Self-management programs emphasize partnerships between patients, doctors

Date: 11/14/2014

Chronic diseases such as asthma, heart disease, arthritis, and diabetes affect some 90 million American adults, with two out of three persons having multiple conditions. These conditions are the leading causes of death and disability in the U.S., and their incidence is likely to increase, as the baby boom generation reaches the ages when the prevalence of chronic disease increases.

Traditional care for these diseases has centered on the role of the physician, but a new model of care is emerging – one that focuses on patient self-management. This approach is not designed to replace the physician or health care provider; rather, it establishes a partnership between the patient and the provider, with the patient becoming his or her own principal caregiver.  

The Healthy Living Center of Excellence, a collaborative program of Elder Services of the Merrimack Valley in Lawrence and Hebrew Senior Life in Boston, is implementing this model of care throughout Massachusetts. Through regional-based efforts with community organizations, local government, foundations, health care providers, and insurers, the Center promotes evidence-based programs designed for adults 18 years of age and older with one or more chronic conditions. 

The good news for patients: the programs are free, thanks to funding from the U.S. Health and Human Services Administration of Community Living and dissemination by health care providers, insurers, senior centers, area agencies on aging, and faith-based organizations. 

With traditional care, many patients with one or more chronic diseases would see a physician periodically, perhaps four times a year for short periods of time. Those visits, however, may not offer enough time for patients to have all of their questions answered about the multiple aspects associated with chronic illnesses – areas such as managing pain, nutrition, physical activity, or even anxiety or depression that might accompany the illness. So, traditional care may not work well for someone who has a long-term chronic condition that needs more attention.   

Individuals who have a chronic disease are advised about the changes they need to make and the added steps they may need to take to attend to their condition. But they must modify their lifestyle significantly to incorporate those changes, and most patients need help, to understand what they need to do on a day-to-day basis to actually implement that change.  

We like to describe this new model of care as one where the patient is the captain of his or her health care ship, and the health care provider is there to offer help and guidance when needed. 

It is important to remember that a large part of a patient’s health goes beyond health care: about 30 to 40 percent of health outcomes are not related to medical issues, but rather to a person’s behavior and lifestyle. Such habits as smoking, drinking, poor diet, and a sedentary lifestyle, for example, have huge impacts on health. An individual’s environment, along with housing conditions – two areas that physicians know affect health but likely have little or no training in – are also critically important. All of these are areas where important, beneficial changes can occur.

The Health Living Center of Excellence’s programs go beyond the traditional medical care of physician testing and evaluation; they are customized to the particular needs of the patient. They evaluate the lifestyle and environmental factors that influence a person’s health to build support systems for the long-term care of the patient. Simply put, the programs are designed to help patients live better, live healthier, and live independently as long as possible. 

Our research on these programs tells us this approach works well and provides multiple benefits. Patients have better health outcomes, better experiences with their care, and better communication with their providers. Patients are more physically active, are much more able to manage their conditions, and are more compliant with therapies, medications, and physician advice. They also make fewer visits to emergency departments.

The programs are offered across Massachusetts through seven regional centers located in Jamaica Plain, Lawrence, Brockton, South Dennis, Marlborough, Worcester, and Turners Falls, and are conducted close to where patients live in community settings such as YMCA’s, libraries, hospitals, and senior centers.

Patients and providers alike may find out more information on these programs by calling The Healthy Living Center of Excellence at 800-892-0890 or visiting www.healthyliving4me.org. For a video discussion of how these programs work, visit www.physicianfocus.org/chronicdisease

Robert Schreiber, M.D., is Medical Director, and Jennifer Raymond, J.D., M.B.A., is Director of Evidence-Based Programs, of The Healthy Living Center for Excellence in Lawrence, Mass. Physician Focus is a public service of the Massachusetts Medical Society. Readers should use their own judgment when seeking medical care and consult with their physician for treatment. Send comments to PhysicianFocus@mms.org.