Homebound to bowling: empowerment through chronic disease self-management

As a practicing primary care physician, Dr. Samantha Ritchie has  many patients that suffer from the tremendous burden of chronic disease, chronic pain and depression.  For some of these patients, the effort it takes to make their appointments is just another challenge to overcome; and outside of these visits they simply don’t have the physical, emotional and mental capacity to be active within a community, a circle of friends, or sometimes even their family.

Here’s why it’s important to pay attention to these health problems:

  • Chronic diseases are the leading cause of death and disability in the U.S., and nearly half of all Americans live with one or more, accounting for 75% of the $2.2 trillion we spend on health care each year (as reported by Centers for Medicare & Medicaid Services).
  • According  to a National Center for Health Statistics Report (2006), more than one quarter of Americans over age 20 have experienced non-acute pain for more than 24 hours in duration.  Of these estimated 77 million people, more than half feel as if they have little or no control over their pain, and 60 percent experience breakthrough pain one or more times daily, severely impacting their quality of life and overall wellbeing.  It is estimated that reduced productivity due to pain costs employers between $60 and 00 billion annually.
  • Depression affects approximately 15-19 million American adults in a given year, impairing their ability to work, sleep, eat and function as he or she normally would.  Major depression is disabling, and people with pre-existing health problems have higher depression tendencies.  Conversely, depression often leads to new health problems.

Disparities in health care are significant and persistent in the U.S. health care system, despite consistent increases in funding.  Racial and ethnic minorities and low income populations experience higher rates of disease, reduced access to care, and lack of routine care and prevention.  The Affordable Care Act takes steps to help mitigate this reality, such as allocating funding to preventive care programs and activities, working to increase the number of primary care providers, and of course, the expansion of Medicaid in 2014 to cover 90 percent of the uninsured.  Recently, CMS announced a competitive grant cycle for the Medicaid Incentives for Prevention of Chronic Diseases—a program that provides financial and non-financial incentives to Medicaid beneficiaries who participate in prevention programs and demonstrate changes in health risk and outcomes, including the adoption of healthy behaviors.

But in the meantime, providers at the local level are relying on local resources to help patients suffering from chronic disease, chronic pain and depression.  The MyHealth Matters Chronic Disease Self-Management (CDSM) workshop is one of those resources, free to sufferers of chronic health conditions as well as their supporters, and is hosted in Olympia at the Thurston County Public Health Department.  It takes place in the evening, one day per week for six consecutive weeks, and provides the skills, tools and support to empower people to manage their chronic health conditions.  It uses a highly interactive format and is led by certified trainers (many of whom have chronic conditions themselves), focusing on issues such as:

  • Fatigue, frustration and isolation;
  • Diet and exercise;
  • Stress and relaxation;
  • Effective medication use;
  • Problem solving and goal setting; and
  • Making choices about medical treatment.

One of Dr. Ritchie’s patients went through this workshop because she suffers from chronic back pain, anxiety and depression.  Recently, Dr. Ritchie related this story:

“Ever since I’ve known her, this patient has  been reclusive and rarely goes beyond the safety of her home.  But she was determined to participate in this workshop, so I helped her sign up—and the results are impressive.  My patient is more upbeat, confident and has a sense of purpose in life—to be healthy and do things that bring her joy.  Perhaps one of the greatest outcomes of this workshop is the relationships she built with other participants.  She realized that other people have very similar issues.  Suddenly, she wasn’t alone anymore in her chronic health struggles.  She found support and acceptance.  When I first saw my patient after she completed the six-week workshop, she shared with me that she had gone bowling for the first time since she could remember.  My patient—suffering from chronic back pain, too scared to leave home and depressed—went bowling.  I can now see in her hope and determination for a healthier life…what an incredible thing to witness.”

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