A Practice Support Program (PSP) learning module designed to help GP practices enable patient self-management is rolling out successfully across the province, with 320 physicians and 232 medical office assistants having completed it or participating as of June 2008.
The module emphasizes the role of the health care team in fostering self-management, suggesting that the physician’s belief that a patient can become an active self-manager is indeed a powerful force.
“Let’s face it, physicians have been involved in a form of self-management for years—even when they tell patients to monitor their condition and come back if it doesn’t resolve,” says Victoria GP Dr Eric Shafonsky. “But with the complexity of conditions and treatment methods these days, that’s not good enough—I see patient self-management as absolutely critical to the survival of primary care.”
Benefits for patients and GPs
The benefits of self-management (described as tasks that one undertakes to live well with a chronic condition[1]) include improved health outcomes, health status, medication management, and quality of life.
The benefits are also there for doctors and medical office assistants, says Dr Shafonsky, who enrolled in Vancouver Island Health Authority’s PSP self-management module after speaking at a previous session and being impressed with what he saw. Although his presentation was on the topic of self-management, Dr Shafonsky realized there was much to be gained from participating in the full module himself.
“I’ve been in practice since 1995 and year after year I’ve seen a deterioration in primary care, with doctors feeling unrecognized, overworked, and overwhelmed,” he says. “When I attended this session I saw people debating and learning from each other—I saw family practice being reinvigorated.”
A bonus effect of patient self-management is physician self-management. By empowering patients and giving them effective tools for monitoring and controlling their condition, the burden of the disease passes from the physician to the patient, where in reality it belongs.
The module in action
The self-management module includes 4 half-day learning sessions with 6- to 8-week action periods in between when GPs and MOAs implement what they have learned with the support of a health authority—specific practice support team.
Using such tools as the Stages of Change model and motivational interviewing, physicians and office staff are supported to work with patients to select behaviors they are prepared to change, learn strategies to change those behaviors, and problem solve. Topics covered in the module are:
• Patient assessment.
• Patient education.
• Goal setting to facilitate self-directed behavioral change.
• Patient support and assistance in problem-solving areas of daily living.
• Consistent patient evaluation and follow-up of self-management plans.
After successful implementation of their first self-management module, the Fraser Health practice support team decided to try something different—specifically, to offer the subsequent self-management program in concert with group visits, another PSP module.
“It occurred to us that self-management involves techniques that could be used readily in group visits, when patients are getting together to learn about a condition,” says Fraser Health practice support team member Jivi Khehra.
Fraser Health is running two cohorts of between 30 and 40 GP/MOA teams each, with a rigorous evaluation planned to help make a decision on whether to offer the programs separately or together in future.
“Anecdotal feedback suggests the combined program is going really well,” says Ms Khehra. “But of course what counts is whether the positive changes are sustained over the longer term.”
Dr Shafonsky says he is encouraged by support for the PSP overall, which he feels validates the role of the GP. He also applauds the inclusion of MOAs in the modules. “They have so much more to offer than answering the phone,” he says.
As well as patient self-management and group visits, the PSP includes modules in advanced access (an approach to scheduling appointments) and chronic disease management. Modules are accredited by the College of Family Physicians of Canada (CFPC), and credits can be applied toward CFPC Maintenance of Proficiency (Mainpro) requirements.
The PSP is an initiative of the joint BCMA/Ministry of Health General Practice Services Committee. For more information, visit www.practicesupport.bc.ca.
—Liza Kallstrom, Lead, Change Management & Practice Support, BCMA