The Living Well with Chronic Conditions Program
(otherwise known as the Chronic Disease Self-Management Program [CDSMP])
is a workshop given 2 1/2 hours, once a week, for 6 weeks, in community
settings, such as senior centers, churches, libraries, and hospitals.
People with different chronic health problems attend together. Workshops
are facilitated by 2 trained leaders, one or both of whom are non-health
professionals with a chronic condition themselves.
Subjects covered include:
Techniques to deal with problems such as
frustration, fatigue, pain, and isolation.
Appropriate exercise for maintaining and improving
strength, flexibility, and endurance.
Appropriate use of medications.
Communicating effectively with family, friends, and
How to evaluate new treatments.
Each participant in the workshop receives a copy of the companion
book, Living a Healthy Life with Chronic Conditions, 3rd Edition,
and an audio relaxation tape, Time for Healing.
It is the process in which the program is taught that makes it
effective. Classes are highly participative, where mutual support and
success build the participants' confidence in their ability to manage
their health and maintain active and fulfilling lives.
the Program Replace Existing Programs and Treatments?
The Self-Management Program will not conflict with existing programs
or treatment. It is designed to enhance regular treatment and
disease-specific education such as Better Breathers, cardiac
rehabilitation, or diabetes instruction. In addition, many people have
more than one chronic condition. The program is especially helpful for
these people, as it gives them the skills to coordinate all the things
needed to manage their health, as well as to help them keep active in
How was the Program
The Division of Family and Community Medicine in the School of
Medicine at Stanford University received a five-year research grant from
the federal Agency for Health Care Research and Policy and the State of
California Tobacco-Related Diseases office. The purpose of the research
was to develop and evaluate, through a randomized controlled trial, a
community-based self-management program that assists people with chronic
illness. The study was completed in 1996.
The research project had several investigators: Halsted Holman, M.D.,
Stanford Professor of Medicine; Kate Lorig, Dr. P.H., Stanford Professor
of Medicine; David Sobel, M.D., Regional Director of Patient Education
for the Northern California Kaiser Permanent Medical Care Program;
Albert Bandura, Ph.D., Stanford Professor of Psychology; and Byron
Brown, Jr., Ph.D., Stanford Professor of Health Research and Policy. The
Program was written by Dr. Lorig, Virgina González, M.P.H., and Diana
Laurent, M.P.H., all of the Stanford Patient Education Research Center.
Ms. González and Ms.Laurent also served as integral members of the
The process of the program was based on the experience of the
investigators and others with self-efficacy, the confidence one has that
he or she can master a new skill or affect one's own health. The content
of the workshop was the result of focus groups with people with chronic
conditions, in which the participants discussed which content areas were
the most important for them.
How was the Program
Over 1,000 people with heart disease, lung disease, stroke or
arthritis participated in a randomized, controlled test of the program,
and were followed for up to three years. Researchers looked for changes
in many areas:
- health status (disability, social/role limitations, pain and
physical discomfort, energy/fatigue, shortness of breath,
psychological well-being/distress, depression, health distress,
self-rated general health),
- health care utilization (visits to physicians, visits to emergency
department, hospital stays, and nights in hospital),
- self-efficacy (confidence to perform self-management behaviors, confidence
to manage disease in general, confidence to achieve outcomes), and
- self-management behaviors (exercise, cognitive symptom management,
mental stress management/relaxation, use of community resources,
communication with physician, and advance directives).
What Were the Results?
Subjects, who took the program, when compared to those who did not,
demonstrated significant improvements in exercise, cognitive symptom
management, communication with physicians, self-reported general health,
health distress, fatigue, disability, and social/role activities
limitations. They also spent fewer days in the hospital, and there was
also a trend toward fewer outpatient visits and hospitalizations. These
data yield a cost to savings ratio of approximately 1:10. Many of these
results persist for as long as three years.
More information about the Chronic Disease Self-Management Program (Living
Well with Chronic Conditions) can be found at:
Wisconsin Contact for
Wisconsin Institute for Healthy Aging
1414 MacArthur Road, Suite B
Madison, WI 53714
Phone: (608) 243-5690
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June 26, 2012