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
[email protected]
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 Astma zelfmanagement via internet
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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 Astma zelfmanagement via internet
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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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6 5.5 5 4.5
AQLQ total score
6.5
7
Asthma related quality of life (AQLQ)
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Rs = 0.59 P < 0.003 2.5
3
3.5
4
HeiQ total score Astma zelfmanagement via internet
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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 Astma zelfmanagement via internet
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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
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4 3 2 1 0 0
1
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0 1
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HeiQ-score
0
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0
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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 Astma zelfmanagement via internet
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