DO IT YOURSELF
obesity can sign up for the free, peer-led course and learn how to better manage their own health, says Alan Glaseroff, chief medical officer of Humboldt-Del Norte IPA, Eureka, and a member of the alliance.
“We started out trying to find ways to use motivational interviewing and action plans in our own practices, but then we came to the conclusion that the best person to deliver this message is a peer and not a physician,” Glaseroff says. “I think the focus now should be looking at ways that we can build up community resources that physicians can refer people to in order to help them succeed.”
Betsy Stapleton, a former nurse practitioner who now serves as a volunteer peer leader in the Pathways program, says organizers are trying to appeal to local providers by billing themselves as the “easy button to press” when patients need education. The key element, she says, is ensuring patients are taking responsibility for their care and the best way to do that is to show them someone who has the same illness and is successfully managing their symptoms.
To date, the Pathways to Health program has more than 300 graduates and has been transformative for the rural community, Glaseroff says. But he also acknowledges that community-based self-management programs run into the same payment wall as those initiatives that take place in physician offices.
“We have some grants and a lot of volunteers, and that is not a sustainable model,” Glaseroff says.
Peer groups are great, says Bodenheimer of UCSF, but they run the risk of attracting the patients who are most motivated to make a change. Community groups fill an important role, he says, but the first line of health management support should take place in the primarycare setting.
Med students show interest
Even though fewer and fewer medical students are choosing to go into family practice, those who do are expressing increasing interest in patient-centered care, says Maureen Gecht-Silver, director of patient education and community medicine in the department of family medicine at the University of Illinois at Chicago College of Medicine.
Gecht-Silver leads a three-session, selfmanagement learning program, mandatory for all second-year family medicine residents that stresses action planning, motivational interviewing techniques and collaboration with patients. Residents work directly with patients to identify their chief concerns and help with problem-solving strategies, she says.
“Our department of family medicine is very interested in becoming a patientcentered medical home, and we see lots of positive changes coming,” Gecht-Silver says. “People are getting more familiar with the terminology, and I have medical students that are signing up for the sessions by choice.”
Self-management is also a key component of the Joint Commission’s Disease-Specific Care Certification program, launched in 2002, which aims to improve care for patients with chronic diseases. However, 95% of the organizations that have pursued this certification are hospitals, says Charles Mowll, the commission’s executive vice president of business development, government and external relations. Future incentives, pilots and eventual payment changes could allow more physicians offices to seek certification, he adds.
At Greenhouse Internists, the staff is keeping its fingers crossed and hoping that funding for self-management education programs won’t run out when the pilot expires, Baron says.
“This used to be a conversation only had by primary-care physicians, but now purchasers and payers seem to be realizing that the way we have handled primary care up until this point has been bad for patients and bad for the value that the system can deliver,” Baron says. “That realization is the most hopeful thing that I see on the horizon.”
Gecht-Silver: Medical students interested in patient-centered care.