VETERANS HEALTH ADMINISTRATION CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF COPD OR ASTHMA 
 Collaborative Self-Management Education: SME Definition (D1)

What Is Collaborative Self-Management Education?¾ Collaborative self-management is defined as the ability of patients and families to apply knowledge and practice skills to optimize their health potential and quality of life in partnership with their health care team (Make 1994; Hindi-Alexander et al. 1987). This definition is based on the assumptions that asthma and COPD are chronic, controllable illnesses and that self-management activities flow from an active partnership between patients and health care providers. The cornerstone of a successful self-management program is the quality of the education and partnership.

 A. Benefits¾ Evidence suggests that self management education (SME) results in a variety of benefits such as reduction of costs for care of asthma and COPD patients, e.g., reduced ER visits, hospital admissions and phone calls as well as improved self confidence and quality of life (Ignacio-Garcia et al. 1995; Lahdensuo et al. 1996; Bolton et al. 1991; Bailey et al. 1990; Reina-Rosenbaum et al. 1997). With capitation reimbursement such as the Veterans Equitable Resource Allocation (VERA), SME is emerging as a crucial element in the cost effective management of chronic disease.

B. Partnership Building¾ The establishment of the patient/family-health provider partnership begins at the time of diagnosis and must be regarded as an inherent part of each subsequent communication. Building the partnership requires that clinicians promote open communication based upon honesty, a sense of urgency and importance regarding the essential ingredients of the educational process.

C. Patient Autonomy¾ Although relatively autonomous self-management is the goal, it is recognized that not all patients may be willing or able to assume this responsibility, especially if they have become socialized over time to be a passive recipient of care. Patient autonomy in goal-setting and decision-making related to treatment should nonetheless be reinforced to the highest extent possible.

D. Principles of Adult Learning¾ A broad body of literature has developed in the recent past about the unique considerations of educating the adult learner. Three key principles have been described which include:
 

E. Provider Responsibility for the Educational Process¾ It is essential that education be considered the responsibility of all members of the health care team and that all patient encounters with the health care delivery system be considered an opportunity for teaching and learning. Whereas the physician or primary health care provider is usually considered the primary arbiter of what the patient needs to know to adequately self-manage his/her illness, rarely will there be time in the average patient encounter to adequately provide such instruction. Whenever possible, a team approach should be implemented including clinical experts from respiratory diagnostics and care, nursing and other disciplines to provide patient and family education. This sends a powerful message to patients and families regarding both the importance of the content and subsequent adherence to the management plan. In addition, although clinical experts may provide teaching, all team members should be prepared to provide patient education corresponding to their patient care or patient interaction responsibilities.

F. Educational Methodology¾ Although the assessment questions, information and expected skills in each specific intervention are generic, educational methodology (written instructions, pamphlets, diagrams, one-on-one and group teaching skills, demonstration-return demonstration, etc.), should be tailored to meet the needs of the individual. For example, an initial assessment of reading skill and inclination as well as visual acuity should be determined before deciding to include detailed reading materials in the teaching plan. Multiple methods suitable to the setting are encouraged; videotapes, for example, are especially useful for skill development and may save provider time. When available, referral sources to existing programs or experts should be considered, e.g., smoking cessation, medication use, supplemental home oxygen, ventilatory assistive devices, weight control, occupational therapy, and exercise, etc. Pamphlets and other educational materials, no matter how well prepared and highly relevant, should be considered adjuncts to the educational process and not the principal means of instruction. 

Table of Contents | Module D2