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Chronic disease self-management (CDSM) programs

Health Factors: Quality of Care
Decision Makers: Healthcare Professionals & Advocates Public Health Professionals & Advocates
Evidence Rating: Scientifically Supported
Population Reach: 50-99% of WI's population
Impact on Disparities: No impact on disparities likely

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Description

Chronic disease self-management (CDSM) programs support patients’ active management of their condition in their daily life through education and behavioral interventions. Programs vary by specific disease but often focus on self-monitoring and medical management, decision making, or adoption and maintenance of health-promoting behaviors. Programs are usually delivered in health care settings by health professionals, including specially trained nurses, but may also be provided by nurses or lay individuals in community settings. Some programs may also be delivered via a computer, text messaging, or applications (apps) on mobile devices such as cell phones and tablets (Massimi 2017).

Expected Beneficial Outcomes

Improved health outcomes
Increased healthy behaviors
Improved quality of life
Increased self-efficacy
Improved mental health
Reduced hospital utilization
Improved chronic disease management
Improved care for chronic conditions

Evidence of Effectiveness

There is strong evidence that chronic disease self-management (CDSM) programs improve health outcomes (Massimi 2017, Zhao 2017, Cochrane-Zwerink 2014, McGillion 2014, Siantz 2014, Sidhu 2014, Brady 2013), increase healthy behaviors (Zhao 2017, Brady 2013, Franek 2013, Cochrane-Foster 2007, van Vugt 2013, McDermott 2013, Jones 2014), improve quality of life (Cochrane-Lenferink 2017, Cochrane-Fryer 2016, Newham 2017, Cochrane-Foster 2007), and increase self-efficacy for patients with various chronic conditions (Cochrane-Fryer 2016, Zhao 2017, Franek 2013, Cochrane-Foster 2007, van Vugt 2013, Stellefson 2013a). Additional evidence is needed to confirm effects for specific symptoms and conditions.

CDSM programs reduce HbA1c levels (Massimi 2017, Zhao 2017, Whitehead 2016, Chodosh 2005) and improve systolic blood pressure in diabetic patients (Massimi 2017), improve systolic (Chodosh 2005, Warsi 2004) and diastolic blood pressure in patients with hypertension (Chodosh 2005), and improve diastolic blood pressure in patients with cardiovascular disease (Massimi 2017). Programs also reduce the number of attacks in asthmatic patients (Warsi 2004) and the frequency of symptoms, physical limitations, and depression for patients with stable angina (McGillion 2014). Such programs may also improve osteoarthritis symptoms (Cochrane-Kroon 2014, Chodosh 2005).

CDSM for patients with chronic obstructive pulmonary disease (COPD) has been shown to improve quality of life (Cochrane-Lenferink 2017, Newham 2017), particularly if it includes an action plan to recognize and treat exacerbation of symptoms (Cochrane-Lenferink 2017). CDSM can also reduce emergency room visits for COPD, especially if programs target mental health and symptom management (Newham 2017). Programs may reduce hospitalizations when used for specific conditions such as COPD (Cochrane-Lenferink 2017, Cochrane-Zwerink 2014), but do not appear to affect hospitalization rates overall (Franek 2013, Cochrane-Foster 2007).

Chronic disease self-management programs may improve patients’ communication with physicians (Brady 2013, Franek 2013). CDSM led by specially trained nurses in chronic care community-based programs can improve health outcomes among patients with diabetes or cardiovascular disease (Massimi 2017). Theory-based CDSM programs have been shown to increase self-efficacy and diabetes knowledge and improve HbA1C among patients with diabetes (Zhao 2017).

Computer-based self-management programs delivered in health care settings can improve patient health behaviors and clinical outcomes (McDermott 2013). Web-based CDSM programs can reduce depression, anxiety, and fatigue, and improve overall quality of life for individuals living with cancer as a chronic disease (Kim 2015a). Computer and mobile-based interventions may increase quality of life and level of activity for people with COPD in the short-term (Cochrane-McCabe 2017). Web-based CDSM appears to improve conditions such as asthma, recurrent pain, and obesity among youth (Stinson 2009) and increase self-efficacy and disease management activities among older adults (Stellefson 2013a). Web-based CDSM also appears to improve health behaviors and clinical and psychological outcomes in patients with diabetes (van Vugt 2013). Programs that use text messaging increase patients’ adherence appointments, antiretroviral therapy, and short-term smoking quit rates (Jones 2014). International studies suggest mobile health (mHealth) apps used for CDSM show potential to improve health outcomes and symptom management (Whitehead 2016).

CDSM programs have been shown to benefit various populations including adults with serious mental illness (Siantz 2014) and minority groups in the short-term (Sidhu 2014). CDSM has also been shown to improve activities of daily living (ADL) for community-dwelling older adults with chronic conditions (van het Bolscher-Niehuis 2016). Additional evidence is needed to determine effects for chronically ill patients with low incomes (Van Hecke 2017).

Implementation

United States

There are many types of chronic disease self-management (CDSM) programs implemented across the Unites States. The Centers for Disease Control and Prevention (CDC) and the National Council on Aging each provide lists of CDSM programs, specific to conditions such as arthritis, asthma, chronic obstructive pulmonary disease (COPD), and diabetes (CDC-CDSM, NCOA-CDSM). The Self-Management Resource Center maintains the Chronic Disease Self-Management Program, created by Stanford, which is widely used and available in English and Spanish (SMRC-CDSMP).

Wisconsin

The Wisconsin Institute for Healthly Aging promotes CDSM as part of the Help Yourself to Better Health Campaign and offers health promotion workshops which may include components of CDSM (WIHA-Better health).

Implementation Resources

CDC-CDSM - Centers for Disease Control and Prevention (CDC). Self-management education: Learn more. Feel better. Managing chronic conditions (any). Accessed on July 24, 2018
CDSMP-Toolkit - National Council on Aging. Chronic disease self-management program (CDSMP): A toolkit for hospitals. 2012. Accessed on July 25, 2018
NCOA-CDSM - National Council on Aging (NCOA). Chronic disease self-management (CDSM) programs. Accessed on July 24, 2018
SMRC-CDSMP - Self-Management Resource Center (SMRC). Chronic disease self-management program (CDSMP). Accessed on July 25, 2018

Citations - Description

Massimi 2017 - Massimi A, De Vito C, Brufola I, et al. Are community-based nurse-led self-management support interventions effective in chronic patients? Results of a systematic review and meta-analysis. PLOS ONE. 2017;12(3):e0173617. Accessed on September 18, 2018

Citations - Evidence

Brady 2013 - Brady TJ, Murphy L, O’Colmain BJ, et al. A meta-analysis of health status, health behaviors, and health care utilization outcomes of the chronic disease self-management program. Preventing Chronic Disease. 2013;10:1-14. Accessed on July 25, 2018
Chodosh 2005* - Chodosh J, Morton SC, Mojica W, et al. Meta-analysis: Chronic disease self-management programs for older adults. Annals of Internal Medicine. 2005;143(6):427-38. Accessed on July 25, 2018
Cochrane-Foster 2007* - Foster G, Taylor SJC, Eldridge S, Ramsay J, Griffiths CJ. Self-management education programmes by lay leaders for people with chronic conditions. Cochrane Database of Systematic Reviews. 2007;(4):CD005108. Accessed on July 25, 2018
Cochrane-Fryer 2016 - Fryer CE, Luker JA, McDonnell MN, Hillier SL. Self management programmes for quality of life in people with stroke. Cochrane Database of Systematic Reviews. 2016;(8):CD010442. Accessed on July 24, 2018
Cochrane-Kroon 2014* - Kroon FPB, van der Burg LRA, Buchbinder R, et al. Self-management education programmes for osteoarthritis. Cochrane Database of Systematic Reviews. 2014;1:CD008953. Accessed on July 25, 2018
Cochrane-Lenferink 2017 - Lenferink A, Brusse-Keizer M, van der Valk PDLPM, et al. Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews. 2017;(8):CD011682. Accessed on July 24, 2018
Cochrane-McCabe 2017 - McCabe C, McCann M, Brady AM. Computer and mobile technology interventions for self-management in chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews. 2017;(5):CD011425. Accessed on July 24, 2018
Cochrane-Zwerink 2014* - Zwerink M, Brusse-Keizer M, van der Valk PDLPM, et al. Self management for patients with chronic obstructive pulmonary disease: Review. Cochrane Database of Systematic Reviews. 2014;(3):CD002990. Accessed on July 25, 2018
Franek 2013 - Franek J. Self-management support interventions for persons with chronic disease: An evidence-based analysis. Ontario Health Technology Assessment Series. 2013;13(9):1-60. Accessed on July 25, 2018
Jones 2014* - Jones KR, Lekhak N, Kaewluang N. Using mobile phones and short message service to deliver self-management interventions for chronic conditions: A meta-review. Worldviews on Evidence-Based Nursing. 2014;11(2):81-88. Accessed on July 25, 2018
Kim 2015a - Kim AR, Park HA. Web-based self-management support interventions for cancer survivors: A systematic review and meta-analyses. Studies in Health Technology and Informatics. 2015;216:142-147. Accessed on July 24, 2018
Massimi 2017 - Massimi A, De Vito C, Brufola I, et al. Are community-based nurse-led self-management support interventions effective in chronic patients? Results of a systematic review and meta-analysis. PLOS ONE. 2017;12(3):e0173617. Accessed on September 18, 2018
McDermott 2013* - McDermott MS, While AE. Maximizing the healthcare environment: A systematic review exploring the potential of computer technology to promote self-management of chronic illness in healthcare settings. Patient Education and Counseling. 2013;92(1):13-22. Accessed on July 25, 2018
McGillion 2014 - McGillon M, O'Keefe-McCarthy S, Carroll SL, et al. Impact of self-management interventions on stable angina symptoms and health-related quality of life: A meta-analysis. BMC Cardiovascular Disorders. 2014;14:1-10. Accessed on July 25, 2018
Newham 2017 - Newham JJ, Presseau J, Heslop-Marshall K, et al. Features of self-management interventions for people with COPD associated with improved health-related quality of life and reduced emergency department visits: A systematic review and meta-analysis. International Journal of Chronic Obstructive Pulmonary Disease. 2017;12:1705-1720. Accessed on July 24, 2018
Siantz 2014* - Siantz E, Aranda MP. Chronic disease self-management interventions for adults with serious mental illness: A systematic review of the literature. General Hospital Psychiatry. 2014;36(3):233-44. Accessed on July 25, 2018
Sidhu 2014 - Sidhu MS, Gale NK, Gill P, et al. A systematic review of lay-led group-based self-management interventions for minority ethnic populations diagnosed with long-term conditions in high income countries. Diversity and Equality in Health and Care. 2014;11(3-4):225-36. Accessed on July 25, 2018
Stellefson 2013a - Stellefson M, Chaney B, Barry AE, et al. Web 2.0 chronic disease self-management for older adults: a systematic review. Journal of Medical Internet Research. 2013;15(2):e35. Accessed on July 25, 2018
Stinson 2009 - Stinson J, Wilson R, Gill N, Yamada J, Holt J. A systematic review of internet-based self-management interventions for youth with health conditions. Journal of Pediatric Psychology. 2009;34(5):495-510. Accessed on July 25, 2018
Van Hecke 2017* - Van Hecke A, Heinen M, Fernández-Ortega P, et al. Systematic literature review on effectiveness of self-management support interventions in patients with chronic conditions and low socio-economic status. Journal of Advanced Nursing. 2017;73(4):775-793. Accessed on July 24, 2018
van het Bolscher-Niehuis 2016* - van het Bolscher-Niehuis MJT, den Ouden MEM, de Vocht HM, Francke AL. Effects of self-management support programmes on activities of daily living of older adults: A systematic review. International Journal of Nursing Studies. 2016;61:230-247. Accessed on July 24, 2018
van Vugt 2013 - van Vugt M, de Wit M, Cleijne WHJJ, Snoek FJ. Use of behavioral change techniques in web-based self-management programs for type 2 diabetes patients: Systematic review. Journal of Medical Internet Research. 2013;15(12):e279. Accessed on July 25, 2018
Warsi 2004 - Warsi A, Wang PS, LaValley MP, Avorn J, Solomon DH. Self-management education programs in chronic disease: A systematic review and methodological critique of the literature. Archives of Internal Medicine. 2004;164(5):1641-49. Accessed on July 25, 2018
Whitehead 2016 - Whitehead L, Seaton P. The effectiveness of self-management mobile phone and tablet apps in long-term condition management: A systematic review. Journal of Medical Internet Research. 2016;18(5):e97. Accessed on July 24, 2018
Zhao 2017* - Zhao FF, Suhonen R, Koskinen S, Leino-Kilpi H. Theory-based self-management educational interventions on patients with type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. Journal of Advanced Nursing. 2017;73(4):812-833. Accessed on July 24, 2018

Citations - Implementation

CDC-CDSM - Centers for Disease Control and Prevention (CDC). Self-management education: Learn more. Feel better. Managing chronic conditions (any). Accessed on July 24, 2018
NCOA-CDSM - National Council on Aging (NCOA). Chronic disease self-management (CDSM) programs. Accessed on July 24, 2018
SMRC-CDSMP - Self-Management Resource Center (SMRC). Chronic disease self-management program (CDSMP). Accessed on July 25, 2018
WIHA-Better health - Wisconsin Institute for Healthy Aging (WIHA). Help yourself to better health campaign. Accessed on July 24, 2018

Page Last Updated

July 24, 2018

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