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An Interprofessional Approach to Chronic Conditions

Approximately 120 million Americans have one or more chronic illnesses and more than 70-80 percent of health care costs are expended on the care of patients with chronic disease. The increase prevalence of chronic conditions, particularly among the elderly, has led to new models of chronic care management. Management of chronic conditions focus on treating the disease, but also managing its symptoms and improving the function and quality of life of the patient/client. New practice guidelines continue to evolve in caring for patients with chronic conditions. Collaboration among health professionals is a new approach in caring for patients with chronic conditions---particularly forming a partnership between caregivers and patients. This collaborative model in managing patients with chronic conditions will enable patients to take an active role in their own care.

This series of learning modules will cover an important area of chronic conditions which all health care professionals should focus on in order to improve geriatric care.

Module 2: Self-Management in Chronic Conditions


Christine Hsieh, MD
Tarae Waddell-Terry, MS

Christine Arenson, MD, Nancy L.Chernett, MPH, Christine Hsieh, MD,
Leigh Ann Hewston, PT, MEd., Tracey Vause-Earland, MS, OTR/L

The Eastern Pennsylvania-Delaware Geriatric Education Center (EPaD GEC) is funded by the Department of Human and Health Services Grant #D31HP08834


"The Institute of Medicine(2003) defines self-management as:

"The tasks that individuals must undertake to live well with one or more chronic conditions. These tasks include having the confidence to deal with medical management, role management, and emotional management of their conditions." (1st Annual Crossing the Quality of Chasm Summit: A focus on communities, Board on Healthcare Services, 2004)

Chronic conditions are "any conditions that require ongoing adjustments by the affected person and interactions with the health care system."
(Improving chronic illness care, 2008)

Conditions such as asthma, diabetes, heart disease, obesity and tobacco are considered to be chronic conditions. Chronic conditions are continuing to increase; therefore developing innovative and impactful methods to deliver quality patient care are essential. It is suggested that: "133 million people, or almost half of all Americans, live with a chronic condition. That number is projected to increase by more than one percent per year by 2030, resulting in an estimated chronically ill population of 171 million."
(IImproving chronic illness care, 2008)

Successful self-management involves support from healthcare professionals which includes assessing one's ability to carry out care, understanding treatment, being aware of the patient's access to resources and providing the patient with the resources necessary to adequately manage their health.

The concept of this module is to give healthcare professionals and students an understanding of self-management, its effectiveness and the need for an interprofessional approach.

Learning Objectives:

Upon completion of this module, the participant will be able to:

  • Define chronic disease self-management and self-management supports.
  • Distinguish self-management education from patient education.
  • Review evidence supporting self-management in chronic conditions.
  • Identify and discuss key principles in self-management.
  • Illustrate an interdisciplinary approach to self-management using Congestive Heart Failure as a case study.
Estimated time for completion: 30 minutes

Since this module will take approximately 30 minutes to complete, it is designed to track your progress allowing you to complete the module in more than one sitting. This progress tracking feature requires that you use the same computer each time you return to work on the module.

Technical Requirements and Notes:

This learning module uses Adobe Flash media and may require you to add a browser "plug-in" in order to display properly. Most computers already have this free plug-in installed. But, if yours does not, it is very easy to download and install. Try the module first because the software is "smart" enough to detect the Flash player. If the module doesn't begin, you will be automatically prompted to download the plug-in.

The module contains links to external websites which will open in a new browser window. Your browser's back button will not return to the module, so these new windows should be closed.

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