Improve patients' health management skills
Teach self-assessment, changing risky behavior
The Well Care Management Process has been in place at Riverside Health System in Newport News, VA, since 1995. Its purpose is to improve the health of designated groups of HMO members by teaching them how to responsibly manage their health.
A key part of the program is behavior change. Participants select a couple of areas of high-risk health behaviors they want to target, and care managers help them work through the stages of change. These stages range from precontemplative, with no plans to change, to a maintenance stage where the person practices the desired behavior consistently. The process is based on a book written by James Prochaska, titled Changing for Good. (This book is no longer in print.)
"Most health care professionals try to immediately put people into a stage of taking action, and people fail because they are not ready for action. They might be in contemplation or preparation or even precontemplation, where they are denying that the behavior is going to adversely affect their health," says Tracee Carmean, BSN, director of Health Communications and Well Care Management at Riverside Health System.
For example, people will not start exercising if they haven't worked through the precursory stages of change. They have to realize that there are more negative aspects to continuing a poor health behavior than making the change, she explains. Therefore, if a person wants to target exercise, they might be asked to make a list of both the pros and cons of exercise. The care manager would work with them until the pro list was quite a bit longer than the con list. Once this is accomplished, they can advance to the next stage of preparation, says Carmean.
The stages of change include:
· Pre-contemplation. In this stage a person is not practicing the desired behavior and does not plan to change.
· Contemplation. The person is contemplating a change in behavior, with plans to change over the next six months. He or she may be practicing the desired behavior on an inconsistent basis.
· Ready for action. The person expects to make changes within the next month, and may be inconsistently practicing the desired behavior.
· Action. This person has consistently practiced the desired behavior for one to six months.
· Maintenance. The behavior has been practiced regularly for six months or more.
When HMO members in designated groups enroll in the Well Care Management Process, they are given a health risk appraisal and clinical fitness test that assesses their flexibility, degree of strength, and aerobic capacity. They are also taught the four steps to self-responsibility, which are as follows:
1. Know your risk factors.
A health risk assessment helps each participant identify his or her healthy and risky lifestyle behaviors.
2. Use self-care resources at home.
Everyone receives a Healthwise Handbook, which provides information on health problems and home treatments.
3. Consult with a health advisor, nurse, or care manager.
If a person needs additional advice or information after using self care resources available at home, he or she is advised to call Ask-A-Nurse, a communitywide telephone advice service provided by Riverside Health System.
4. Consult your primary care physician if appropriate.
After an assessment of the medical urgency of the situation using the Healthwise Handbook or telephone advice service, people will know whether or not they should see a doctor.
Individualized consultations are scheduled with each participant following the enrollment session. During that time, the data from the health risk appraisal are reviewed, the four steps to self-responsibility are reinforced, and the participant selects health risks to target. After the consult, participants receive periodic follow-up calls depending on the progress they make. People in the program are reassessed at the end of the year.
The Well Care Management Process is applied to several different patient groups, including employees of the medical facility, a physician practice population, a diabetes group, and an asthma group. However, Carmean is quick to point out that the program is not a disease management program.
"We aren't trying to provide disease management. There is some facilitation to educate that person on the importance of managing their own disease process, but we are focused on the whole person's health, not just whether or not a person is taking his or her insulin," says Carmean.
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