Supporting your own direction - Health skills and own direction
Supporting your own direction
People who (are able to) have little direct control have less influence on their health and on the care they receive. They therefore often need more guidance: support of their own management or self-management support.
Teach communication and skills
Your support starts with making contact and connecting with the needs and wishes of the patient. That is the basis of patient-oriented communication. The goal is that the patient will soon (better) be able to take control over his or her own life. This is therefore about giving information and guiding you to (more) healthy behavior. You can use the information arrow with the steps open / understand / want / can / do / continue to do.
Yet support for self-management requires more. Information is often about one topic: using medication, performing self-monitoring, tooth brushing. Incidentally, that is often complicated enough. But in your own direction it is by definition about how you organize your life while you have a disease or disability and receive medical treatment. That requires all kinds of decisions, at different times, about different things.
Supporting your own management means that you teach the patient to identify and solve problems: going through a problem-solving process. You then look not only at the behavior (using medication, performing self-monitoring, brushing teeth), but also at how the patient addresses his problems. Keep on doing the information arrow with the patient to discuss how he can solve problems with medication, oral care and lifestyle advice.
Supporting your own direction
- Look at the individual, the person, not at someone from a target group
- Take into account needs and possibilities
- Pay regular attention to adherence and self-control
- Practice assistants and pharmacy assistants:
- Check whether the patient participates in a care program, what information and guidance the program offers and who performs the support (GP, POH, other health care provider)
- Check whether there is a personal health record in which the patient and the care providers work
- See if there are specific support programs (district, municipality, GGD, social card settings, digital)
- Be open
- Request permission: "Do you think it's good to talk about ...", "may I ask you about ...?", "Can I tell you about ...?" Or remember an appointment that you have previously made: 'we have previously agreed that we would discuss together on a regular basis how it goes with ... do you think it is good that we do this now or are there other things that you would rather discuss?'
- Pay extra attention to the steps of behavioral change: check each time how it goes; ask for side effects in chronic medication use; discuss what goes well and what does not; give compliments about what goes well
- Find out which step you can strengthen
- Check whether your patient understands what he can do about his health, for example by asking how he is using his medication
- Fill in any information, but do not tell too much at once; construction, if you see your patient more often, repeat if necessary
- Use any tools (pictures, objects, icons, digital material)
- Check whether your patient understands the information: 'I want to know if I have explained it correctly, can you explain how you will use the medication at home?'
- Want (decisions, motivation)
- Stand still longer at the step ''Want''
- A: attitude (weighing)
- Ask the patient what he finds important
- Ask the patient to think of different options yourself; what advantages and disadvantages does he expect from the various possibilities?
- S: social influence
- Check whether the patient experiences support from the environment; let you know that you appreciate it; involve the family members in the care
- E: own effectiveness
- Go together after what did and did not succeed
- Get the outcome of the step
- The patient makes the decision:
- Ask the patient about his decision: what will he do?
- Let the patient choose, if possible, different options: what does he choose?
- Make it clear that you respect his choice
- Help in coming up with small steps that lead to successful experiences
- Note the goals / choices in the patient record
- Can and do (skills and obstacles, appointments)
- Incorporate repetition moments
- Tell that mistakes can easily slip into ... (oral care, medication use)
- Check whether an operation is going well; for example, ask to explain or do an action; improve the action if necessary
- Make appointments and record them in the patient file
- Keep doing
- Teach the steps of problem solving:
- Possibly make an appointment for further support
- Agree when the patient needs to contact (earlier)
Support your own direction with medication
Approximately half of the patients use the prescribed medicines as intended. The other half does not take them in or does not use them in the right way. This is often called therapy (un) faithfulness.
Factors that influence adherence
Adherence to therapy depends on many factors: the medicine, the disease, the patient and his circumstances and the care providers. For some medicines, adherence is higher (blood sugar lowering tablets and blood pressure reducers), at other lower (medicines for asthma, COPD and depression). It also matters how often a drug has to be taken. For medicines that have to be taken four times a day, adherence is 50%. Drugs that have to be taken only once a day are taken in the right way in 78%. In addition, 4Ds reduce adherence (in English): depression, dementia, drug dependence and denial.
Promoting therapy adherence
Many things have been tried to improve adherence. What really works (proven effective) is:
- Self-monitoring (self-tracking of complaints and measurement data) and self-management (self-management);
- Simplification of dosing schedules;
- Medication assessments by the pharmacist.
Informing the patient only often does not work sufficiently. But support is of course also involved in self-monitoring and self-management. You can offer this by communicating patient-oriented: you match the needs of the patient. You can increase therapy compliance by talking about the use of medicines with the patient openly and with interest. Not to tell the patient that he is not doing well. Connects with the patient's concerns, wishes and experiences. Ask questions and use the information arrow.
In the next box you will find questions that you can ask to support your own management of medication use.
Help sentences in your conversation about medication use
- Can I ask you about the use of these medicines?
- How do you find it to use these resources?
- Can you tell us what this product is for and how you use it?
- What questions do you still have?
- What does this mean for you now?
- How do you think about this?
Can and do
- Are you able to use the medicines?
- Everyone will forget to take his medication. How is that with you?
- A lot of people think about stopping their medicines. That makes sense, especially in the beginning when the pills have no effect, but already give side effects. How is that with you?
- You probably have a good reason that you stopped taking the medication. May I ask which?
- Would you like to discuss with the doctor or pharmacist whether there are other solutions?
Handles for supporting your own direction
There are all kinds of tools to support your own direction: for patients and also for care providers.
Tools for patients
- Accessible information (on or via the site of care providers and information organizations);
- Personal health record;
- Health monitoring tools and monitoring (monitors), including diaries, telemonitoring, health apps;
- Courses, groups (live or digital);
- Choice aids.
Assistive products for health care providers
Articles and assistance have been written for healthcare providers. You can find them at http://www.kennispleinchronischezorg.nl. For example: Guide for primary care providers to support people who have limited health skills http://www.kennispleinchronischezorg.nl/eerstelijn/gezondheidsvaardigheden-praktijk voorbeeld-laaggeletterdheid-zelfmanagement.html
An important learning point for students and caregivers is that they do not think for their patients, but become coaches of their patients. Many students and caregivers have to get used to this. It is so natural to give advice based on your expertise. This makes it difficult to first check whether this is the best way to help patients with their own management.
Self-management (and supporting it) is central to what the patient needs and what he finds important. The conversation with the patient is not about what the patient 'has to do', but what he thinks is important, what he can do about his health and how he can manage it.
In the following chapters about the specific patient groups you can find points of interest in supporting the own direction of that specific group.
Supporting self-management is teamwork
On your own supporting your patients' own direction is not that effective. Many patients also have contact with other health care providers. They must be aligned and look in the same way. A joint approach is therefore necessary. This requires collaboration within the practice and with other healthcare providers.
When you ask care providers if they support self-management, the answer is almost always: 'yes, of course'. And that's right. With almost everyone that is part of his or her work. But how much attention is paid to it and how it is structured, and whether there is coordination with colleagues inside and outside the practice, that is quite different.
The Z-scan is a screening list with which you can investigate how far your practice is in structurally supporting your own management http://zelfzorgondersteund-instrumentenkiezer.nl/z-scan-een-zelfdiagnose-instrument-zelfmanagementondersteuning/