By Jane Calligeros, Founder & CEO CDM Plus
There are 4 things Kenny Rogers can teach us about Chronic Disease Self-Management and we need to teach these skills to our patients. I was very sad to hear about Kenny Rogers passing away a few weeks ago. Growing up I remember my Dad used to sing his songs all the time with the radio in the car or at home. In my early days (you might even say olden days now) when I was studying Nursing at university, I would play his CD (compact disc for our millennial readers) on repeat for hours and hours when I was up all night writing assignments. One of my favourite songs was The Gambler and for those people that have never heard the song before it describes a train journey late at night with two men. One of the men identifies himself as ‘The Gambler’ and throughout the song gives the other man advice as though they were playing a game of cards.
Health professionals working in primary care are the character ‘The Gambler’ and the man represents patients with chronic disease. Chronic Disease Management at a practice level is about the delivery of long-term care for patients. We do this as a practice team through coordination using appointments such as Care Plans, Reviews and Health Assessments. Patients also attend practices for other clinical tasks such as Skin Checks, Immunisations, B12 injections, BP checks, INRs, Spirometry and Wound Care. The issue with the delivery of chronic disease management is that they focus on the clinical tasks listed and not so much on the patient role outside of attending these appointments. Delivering patient centred care is a long-term solution that needs to actively involve the patient in their management. And if we are going to ‘learn to play the game, boy you gotta learn to play it right’.
Patient engagement, self-management and attendance rates are all directly related. In the chorus, Kenny gives us 4 self-management skills we need to teach our patients:
- Know when to Hold them
Every day patient tasks that can help monitor and manage their condition. Depending on the patient’s condition it may include tasks such as recording Blood Pressure, Heart Rate, Weight, Respiratory Rate, Peak Flow, Blood Glucose Levels, Medication, Journal of symptoms, Nutrition, Physical Activity and Mood.
- Know when to Fold them
Educating patients to identify which signs & symptoms are connected to their condition and the actions they need to take. For example, if the patient had Diabetes and recorded a low Blood Glucose Level what do they need to do? What is a low reading? What is a high reading? What is a Normal or Acceptable reading? Linking the patient tasks with the signs and symptoms of their condition can put together the action plan for the patient which improves self-efficacy.
- Know when to Walk Away
Once the patient is able to complete the everyday tasks and link signs and symptoms to their condition, they can implement the action plan. The first level in the action plan is knowing how and when to ask for help from their GP. For example, a patient with Diabetes that is feeling unwell and recording higher readings would contact their GP for further advice.
- Know when to Run
Knowing when to run is the second level in the action plan which is calling for an ambulance. When developing the action plan the patient is aware of certain ‘Red Flag’ situations that require urgent assistance like dialing 000.
Support networks like carers, families and service providers play an important part in self-management from appointment management, to communicating with healthcare professionals, transport and medication management. Patients with multiple conditions can also have multiple health care professionals involved in their care. Patients may not have the capacity to self-manage all aspects of their care and tasks may need to be provided through the support network.
Practices and patients face many challenges over the coming weeks and months during the current pandemic to deliver care for patients living with chronic conditions. The average practice population is around 4,000 patients and half of these patients have at least one chronic condition. For the next 6 months chronic disease management will replace face to face appointments with Phone and Telehealth. Now is the time to decide which patients can make it through the chorus on their own and which ones need more support to increase the self-management. Our chronic disease patients are at risk of presenting acutely to hospitals during the pandemic if we cannot help them self-manage.
Let’s help our patients build self-efficacy or ‘the ace that they can keep’.