The purpose of this study was to analyze and measure the short-term and long-term impacts of a chronic disease self-management program (CDSP) for individuals living with HIV/AIDS. This study was a follow-up study on an HIV/AIDS Organization in Southern California’s (HAOSC’s) CDSP programs in 2007 and 2008 called “Newly Empowered Women” (NEW), a six (6) week CDSP for women diagnosed with HIV/AIDS which sought to promote self-efficacy through education and self-management skills. A retrospective longitudinal study on the female clients who participated with this program in 2007 and 2008 determined whether clients retained the skills taught in the CDSP and if they attained self-efficacy through improved behavioral changes in better overall self-management that were influenced as a result of their participation. Behavioral changes were examined and measured in the areas of self-rated health, anxiety and stress, social activities, communication with physicians, and the client’s overall self-confidence in managing symptoms related to the disease. The measurement of change in these areas informed the study on the effectiveness and practicality of the skills being taught in the CDSP and their effectiveness in the promotion of self-efficacy. It also highlighted which skills seem to be most helpful and impactful to clients, and if the skills they learned were retained over time. The study measured the short-term impacts from completion of the CDSP to the 6-month follow-up period and also measured the long-term impacts the CDSP had on client health outcomes three (3) and four (4) years after the initial program was implemented to see if there was a correlation between increased self-efficacy and improved health outcomes. Participant CD4 and viral load counts were analyzed, as these are determinant biological markers in measuring the immunological impacts of the disease. Measuring these variables over time for individuals that were in a CDSP gave the study insight into the CDSP’s short-term and long-term effectiveness in the promotion and sustainment of self-efficacy for individuals living with HIV/AIDS and how the effective management of their chronic illness can lead to overall better health outcomes. Additionally, this study sought to better understand the experience of the women who participated in the CDSP through incorporating a mixed methods qualitative approach, by interviewing some of the women who had participated in the CDSP to identify common themes or lessons learned, best practices of the program, and areas for improvement. Although this study was not able to show that changes in behavior and increased self-efficacy impact health outcomes, more complex analysis should be done in this area, as this study highlighted the positive impacts a CDSP can have on increasing self-management skills and promoting self-efficacy over the short-term and long-term for individuals diagnosed with HIV/AIDS.

Previous researchers have identified that participation in a pulmonary rehabilitation program improves health outcomes yet, continuation in a weekly maintenance program yielded mixed results. Self-management programs have had reported use in chronic obstructive pulmonary disease (COPD). A meta analysis has identified that no self-management program had evaluated the effect of this type of intervention on the functional status of the participant with COPD. Reduced functional status is well reported as an indicator of disease progression in COPD. Adjuvant therapies for people with COPD need to demonstrate an effect in this domain. The Stanford model chronic disease self-management program (CDSMP) had been reported as a program that may optimise the health of people with chronic health conditions. However, its utility has not been formally evaluated for people with COPD. There have not been any reports of a comparison of the Stanford model CDSMP with pulmonary rehabilitation via a randomised controlled study in COPD. Aim: To compare and evaluate the health outcomes from participation in nurse ledwellness-promoting interventions conducted in the ambulatory care setting of a metropolitan hospital. Participants were randomised to either a six-week behavioural intervention: the Stanford model CDSMP or, a six-week pulmonary rehabilitation program and results compared to usual care (a historical control group). The efficacy of the interventions was measured at week seven and repeated at week 26 and 52. Following the week seven evaluation, the pulmonary rehabilitation program participants were rerandomised to usual care or, weekly maintenance pulmonary rehabilitation for 18 weeks and, followed up until the study completion at week 52.Little is reported about the costs of care for people with COPD in Australia. This study prospectively evaluated the costs of the interventions and health resource for the 52 weeks and undertook a cost utility analysis. Methods: Walking tests (The Incremental Shuttle Walking Test) and questionnaires asking participants about their health related quality of life, mood status, dyspnoea and self efficacy were assessed prior to randomisation to either six week intervention and repeated at weeks 7, 26 and 52. The implementation of these adjuvant therapies enabled all costs associated with the interventions to be prospectively examined and compared. Results: During the two years of recruitment 252 people (54% males) with a mean age 71 years (SD 11, range 39-93 years) were referred to the study. Student’s ttests identified that there were no statistically significant differences (P=0.16) between all those referred by age and gender as compared to all those admitted to Hospital A with an exacerbation of COPD. Ninety-seven people (51% male) with a mean age of 68 years (SD 9, range 39-87 years) agreed to participate in the study. Follow up in the study continued for 12 months following enrolment with only a modest level of attrition by week seven (3%) and week 52 (25%). Following the six-week interventions, both the pulmonary rehabilitation and CDSMP groups recorded statistically significant increases in functional capacity, self-efficacy and health related quality of life.Functional performance was additionally evaluated in the intervention arms with participants wearing pedometers for the six-week period of the interventions. There were no statistically significant differences between steps per week (P=0.15) and kilometres per week (P=0.17) walked between these two groups in functional performance. The Spearman rho statistic identified no statistically significant relationship between functional performance and the severity of COPD (rs (33) = 0.19, P = 0.26). No significant correlation between functional capacity and functional performance was identified (rs (32) = 0.19, P = 0.29). This suggests that other factors contribute to daily functional performance. The largest cost of care for people with COPD has been reported to be unplanned admissions due to an exacerbation of COPD.In this study there were no statistically significant differences between the three intervention groups in the prospective measurement of ambulatory care visits, Emergency Department presentations and admissions to hospital. The calculation of costs illuminated the costs of care in COPD are greater than the population norm. In addition, maintenance pulmonary rehabilitation generated a greater quality adjusted life year (QALY) than a six-week program. Despite the strength of the participants preferences (as measured by the QALY) for maintenance PRP, there were no significant differences in use of hospital resources throughout the study period by the three intervention groups, which suggests some degree of equivalence.

Despite the efficacy of pulmonary rehabilitation programs which assist patients in managing chronic obstructive pulmonary disease (COPD), the high costs and lack of availability of such programs pose considerable barriers for underserved COPD patients, such as those living in rural communities. Because of this, patients are encouraged to actively self-manage COPD. Unfortunately, COPD patients have reported dissatisfaction with the self-management education they are provided. This mixed methods study assessed the self-management learning needs of COPD patients treated at a Certified Federal Rural Health Clinic through conducting focus group interviews (n = 2) to inform the development a targeted self-management education DVD. The effectiveness of 3 distinct educational treatments (DVD vs. Pamphlet vs. DVD Pamphlet) was evaluated by comparing outcomes related to informational needs, self-management self-efficacy, and generic/lung-specific HRQoL in a randomly-assigned, multiple-group pretestposttest design with a control group (n = 41). Focus group data was analyzed using three qualitative analysis tools. Findings from the interviews indicated that patients viewed self-management as simply taking prescribed medications and reducing activity. Patients reported a lack of knowledge and skill development related to rehabilitative activities such as controlled breathing and stress reduction. A multivariate analysis of covariance was conducted to determine the effect of 3 educational treatments on multiple outcome measures. Three nontrend orthogonal planned contrasts were tested to determine selected contrast effects. The data analysis revealed that participants receiving a DVD reported statistically significantly higher levels of lung-specific physical functioning as compared to those in the Pamphlet group. Additionally, the DVD group revealed clinically significant improvements on the physical ( 19.01) and emotional ( 10.74) functioning dimensions of lung-specific HRQoL; whereas, no such improvement occurred within the Pamphlet and control groups. Results also suggested that providing patients with a Pamphlet alone was more effective than providing participants with both interventions concurrently to increase self-management self-efficacy. The simultaneous provision of both interventions did, however, enhance generic HRQoL more so than the provision of one of the two treatments alone. Finally, any type of self-management education as compared to usual care did not statistically significantly improve outcome variables among this small sample of rural patients.

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No description available.

Large portions of the US population live in poor inner-city communities. Health needs assessment data have shown that these communities have disproportionately high rates of chronic illnesses. The patient-centered medical home (PCMH) model was developed to address the gaps that exist in the primary care system, and emphasizes a redesign of primary care that is patient centered, utilizes multiple levels of healthcare professionals, information technology, and care coordination. However, little evidence exists on the value of this model which may explain why it has not gained wide acceptance by primary care providers. Therefore, this study was designed to examine the efficacy of the PCMH model through emergency department and inpatient utilization reductions, and with a specific focus on the role of social connectedness. This research used existing data on 706 participants from Columbia University and a local New York inner-city hospital. An in-depth analysis of hospital utilization data, using an unpaired two-sample t-test and linear regression, found that the PCMH framework strengthens continuity of care and care coordination, and helps reduce avoidable hospitalization utilization. Additionally, these reductions were greater for study participants with strong social support networks. This research highlights the relationships between primary care, social support networks, and good health outcomes. Over time, further enhancement of the PCMH and systemic changes to the delivery of care may contribute to the development of a stronger primary care system that place patients at the center of care, focuses on the importance of social connectedness, and contributes to a lasting impact on society through the development of overall healthier communities.