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| CDSMP History Three factors - an aging population, an increase in chronic disease and co-morbidity, and new concepts about aging - plus a lack of health education programs appropriate for persons with multiple chronic conditions served as the impetus for a Chronic Disease Self-Management Program. The Chronic Disease Self-Management Program originated from Stanford University in California, US, where self-management programs for people with chronic health problems have been developed, tested and evaluated over the last 20 years at the Stanford Patient Education Research Center. The first program was the Arthritis Self-Management Course, which became the prototype for subsequent self-management programs. All of the programs were designed to help people gain self-confidence in their ability to control their symptoms and understand how their health problems affect their lives. Once a program is developed, it is evaluated for its effectiveness through a randomized, controlled trial (2-4 years in length). Programs are released for dissemination only after they have been shown to be safe and effective through these trials. The Chronic Disease Self-Management Program was developed at the Stanford Patient Education Research Center as a collaborative research project between Stanford and Northern California Kaiser Permanente Medical Care Program. The primary developers are Kate Lorig, R.N., Dr.P.H., Virginia Gonzalez, M.P.H., and Diana Laurent, M.P.H., all of whom are at Stanford. Several assumptions underlie the program: • people with chronic conditions have similar concerns and problems; • people with chronic conditions must deal not only with their disease(s), but also with the impact on their lives and emotions; • lay people with chronic conditions, when given a detailed leader's manual, can teach the CDSMP as effectively, if not more effectively, than health professionals; and • the process or the way the CDSMP is taught is as important, if not more important, than the subject matter that is taught. All of these assumptions have been evaluated in published studies. In a five year research project, the CDSMP was evaluated in a randomized study involving more than 1000 subjects. This study found that people who took the program, when compared to people who did not take the program, improved their healthful behaviours (exercise, cognitive symptom management, coping and communications with physicians), improved their health status (self-reported health, fatigue, disability, social/role activities, and health distress), and decreased their days in the hospital. The program is currently being disseminated nation-wide in the United States by the Kaiser system. In 1994, the program was introduced in Australia, and the program has recently been adopted in by the National Health Service of England. In Canada, the Chronic Disease Self-Management Program was implemented by the University of Victoria - Centre on Aging as a pilot program in the Yukon in 1998 and has since become a permanent government-funded program. In 2000, the Centre implemented the program in the Vancouver and Richmond Health Regions and it has also become a permanent program. In 2001, Health Canada provided a grant to the Centre on Aging to implement a 28 month project entitled "The Diabetes Self-Management Program." This program was implemented by a partnership between the University of Victoria's Centre on Aging and the BC Division of the Canadian Diabetes Association. In 2003 to 2006, the Centre on Aging received a grant from the BC Ministry of Health to implement the program in British Columbia. During this period, 65 leader training workshops were held to train 706 leaders and 386 courses were delivered to 4,368 participants. In March 2006, the Centre on Aging received funds to implement the program at the same level for the next three years. For information on the provincial implementation of the Chronic Disease Self-Management Program or research activities, please contact Dr. Patrick McGowan at 604-940-3574 or email mcgowan@dccnet.com. |
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