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Research Section

Effectiveness of the Chronic Disease Self-Management Program

The Chronic Disease Self-management program was developed by Stanford Patient Education Research Center, whose programs, around since the 1980s, are currently used in 24 countries. The first randomized controlled trial of the Stanford program was completed in 1996 and included results for 1,000 people followed over three years. It demonstrated significant improvements in patient’s ability to manage their chronic disease(s) and use health care resources effectively, with a cost-effectiveness ration of 1:10.  Results showed statistically significant improvements in physical exercise, emotional distress, communication with physicians, and reduction in anxiety, fatigue, incapacity and limitations in social functioning, along with unplanned hospital admissions and physician visits. Results have been validated through successful implementation that produced similar results in different countries and populations, including Canada. Similar results have occurred in the MUHC patient population who on average are living with three chronic conditions.

Initial Research 

The research on self-management programs began with an evaluation of the Arthritis Self-Management Program and found that experimental subjects exceeded control subjects significantly in knowledge, recommended behaviours and in lessened pain, and that these changes remained significant at 20 months (Lorig, Lubeck et al, 1985).
It also found that tested forms of reinforcement did not alter those effects (Lorig & Holman, 1989), and that lay persons can deliver the program with results similar to those achieved by professionals leading the program (Lorig, et al., 1986). Locally, the effectiveness of self-management training for arthritis has been documented (McGowan & Green, 1995; Green, Gutman, McGowan, & Wister, 1996). As well, in 1992, the Arthritis Self-Management Program was implemented and evaluated in 
First Nations communities in B.C.

The Chronic Disease Self-Management Program was initially tested in a randomised, controlled trial conducted by the Stanford University Patient Education Research Centre (Lorig, Sobel, Stewart, Brown, Bandura, Ritter, Gonzalez, Laurent, & Holman, 1999). In this study, effectiveness was measured in terms of changes in behaviour, health status, and health service utilisation. Data were collected from two groups at two points six months apart. Data were collected by mailed questionnaires from 952 patients (all over age 40), of which 561 were randomly assigned to the treatment group and 391 to the control group (those who did not receive the program). There were no significant differences in baseline data between the treatment and control groups.

Health behaviour changes occurred more often in the treatment group than in the control group (p ‹ 0.01) for all three behaviour-change indicators: number of minutes per week of exercise; increased practice of cognitive symptom management; and improved communication with their physician. Treatment group subjects also had more positive scores for self-related health status, including disability, social/role activity limitation, energy/fatigue, and health distress. Finally, fewer hospitalizations and fewer nights in hospital were found for the treatment group. No significant differences in visits to physicians were identified, however. In a two-year post-program follow-up study (Lorig, Ritter, Stewart, Sobel, Brown, Bandura, Gonzalez, Laurent & Holman, 2001) the researchers found ". compared with baseline for each of the two years, emergency room and outpatient visits and health distress were reduced (P ‹ 0.05), and self-efficacy improved (P ‹ 0.05)."

In Canada

The CDSMP was implemented as a pilot program in the Yukon in 1998 and has since become a permanent government-funded program. An evaluation conducted by McGowan (2000) [Microsoft Word format] showed that, four months after the program, participants had statistically significant improvements on 12 of 17 outcome measures.

Recently, a comprehensive literature review found that self-management training is effective in helping people manage diabetes, asthma, hypertension, depression, and congestive heart failure (BC Office of Health Technology Assessment, 2002).

In 2000, the CDSMP was implemented in the Vancouver and Richmond Health Regions and subsequently became a permanent program. Findings from two evaluations of the program (September 2001 and June 2003) were similar to the Yukon findings.

In December 2001, Health Canada funded a 28-month project (McGowan, Lorig, & Van Walleghem) to implement and evaluate the CDSMP for persons with Type 2 diabetes in British Columbia. The evaluation of this project is now complete and available here.

In the Spring of 2003, the BC Ministry of Health provided resources to the University of Victoria - Centre on Aging to implement and evaluate the CDSMP in each health region

The Chronic Disease Self-Management Program - Program Evaluation British Columbia 2003 - 2006 is now available.

Chronic Disease Self-Management Program - A Public Health publication, a new study conducted by Mathew Lee Smith et al., April 2015: Reaching diverse participants utilizing a diverse delivery infrastructure: a replication study.

 


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