Implementation and Evolution of a Regional Chronic Disease Self-Management Program

By Liddy, Clare; Johnston, Sharon et al. | Canadian Journal of Public Health, January 1, 2016 | Go to article overview

Implementation and Evolution of a Regional Chronic Disease Self-Management Program


Liddy, Clare, Johnston, Sharon, Nash, Kate, Irving, Hannah, Davidson, Rachel, Canadian Journal of Public Health


In Canada, approximately half the population lives with at least one chronic condition.1 To optimally manage chronic conditions, patients must make long-term health behaviour changes alongside day-to-day decisions related to their chronic conditions. In other words, they must self-manage.1,2 While patients often need help developing the skills necessary to manage their own care, physicians can assist in this matter by providing self-management support, defined as a) a portfolio of techniques and tools that help patients choose healthy behaviours and b) a fundamental shift of the patient-caregiver relationship into a collaborative partnership.3 Family physicians are well positioned to offer self-management support;4 however, clinicians are often constrained by the length of a typical office visit and struggle to provide ongoing support and follow-up to patients, given other competing demands.5

One solution is to refer patients to community-based resources that can help them develop the skills and knowledge they need to live well with one or more chronic conditions. Studies have found that such programs can improve patients' quality of life, knowledge of their condition and self-efficacy,6 and lead to improvements in health outcomes such as reduced rates of hospitalization and emergency room visits.7,8

In recent years, a number of regional programs have been developed across Canada to deliver self-management support to patients with chronic diseases.9-11 However, these programs lack coordination and are often only available in certain pockets, situated within other initiatives or targeted at specific chronic diseases or subpopulations, limiting their potential reach and accessibility.1,9,12 Furthermore, primary care providers exhibit low rates of referral to self-management programs, less than one quarter of eligible patients being referred to a specific self-management group or class.13 There is a need across Canada to implement regional programs that support a culture of self-management and improve access to self-management support for patients with chronic diseases.

This article describes how an innovative regional self-management program called Living Healthy Champlain (LHC) was created in a large health region of Ontario. LHC coordinates, promotes and facilitates a variety of self-management programs across our region.14 The impact of the program is described through the lens of the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.15 Our results will be highly relevant for other health regions that are seeking to introduce and/ or support chronic disease self-management programs.

PARTICIPANTS

The target population for LHC is health and/or social service delivery organizations, providers and people living with chronic conditions in the Champlain Local Health Integration Network (LHIN).

SETTING

The Champlain LHIN is a large health region of 18,000 km2 located in eastern Ontario with a population of 1.2 million people. The region is culturally and linguistically diverse, with a francophone population substantially larger than the Ontario average (19.2% vs. 4.7%), and significant Aboriginal (1.4%) and recent immigrant (3.3%) populations. The proportion of seniors in the region is in line with the Ontario average (12.5% vs. 12.8%). Likewise, the frequency of chronic disease in the Champlain LHIN is comparable with the rest of Ontario, with a significant number of individuals suffering from high blood pressure (13.6% of people over age 12), diabetes (4.6% of people over age 12) and heart disease (6.5% of people over age 30).16

INTERVENTION (CREATION OF THE LIVING HEALTHY CHAMPLAIN PROGRAM)

We partnered with local health and social care organizations throughout the Champlain LHIN to create the LHC program (see Figure 1 for a timeline of its development) in response to a new, integrated health services plan17 for the region, which included a greater focus on chronic disease prevention and management. …

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