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P - Informed Self-Management

Roadmap: What’s Needed on Key Clinical Issues The relationship between “informed self-management” and “patient education” is not well understood. Significant effort is required to establish and integrate effective self-management programming, within inpatient and outpatient SCI rehabilitation practice. Ultimately, this would be most effectively driven within a policy framework that is consistent with the chronic disease model,1 with embedded reimbursement structures that encourage patient-provider interactions, focusing on prevention, wellness and patient empowerment. There is a general and increasing appreciation of the importance of self-management in chronic diseases, such as diabetes or arthritis. However, there needs to be an enhanced awareness that self-management applies to SCI, and that existing tools and methods need to be tailored to best meet individual needs. There are four key clinical priorities, consistent with enhancing rehabilitation practice through integration of self-management programming: 1. Incorporate an educational specialist as part of the rehabilitation team • As initiated by other sites in Canada, this specialist should have knowledge of, and responsibility for, facilitating self-management, to ensure the incorporation of adult education principles, to embed self-management processes within educational practice (e.g., problem- solving, systematic barrier and facilitator identification, goal-setting and action planning); and to lead educational resource creation. 2. Coordinate and share expertise and resources among Canadian rehabilitation programs • Eliminate duplication of educational/self-management resource creation and best practice application. The SCI KMN serves as a model for the benefits of shared and coordinated expertise and resources, to identify key practice elements and align evaluation processes, relative to educational practice and resource development. • Tailor self-management programs and tools, originally designed for various chronic diseases, to better meet the needs of individuals with SCI. • Align nationally and link with strategic partners across the care continuum, driven by rehabilitation providers. • Collaborate with national sponsors, in partnership with provincial affiliates, to establish educational networks with consolidated infra- structure and shared key resources (e.g., creation of a battery of self-management tools). 3. Train current and future rehabilitation providers about adult education principles and self-management proceses • Include self-management concepts, within professional school and continuing medical education curriculum. • Advocate for unmet needs to appropriate administrators, curriculum developers, policy makers, etc. 4. Routinely colect and national y review the effectivenes of self-management and education programs • Routinely document rehabilitation educational practice and its perceived effectiveness (refer to Table 1.0 for some best practice indicators and outcome measurement tools). Initial efforts from the SCI KMN can inform comprehensive, pan-Canadian implementation of SCI-specific outcome assessments during rehabilitation. Table 1.0 Measurement of Educational Practice – Best Practice Indicators Best Practice Indicator How measured? How measured? Who measures it? Where? When is it idealy measured? Routine educational needs assessment: patient priorities, learning readiness, learning styles, barriers, facilitators Needs Assessment Checklist9 or interview/ customized assessment Designated care provider(s) within the rehab team – Educational Specialist During inpatient rehab stay (near admission with review) Patient-reported outcomes assessing effectiveness of education delivered Customized assessment (scale being developed by SCI KMN incorporates Likert scale questions (e.g., Education provided was effective in assisting me self-manage my health) Patient facilitated by designated care provider(s), within the rehab team Near inpatient discharge and 3-6 months post-discharge Patient is confident about ability to self-manage health Moorong Self-Efficacy Scale10 Patient facilitated by designated care provider(s) within the rehab team Near inpatient discharge and 3-6 months post-discharge The organization implements documented protocols and procedures for provision of educational practice that facilitates self-management Checklist from assessor Organizational level linked with Accreditation Canada (AC) Based on Accreditation Canada INFORMED SELF-MANAGEMENT | PARTICIPATION 165


P - Informed Self-Management
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