Ondersteuning van astma zelfmanagement in de

Ondersteuning van astma zelfmanagement
in de huisartsenpraktijk via internet:
Karakteristieken van patiënten en het PatiëntCoach
webportaal
Jaap K. Sont, associate professor
Afdeling Medische Besliskunde
Leids Universitair Medisch Centrum
j.k.sont@lumc.nl
Definitie zelfmanagement
• Het zodanig omgaan met de chronische aandoening
• symptomen,
• behandeling,
• lichamelijke,
• sociale consequenties en
• bijbehorende aanpassingen in leefstijl,
• dat de aandoening optimaal wordt ingepast in het
leven
ww.zelfmanagement.com
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PRECEDE-PROCEED Model
Predisposing factors
Knowledge
Attitudes
Self-efficacy
Intentions
Emotions
Sociodemographic
factors
Reinforcing factors
Attitude/behaviour of health
personnel, peers and
parents
Symptom relief
Behaviour and lifestyle
Preventive actions
Compliance
Self-care
Health
Enabling factors
Availability/accessability of
resources
Education
Skills
Quality of life
Environment
Modified PRECEDE-PROCEED Model for Health Promotion, adapted from Health Promotion Planning:
An Educational and Environmental Approach (2nd ed.) by Green L.W. et al. Mountain View, Cal.: Mayfield, 1991.
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Health education impact Questionnaire (HeiQ)
• Profile of health education / self-management outcomes
• 40 questions
• 8 domains:
• Health directed behaviour
• Positive and active engagement in life
• Emotional well-being
• Self monitoring and insight
• Constructive attitudes and approaches
• Skill and technique acquisition
• Social integration and support
• Health service navigation
Osborne et al. Patient Educ Couns 2007
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Patient characteristics
• IMPASSE self-management implementation study
• N = 24
• asthma diagnosed by GP
• 4 male / 20 female
• Age (range): 38.5 (18 - 65) years
• Lung function
• FEV1 (range): 88.3 (56-116) % predicted
• Asthma control
• ACQ (range): 1.04 (0.14-2.42)
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5.5
5
4.5
AQLQ total score
6.5
7
Asthma related quality of life (AQLQ)
4
Rs = 0.59
P < 0.003
2.5
3
3.5
4
HeiQ total score
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120
Lung function FEV1 (% predicted)
100
90
80
70
50
60
FEV1 (% predicted)
110
Rs = 0.48
P < 0.02
2.5
3
3.5
4
HeiQ total score
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HeiQ
profile
Health directed behaviour
Constructive attitudes
Emotional
Social support
Self monitoring
Health service navigation
Pos. engagement in life
Skills acquisition
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
4
3
2
1
0
0
1
2
3
4
0 1
2
3
4
HeiQ-score
0
1
2
3
4
0
1
2 3
4
1
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PatiëntCoach home page
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PatiëntCoach zorgverlenerportaal
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PatiëntCoach astma monitoring
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PatiëntCoach COPD monitoring
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PatiëntCoach agenda
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PatientCoach actieplan COPD
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PatiëntCoach
• individueel zorgplan
• (thuis)monitoren van streefdoelen
en fysiologische-, gedrags- en
functionele parameters
• motivationele feedback
• persoonlijke agenda met acties,
afspraken en notities
• forum voor patiënten
• e-consult / e-bericht
• inloggen en authenticatie van
patiënten via DigiD
• forum voor zorgverleners
• reminders
• interactieve educatie op maat
• inloggen en authenticatie van
zorgverleners via UZI-pas of Digi-pas
• helpdesk
• inloggen en authenticatie van
zorgverleners vanuit eigen
informatiesysteem (HIS / EZIS)
• persoonlijke pagina te delen met
vrienden
• nieuwsberichten
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Conclusies
• Gunstiger zelfmanagement kenmerken hangen samen met een
• betere longfunctie,
• betere astma controle en
• betere astma gerelateerde kwaliteit van leven
• De HeiQ geeft inzicht in het zelfmanagement profiel van
individuele patiënten
• PatiëntCoach
• is een generiek, flexibel en modulair platform voor ondersteuning
van zelfmanagement bij chronische aandoeningen
• maakt met specifieke zelfmanagement modules ondersteuning op
maat mogelijk
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PatientCoach asthma / COPD
Funding
Partners
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Health education impact Questionnaire (HeiQ)
• Health directed behaviour
• healthful behaviours: prevention, diet, exercise, relaxation; tangible change
• Positive and active engagement in life
• getting engaged in life, intent for actions, indicators of now being involved in life
• Emotional well-being
• health-related negative affect; attitude to life; anxiety, stress, anger and depression
• Self monitoring and insight
• self monitoring of (sub)clinical indicators, setting reasonable limits or targets, and
insight into living with a health problem
• Constructive attitudes and approaches
• minimising the illness – “I am not going to let this disease control my life”
• Skill and technique acquisition
• symptom relief skills, skills and techniques to manage own health
• Social integration and support
• social interaction, feelings of social isolation as a result of the illness, sense of support,
seeking support from others
• Health service navigation
• communication, decision processes, relationships, understanding; interaction with and
negotiation of the healthcare system
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