In New Disease Management Model, Patient is Part of the Solution

Tuesday, September 19th, 2006
This post was written by Melanie Matthews

Decimated. Dying. Crumbling. Just a few adjectives used by presenters at the 11th annual Health Management Congress to describe the state of primary care in the United States. Discouraged by increased demands on primary care providers and reimbursement formulas that may eat into their expected salaries, 50 percent fewer medical students are choosing family medicine as a specialty. With patient visits limited to 10 to 15 minutes, primary care physicians don’t have time to address the behavioral issues associated with many chronic illnesses. In addition, their medical training has not prepared them to properly educate patients. While health plans and hospitals figure out how to woo more general practitioners into medicine and adjust reimbursement and education models, patients are being asked to take a more involved role in the management of their chronic illnesses.

Kate Lorig, a registered nurse, doctor of public health and professor of medicine at Stanford Patient Education Research Center, believes that patients themselves may be the best medicine — so much so that she has tapped them to lead her organization’s self-management programs for people with chronic illnesses. Over the last two decades, her organization has developed, tested and evaluated self-management programs for the chronically ill. “In order to help patients become better self-managers, we must raise their self-efficacy,” she said during a congress panel discussion on behavioral advances in effective health and disease management programs. “We must address the anxiety, depression and fear of the chronically ill before their behaviors can change.”

Led by a pair of lay leaders with related health problems, Dr. Lorig’s programs are designed to help people gain self-confidence in their ability to control their symptoms and understand how their health issues affect their lives. The small-group workshops for diabetes, arthritis, HIV/AIDS, back pain and chronic disease are generally six weeks long, meeting once a week for about two hours. The meetings are highly interactive, focusing on building skills, sharing experiences and support.

To listen to Dr. Lorig describe the identification and training of patient leaders for the self-management workshops, cultural considerations and other program details, please click here.

Many of the completed programs have been adopted by health plans, organizations, American cities and locations outside the United States for use in their disease management efforts. Several of the programs are offered in Spanish, and web-based versions of patient-led self-management efforts are being developed. Dr. Lorig’s team is currently seeking volunteers with type II diabetes to participate in a six-week online workshop. Participants will learn the skills needed for the day-to-day management of type II diabetes as well as maintaining or increasing life’s activities. To find out more about the program, please visit:

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