Long-term condition management (also known as chronic disease management) is a major challenge for health care systems worldwide. The literature confirms that self-management has the ability to help improve health status, improve health behaviours and reduce health care utilisation for people with long-term conditions.
The Flinders Programme
The Flinders Programme of Chronic Condition Self-Management is a set of generic tools and processes enabling clinicians and clients to undertake a structured holistic assessment that identifies self management capacity, barriers, enablers, problems and goals leading to the development of personalised care plans. This evidence-based model has proven useful in a range of settings and population groups for improving quality of care and health outcomes. It is now being used throughout Australia, New Zealand, Canada and Singapore.
The Flinders Programme allows for the development of a health professional and client partnership approach. It enables the health professional and client to follow a structured process to assess the client’s self-management capacity, to identify client-defined problems and to collaboratively formulate small, behavioural goals. This leads to the development of a personalised self-management care plan, including monitor and review options.
Background
The Flinders Self-Management training course was developed by the Flinders Human Behaviour and Health Research Unit (FHBHRU) in Adelaide, Australia. Research during the Coordinated Care Trials in the late 1990s identified self management as a key identifier of a person's health need. Subsequent studies showed that an improvement in people’s ability to self-manage were related to improved health outcomes for people with a range of chronic conditions. This included use of the Problems and Goals Assessment for all the South Australia HealthPlus trials. The Partners in Health and Cue and Response Interviews were subsequently developed (Battersby, 2005).
Workshop Aims and Objectives
The purpose of the training workshop is to equip health professionals with the necessary knowledge, skills and attitudes to effectively use an evidence-based self-management support model for maximising health outcomes for people with long-term conditions.
The specific objectives of the workshop are to:
- Increase knowledge of chronic care management
- understand self-management theory and the practice behind goal setting; care planning; motivational technique and outcome measurement.
- Increase knowledge of quality improvement in chronic illness care
- Develop a range of assessment and communication skills in a positive, supportive learning environment
- Increase awareness to provide culturally appropriate self management support to clients with chronic conditions.
- Gain a "Certificate of Competence - Flinders Programme" & credit points for post graduate certificate
- Gain practical skills and tools to more effectively implement Care Plus and CCM programmes
Competencies
After the workshop participants will be able to:
- Access literature that supports self-management theory and practice
- Identify and work with community resources, NGOs and government agencies
- Evaluate the client’s readiness to change
- Implement stage specific interventions and strategies
- Administer the Partner in Health Scale & carry out a Cue and Response Interview
- Identify self-management issues
- Identify client-defined problems and formulate a problem and goal statement
- Develop a self-management care plan
- Confidently use self-management intervention tools e.g. Flinders Symptom Action Plan, Monitoring Diaries, Patient Self-Management Handbook and Patient Checklist
- Identify local community services, resources, courses and groups for intervention purposes
- Understand and utilise communication skills such as reflective listening and expressing empathy
- Teach structured problem solving techniques to clients to cope with everyday problems
- Use a client-centred practice model
- Provide culturally appropriate self-management support based on clients needs
- Recognise and respect the individual beliefs and values of clients
- Increase the client’s confidence in their ability to cope with their health condition and deal with barriers to effective self-management
- Build the client’s confidence in their self-management capacity
- Utilise quality improvement cycles for chronic illness care
Flinders Training in New Zealand
Flinders 2 day training workshops are now available through a number of PHOs, the University of Auckland Long-Term Conditions Paper (number of regions around the country) and through Healtlh Navigator NZ or HealthMatters NZ.
Next Flinders Workshop
Workshops are held 2-3 times per year around the country. For more information:
- Complete and return the following Flinders Workshop - Registration Form
- Expressions of interest - put Flinders Workshop in the contact form
Defining Self-Management for Chronic Conditions
Self-management for long-term conditions is defined as a person with chronic disease “engaging in activities that protect and promote health, monitoring and managing the impact of illness on functioning, emotions and interpersonal relationships, and adhering to treatment regimes” (Gruman & Von Korff, 1996).
Lorig and Holman (2000) identify five fundamental skills for self management:
- problem solving,
- decision making,
- resource utilization,
- forming a patient/health care provider partnership, and
- taking action.
Self-management enables people to make informed decisions, to adopt new viewpoints and general skills that can be applied to new challenges as they occur, to practice acquired health behaviours, and to sustain or regain emotional strength (Lorig, Mazonson, & Holman, 1993, p.11). Successful chronic disease self-management is therefore contingent on continued collaboration between health care providers and people with chronic disease; on behavioural and lifestyle changes; and on monitoring and problem solving on a daily basis (Lorig et al.1993; Wright, Barlow, Turner, & Bancroft, 2003).
Self-Management vs. Medical Care
Self-management is not a substitute for medical treatment (Lorig et al., 1993; Weeks et al., 2003). Self-management and medical treatment holistically complement each other to achieve the best health outcomes possible for people with chronic disease. Positive outcomes resulting from self-management occur in addition to positive outcomes from medical care.
Patient Self-Management Education vs. Traditional Patient Health Education
Patient self-management education is distinctly different to traditional patient health education. Patient health education, involving didactic instruction, provides illness-specific information and practical skills and has limited success in improving health behaviours or health outcomes.
Self-management education is concerned with problem-solving skills to help the patient proactively deal with challenges related to their chronic condition. Self-management therefore supplements traditional patient health education (Bodenheimer et al., 2002).
References
For full list, visit FHBHRU Publications
Lawn, S., Battersby, M., Harvey, P., Pols, R. & Ackland, A. (2009) A behavioural therapy approach to self-managing chronic conditions: The Flinders Program. Diabetes Voice, 54, 30-32.
Battersby, M., Hoffmann, S., Cadilhac, D., Osborne, R., Lalor, E., & Lindley, R. (2009). "Getting your life back on track after stroke" A Phase 2 Multi Centred, Single Blind, Randomised Controlled Trail (RCT) of the Stroke Self-Management Program (SSMP) Vs the Stanford Chronic Condition Self Management Program (CCSMP) or Standard Care in Stroke Survivors. International Journal of Stroke, 4(2) 137-44.
Battersby, M. W., J. Ah Kit, C. Prideaux, P. W. Harvey, J. P. Collins and P. D. Mills (2008). "Implementing the Flinders Model of self-management support with Aboriginal people who have diabetes: findings from a pilot study." Australian Journal of Primary Health 14(1): 66-74.
Battersby, M., P. Harvey, P. D. Mills, E. Kalucy, R. G. Pols, P. A. Frith, P. McDonald, A. Esterman, G. Tsourtos, R. Donato, R. Pearce and C. McGowan (2007). "SA HealthPlus: a controlled trial of a statewide application of a generic model of chronic illness care." Milbank Quarterly 85(1): 37-67.
Battersby, M. W. (2005). Health Reform through Coordinated Care: SA HealthPlus. British Medical Journal, 330, 662-665.
Battersby, M., Ask, A., Reece, M., Markwick, M., & Collins, J. (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), 41-49.
Bodenheimer, T., Lorig, K., Holman, H. & Crumbach, K. (2002). Patient Self-Management of Chronic Disease in Primary Care. Journal of American Medical Association, 288(19), 2469-2479.
Lorig, K., & Holman, H. (2000). Self-Management Education: Context, Definition, and Outcomes and Mechanisms. Population Health Division, Commonwealth Department of Health and Ageing.
Lorig, K., Mazonson, P. & Holman, H. (1993). Evidence Suggesting that Health Education for Self-Management in Clients with Chronic Arthritis has Sustained Health Benefits While Reducing Health Care Costs. Arthritis and Rheumatism, 36(4), 439-446.
Weeks, A., McAvoy, B., Peterson, C., Furler, J., Walker, C., Swerissen, H., & Belfrage, J. (2003). Negotiation Ownership of Chronic Illness: An Appropriate Role for Health Professionals in Chronic Illness Self-Management Programs. Australian Journal of Primary Health, 9(2&3), 25-33.
Wright, C., Barlow, J., Turner, A., & Bancroft, G. (2003). Self-Management Training for People with Chronic Disease: An Exploratory Study. British Journal of Health Psychology, 8, 465-476.
Additional Information
Flinders Human Behaviour & Health Research Unit website and information about The ‘Flinders Model’ of Chronic Condition Self-Management
http://som.flinders.edu.au/FUSA/CCTU/self_management.htm