Strong Health Teaches Self-Management of Chronic Conditions - Improves Health Status while Reducing Hospitalization

November 01, 1999

"Living healthy with a chronic condition" might sound like an oxymoron, but it's not. It's the name of a new Strong Health program that teaches people how to self-manage their chronic conditions and maintain healthier, more active and fulfilling lives. It is taught by volunteers who themselves have a chronic condition and have been trained to lead the workshop.

Based on a program developed by Stanford University, the six-week, peer-led workshop is structured around the belief that patients with different chronic diseases face similar challenges, and that they can learn from each other's experiences. The program is also banking on the principle that confident, knowledgeable patients practicing self-management will experience improved health and will need fewer health care resources.

"Chronic disease has emerged as the largest threat to health status and the largest cause of health care expenditures-almost 70 percent," says Polly Street, director of Strong Health Care Management. "The benefit of self-management goes beyond the potential of substantial health care cost savings, it can actually improve health."

The Stanford University study that led to this program evaluated the effectiveness of a self-management workshop for chronic disease for use with a diverse group of chronic disease patients. Results from the six-month study of 952 patients 40 years of age or older with a physician-confirmed diagnosis of heart disease, lung disease, stroke, or arthritis, was completed in 1996.

The patients who participated in the program-when compared with those who did not- increased their level of weekly exercise, improved communication with their physicians, and reported feeling less fatigued, less pain, and were more socially active. They also had fewer hospitalizations and days in the hospital, and showed a trend toward fewer outpatient visits. According to the study report, many of these results persist for as long as three years. The program was tested in California and Washington over the past several years and is now also being disseminated by Kaiser Permanente nationwide.

Anyone with a chronic health condition, such as: heart problems, chronic back problems, chronic pain, lung illness (asthma, bronchitis), stroke, multiple sclerosis, diabetes, chronic fatigue syndrome, arthritis, emphysema, lupus, severe allergies and other similar diseases, can attend. The workshop also welcomes caregivers of chronic disease sufferers.

The topics covered in "Living Healthy with a Chronic Condition" (also the name of the book Stanford produced for use with the workshop) include: exercise; use of cognitive symptom management techniques; healthy eating; fatigue management; use of community resources; use of medications; dealing with the emotions of fear, anger, and depression; communication with others, including health professionals; problem-solving; and decision making.

The instructors are taught to follow a specific protocol. In addition to teaching the class, the instructors facilitate discussions that help participants make self-managing choices, reach treatment goals and share their own ideas for managing chronic conditions.

Lois Goodman, a volunteer leader who has multiple sclerosis, was trained as a master instructor, which means she can teach the workshop and also train others how to do the same. "Classes are very interactive and participatory. People in the class tend to open up with more comfort than they feel they can with their doctor, where time is limited, or even with their family members who try to understand and help. There's a common bond in the class. Getting through some everyday problems that we all share and discussing how we cope and adapt was the most helpful part for me," Goodman says. "An important lesson I learned from the course is not setting goals too high. I think many of us tend to focus on the things we can't do and want to do, and we need to step back and make our goals more attainable. The feeling you get once you attain a goal is a very worthwhile feeling and you can go onto the next step after that."

According to Street, "Living Healthy with a Chronic Condition" will enhance regular treatment and disease-specific education such as Better Breathers, cardiac rehabilitation, or diabetes instruction, which she says are also successful in improving health status and decreasing health care costs.

The workshop meets weekly for six consecutive weeks. Each class lasts two and a half hours and is limited to 15 people. Daytime and evening classes are offered. There is a $15 fee to cover the cost of materials, with scholarships available to those who qualify.

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