Collaborative Self-Management Education: SME within the VA (D2)

VETERANS HEALTH ADMINISTRATION CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF COPD OR ASTHMA

Collaborative Self-Management Education: SME within the VA (D2)
Approaches to SME within the VA: The approaches to education for asthma and COPD self-management adopted here include the following assumptions:

A. Educator Availability: The number and skills of educators available for asthma and COPD SME will vary in VA facilities, thus guidelines relating to this education were written in simple language for the ease of use by all levels of providers.

B. Asthma/COPD SME takes time: It is important to find the best educational opportunities for each facility. This may require considerable creativity and innovation. For example, inhaler education should not be taught as a single intervention just to meet minimal documentation requirements. Rather it should be taught to assure ongoing adherence to knowledge and skills of:

The disease process
A medicine management plan
The use of inhalers with and without a holding chamber
A medication action plan

Such an approach has been shown to be effective in terms of patient adherence and cost-effectiveness.

C. Accomplishing SME goals with existing resources.

Teaching initial medicine use described above in the PFT laboratory where there are graphics to display changes and show the effectiveness of medicines. Time can be scheduled for education (there is also some down time while waiting for a bronchodilator response) and less distraction than a busy primary care area.
Restructure respiratory care services (RCS) so respiratory care practitioners (RCPs) can use their knowledge and skills as assessors and educators.
Teach in groups promoting knowledge and skills enhancement among the participants as well as cost-effective use of resources. Arrange class times convenient to the patients (say, evenings or weekends.)
Develop a program of supervised exercise (perhaps with cardiac rehabilitation or a community center) for those who will not or cannot participate in a home program of exercise.

D. Irrespective of how education is accomplished, every effort should be made to provide SME education to patients with asthma and COPD. Benefit-to-cost analyses are clearly showing well designed education opportunities produce positive outcomes.

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