4 Questions About Self-Management Education in Patients With Rheumatic Diseases

Self-management education programs are implemented to help reduce symptoms and improve quality of life among patients with chronic health conditions, such as rheumatoid arthritis. The programs can be implemented at the institution or community levels.

At the 2019 American College of Rheumatology (ACR)/Association of Rheumatology Professionals (ARP) Annual Meeting, one session in particular hosted a discussion about self-management education programs for patients with rheumatic diseases. Rheumatology Consultant spoke with session speaker Robyn Wiesel, MCHES, who is the associate director of Public and Patient Education at Hospital for Special Surgery (HSS), about her session.

RHEUM CON: What prompted you to give a presentation at the 2019 ACR/ARP Annual Meeting on self-management education for patients with rheumatic diseases?

Robyn Wiesel: At HSS, our department focuses largely on self-management educational programs for our patients in orthopedics, as well as rheumatology. HSS has been a recognized leader in musculoskeletal medicine for more than a century. We have established an ongoing commitment to both physical and general wellness, education, and community programming. As such, the Hospital is well-positioned to provide expert knowledge to our patients and community members on how to self-manage their health conditions.

During a session at the 2019 ACR/ARP Annual Meeting, we spoke to clinicians about how HSS assessed the needs of our community through our Community Health Needs Assessment that was launched in March 2019. We developed this assessment with our community partners, as well as many interdisciplinary teams at HSS, to ensure that we were asking the right questions. We disseminated a 60-question survey through our patient waiting areas and via our social media, email, and mail platforms. We received more than 11,000 responses about musculoskeletal health-related needs from our patients and the community.

The results gave us insight to what our patients and community members feel their musculoskeletal health needs are and how we can best educate and help them feel more empowered to self-manage their condition. With our vision as being the most trusted educator, our goal is not just to educate our patients but empower them to manage their chronic conditions.

RHEUM CON: Why is self-management important for patients?

RW: Many people with a chronic health condition may not feel confident in managing their care. Based on the findings from our assessment, using pain management as an example, more than half of respondents (53%) reported using prescription pain killers, with 86% indicating they should not take more than the recommended dosage of prescription medication when feeling pain more than usual. However, almost two-thirds of respondents (64%) reported never using complementary treatments (ie, yoga, meditation, mindful breathing) to manage their pain.

Many times, patients need more than a prescription, so we develop programming to educate patients about what they can do to better manage their health. For example, the Pain and Stress Management Program at HSS focuses on complementary practices, such as meditation and mindful breathing, helped patients manage chronic pain and in some cases reduced the need for medication, such as opioids.

There are patients who rely on high levels of opioids who do not have any other option for their pain, such as a surgical intervention. While there is a need for opioids, sometimes practicing relaxation techniques or more stress management might help push off that next dose, even just for a few hours.

Patients feel more empowered that they can do something to help themselves. We launched the pilot program in 2018 in our orthopedic clinic. Based on the success of the program in the orthopedic clinic, it has been expanded to include patients in the rheumatology clinic as well, many of whom rely on opioid medication to manage chronic pain. There is evidence that self-management support improves patients’ health-related behaviors and results in improved clinical outcomes. When patients feel more empowered, they are more in control of their overall care. We were hoping that rheumatologists understand that and see the impact that self-management education has on their patients and their improved health outcomes. We want rheumatologists to become more involved in helping patients refer to these programs and act as advocates for the program.

RHEUM CON: What are the first steps that a rheumatologist can take to develop and be a part of a program like this?

RW: The first thing is assessing the needs of your patients. A rheumatologist might see patients in the same day with 10 different rheumatic conditions. Not all rheumatic conditions require the same education, but some are similar.

Working with your staff is key, too. Collaboration is key—meet with a nutritionist in your institution if you can, or reach out to a social worker or nurse educator with questions. It is a high expectation for rheumatologists to start a full-fledged self-management education program on their own. Some offices have a nurse or even a social worker available to talk with patients: “Do you understand what the doctor said to you today? Do you understand your medications? Here are the resources in the community for you. The local community center has a pool that would be great for you. It is nonweight bearing. You get to move.”

I do not think patients are given enough resources. It also does not have to be a whole program. We are lucky that we have the opportunity here at HSS to develop all these programs for our patients. A smaller practice might not have a program, but programs and resources might available through your community so that you can at least refer your patients to the those programs.

RHEUM CON: What are some of the key take-away messages about having a program like this?

RW: Two key take-away messages would be that collaboration is the best way to educate and impact the most people. These programs support interdisciplinary and inter-institutional teamwork. It is easy to get information out there. Leverage your social media. As a physician, leverage your institution. If you are lucky enough to be part of a large institution, leverage those people who can help you—either your education team, your marketing team, or your colleagues. It should not be one physician helping many; it should be a collaboration of many helping all.

Reference:

1. Ologhobo T, Wiesel R. Engage patients in needs assessment: effective self-management programming. Talk presented at: 2019 American College of Rheumatology/Association of Rheumatology Professionals Annual Meeting; November 8-13, 2019; Atlanta, GA. https://www.rheumatology.org/Portals/0/Files/Annual-Meeting-Session-Tracker-2019.pdf.