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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 are education and behavioral interventions that support patients’ active management of their condition in their daily life. Programs may focus on self-monitoring and medical management, decision making, or adoption and maintenance of health-promoting behaviors to minimize disability and delay the progress of chronic disease. Programs are usually delivered in health care settings by health professionals, but may also be delivered by lay individuals in community settings or via computer or phone applications or messaging. The components of self-management interventions vary by specific chronic disease.

Expected Beneficial Outcomes

Improved health outcomes
Increased healthy behaviors
Improved quality of life
Improved mental health
Reduced hospital utilization
Improved chronic disease management

Evidence of Effectiveness

There is strong evidence that chronic disease self-management (CDSM) programs improve health outcomes for patients with various chronic conditions (Cochrane-Zwerink 2014, McGillion 2014, Siantz 2014, Sidhu 2014, Brady 2013, Stinson 2009, Chodosh 2005, Warsi 2004). Additional evidence is needed to confirm effects for specific symptoms and conditions.

CDSM programs vary in focus, implementation, and effect. Programs have been shown to reduce HbA1C levels in diabetic patients, improve systolic (Chodosh 2005, Warsi 2004) and diastolic blood pressure in patients with hypertension (Chodosh 2005), and reduce the number of attacks in asthma patients (Warsi 2004). Programs also improve quality of life for patients with chronic obstructive pulmonary disease (Cochrane-Zwerink 2014) and reduce the frequency of symptoms, physical limitation, and depression for patients with stable angina (McGillion 2014). Such programs have been shown to improve osteoarthritis symptoms, but gains appear to be of doubtful clinical importance overall (Cochrane-Kroon 2014, Chodosh 2005). CDSM programs may reduce hospitalizations when used for some specific conditions such as COPD (Cochrane-Zwerink 2014), but do not appear to affect hospitalization rates overall (Franek 2013, Cochrane-Foster 2007).

Self-management programs have been shown to produce small improvements in patients’ health-related quality of life (Franek 2013) and health behaviors, including exercise, cognitive symptom management (Brady 2013, Franek 2013, Cochrane-Foster 2007), and communication with physicians (Brady 2013, Franek 2013). They also improve patients’ self-efficacy (Franek 2013, van Vugt 2013, Cochrane-Foster 2007). CDSM programs have been shown to benefit various populations including adults with serious mental illness (Siantz 2014) and minority populations, at least in the short-term (Sidhu 2014).

Computer-based self-management programs delivered in health-supported settings can improve patient health behaviors and clinical outcomes (McDermott 2013). Internet-based CDSM appears to improve some health outcomes in youth (Stinson 2009) and self-efficacy and disease management activities in older adults (Stellefson 2013a); it also appears to improve health behaviors and clinical and psychological outcomes in patients with diabetes (van Vugt 2013). Programs using mobile phone text messaging increase patients’ adherence to positive health behaviors (Jones 2014).

CDSM programs led by lay leaders may result in some small health status improvements but, overall, these benefits do not appear to be clinically important (Cochrane-Foster 2007).

Implementation

United States

There are many types of chronic disease self-management programs implemented across the Unites States. The Chronic Disease Self-Management Program created by Stanford is a program that is frequently used and has been shown to be effective (Stanford CDSMP).

Wisconsin

The Wisconsin Institute for Health Aging implements the Chronic Disease Self-Management Program as the Living Well with Chronic Conditions Program (WI DHS-Living well).

Implementation Resources

CDSMP-Toolkit - National Council on Aging. Chronic disease self-management program (CDSMP): A toolkit for hospitals. 2012. Accessed on February 2, 2016
Stanford CDSMP - Stanford School of Medicine. Chronic disease self-management program (better choices, better health workshop). Accessed on January 26, 2016

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 January 26, 2016
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 January 26, 2016
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 January 26, 2016
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 January 26, 2016
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 January 26, 2016
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 January 26, 2016
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 January 26, 2016
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 January 26, 2016
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 January 26, 2016
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 January 26, 2016
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 February 2, 2016
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 January 26, 2016
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 January 26, 2016
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 January 26, 2016
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 January 26, 2016

Citations - Implementation

Stanford CDSMP - Stanford School of Medicine. Chronic disease self-management program (better choices, better health workshop). Accessed on January 26, 2016
WI DHS-Living well - Wisconsin Department of Health Services (DHS). Living well with chronic conditions. Accessed on January 26, 2016

Page Last Updated

July 23, 2015

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