Nathalie Eikelenboom MSc September 2014 SeMaS SelfManagement screening Selfmanagement one size does not fit all 1 SeMaS assessment of patients competences ID: 619270
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Slide1
SeMaS: a tool for personalized counselling and support of self-management in primary care
Nathalie Eikelenboom, MScSeptember 2014Slide2
SeMaS: Self-Management screening
Self-management: one
size does not fit all1SeMaS:
assessment
of
patients’ competences/barriers for self-management27 items, 10 minutes fill-in timeTailored self-management support by trained practice nurse
1
Trappenburg et al, Self-management: One size does not fit all. Patient Educ Couns (2013) Slide3
Self-Management definition
‘the care taken by individuals towards their own health and well being: it comprises the actions they take to lead a healthy lifestyle; to meet their social, emotional and psychological needs; to care for their long-term condition; and to prevent further illness or accidents’Slide4
Development of SeMaSSlide5
SeMaS study outline
Control arm: 8 practices
Intervention arm: 7 practices
Training SeMaS en practice visit
Baseline measurement
+/- 400 patients
Baseline measurement
+/- 350
patients
T=0
: follow-up consult with practice nurse
; care as usual
T=0:
follow-up
consult with practice nurse with tailored self-management supportSeMaS profile with feedbackStratified cluster randomization of 15 DOH general practices
T=1 week: questionnaire consult
T=1 week: questionnaire consult
Eikelenboom et al.,
Implementation
of
personalized
self-management
support using the self-management screening
questionnaire SeMaS; a
study
protocol
for
a cluster
randomized
trial . Trials (2013)Slide6
depri
Locus
of
control
Internal
Self-monitoring
Somewhat
willing
Functioning
in
groups
Difficult
Computer
skillsAverageBurden of diseaseAverage
Self-efficacyHigh
Social
support
Low
Coping
Problem
solving
Anxiety
Sometimes
Depression
High
More competent
SeMaS
profile
©
Koninklijke
Philips Electronics N.V. 2012Slide7
SeMaS categoriesSlide8
Qualitative analysis
1
Grol & Wensing, What drives change? Barriers to and incentives for achieving evidence-based practice.
Med
J
Aust (2004) Level1Barriers/incentivesinnovationAdvantages in practice, feasibility, credibility,
accessibility,
attractivenesspatientKnowledge,
skills, attitude,
compliance
professional
Awareness, knowledge, attitude, motivation to
change, behavioural routinessocial contextOpinion of colleagues, culture of the network, collaboration, leadershiporganizational contextOrganization of care processes, staff, capacities,resources,
structureseconomic and political contextFinancial arrangements, regulations, policiesSlide9
Qualitative analysis
Level
1FacilitatorBarrier
Innovation
Provides a
structure to discuss characteristicsDifficult wording of itemsPatientIncreased insight in
individual characteristicsRandom
selection of patients, not based on current level of self-management
ProfessionalProvides input for
individua
l
care plan
Attitude towards self-management1 Grol & Wensing, What drives change? Barriers to and incentives for achieving evidence-based practice. Med J Aust (2004) Slide10
Qualitative analysis
Level
FacilitatorBarrier
Social
context
Support from colleaguesInterest of GPs is variableOrganizational contextSufficient capacity for
innovationLimited time planned
for consultFinancial and political contextPractice and care group
policy on self-management
Self-monitoring
tools
for
patients not reimbursedSlide11
Quotes
Innovation“there was a clear
line to self-management in my consult”“
some
patients said they found the questions difficult”Patient“patients recognized themselves in the profiles”
“there is a group that is happy
that things can be organized differently. There
will also be a middle
group
, and a
group
that does not want to, or is not able to self-manage”Slide12
Quotes
Professional“SeMaS is usefull when
creating an individual care plan with the
patient
”
“we have to stimulate people, but I notice that it doesn’t work anymore nowadays”Social
context“the GP’s differed
in how involved they were in the SeMaS project”“I discussed the SeMaS with
my colleague practice nurse”Slide13
Quotes
Organizational context“it was sometimes
difficult to plan the SeMaS in the consult, besides the usual
subjects
and
measurements that have to be done”Financial and political context“making people aware of their own
responsibility for their
health is part of the policy in our practice”“sometimes the financial
agreements with health insurers are
not
translated
to the workplace”Slide14
Questionnaire consult
Intervention group:was SeMaS discussed
?Which subjects
were
discussed?Did you receive information, advice or referral to self-management interventions?Slide15Slide16
Take home message
SeMaS is the first step in providing
personalized self-management support.
© Health and Social Care Alliance ScotlandSlide17
Contact:
Nathalie Eikelenboom
nathalie.eikelenboom@radboudumc.nl
n.eikelenboom@doh-huisarts.nl
Co-creation
team SeMaS