage with their patients . An alternative model has been developed which reimburses doctors appropriately for the time they spend with high risk patients as well as reimbursing them for being available to these patients between consultations . This has been implemented on a small scale in 2017 by a number of schemes for whom we provide managed care services and will be expanded once the impact of the model has been demonstrated .

• Regular communication between patients and family practitioners is encouraged at all points of contact . Once the appropriate consent is given to Medscheme by a patient , relevant health information is shared with their treating healthcare providers . This information is delivered via the electronic medical record ( EMR ). The EMR seeks to facilitate meaningful conversations between the FP and the patient as their treatment requirements change over time .

• The personal health record enables patients to engage with their health record , ensuring that they understand the effects of their lifestyle and responses to treatment . Patients are able to track progress and treatment history ( including consultations , treatments and medications lists ) thus facilitating future conversations with their FP around health concerns and treatment preferences .

• Telephonic contact between the patient and a Medscheme Care Manager assists the patient to navigate the healthcare system . This includes providing guidance on how to access appropriate scheme benefits ( e . g . chronic medicines ), obtain credible health information and provide guidance on how to overcome personal barriers to health improvement .

• The Chronic Disease Self-Management Program ( CDSMP ) is an evidence-based self-management intervention delivered by Medscheme . This programme has been developed by researchers at Stanford University , and it is a well-documented example of an intervention to improve patient activation and to promote peer to peer mentoring . Medscheme has acquired the licence to offer clients training in CDSMP and have two T-Trainers available , both certified by Stanford University . This licence allows us to train lay individuals or health care professionals to become programme leaders offering CDSMP courses to their communities and organisations . The training has been provided to Medscheme Care Managers and wellness champions who interact with and provide support to identified patients .

The self-management toolbox discussed during the CDSMP courses , and communicated through Medscheme ’ s telephonic interventions , covers aspects such as :

• Goal-setting , decision-making and problem-solving

• Advising patients to prepare a list of issues for discussion with their family practitioner , prioritising areas of concern

• Encouraging patients to keep a symptom diary , a medication list including approved chronic medicine and over the counter medications , as well as a record of treatment received and test results

• Advising patients on how best to make informed decisions about their health and

• Emphasising the importance of improved communication with their FP as their coordinator of care .

In closing , the goal of self-management is to help patients to better manage the symptoms of chronic conditions , the physical and social consequences as well as the lifestyle changes brought about by the condition . By becoming active partners with their healthcare practitioners , patients experience improved patient self-efficacy , decreased visits to hospital emergency rooms , and improvements in health status and improved patient quality of life .

References available on request .

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MAY 2017 | MEDICAL CHRONICLE

CLINICAL

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