Self-Management Barriers & Resources Among Vulnerable Elders

描述（由申请人提供）：对患者的教育和对自我管理的支持是新兴慢性护理模式的核心组成部分。因此，研究确定患者的偏好、自我管理的障碍和资源，以及提供者/系统对自我管理教育和支持的障碍，对于实施新兴的慢性护理模式至关重要。我们有一个很好的机会，通过利用我们正在进行的nia资助的研究，老年资源和老年人合作护理（GRACE），来检查自我管理的偏好、障碍和资源。使用循证指南，每位患者接受任何确定的老年综合征的标准化自我管理建议。通过激活和尝试特定的护理建议，参与GRACE的提供者和患者对自我管理的偏好、障碍和资源有经验知识。本研究的目的是捕获和系统化这些知识，并将其转化为有效的量身定制的干预方案。我们集中研究老年人中三种常见的相关疾病，这三种疾病被医学研究所列为优先研究领域：药物管理、慢性疼痛和抑郁症。具体目标是：1)确定患者的偏好、障碍和自我管理的资源；2)确定初级保健提供者和家人/朋友照顾者的偏好、障碍和资源，以进行教育和支持自我管理；3)基于这些发现，确定干预措施，以改善自我管理的教育和支持。干预理念和目标将由5A的护理过程模型和来自Hiss（2001）和Glasgow（2003）的8个实施概率标准构成。为了确定患者的偏好、障碍和资源（目标1），我们将使用家庭访谈，并辅以对家庭和邻近环境的直接观察。GRACE供应商也将接受面谈。焦点小组将用于从护理人员和初级保健提供者那里获取信息（目标2）。为了完成目标3，我们将借鉴目标1和目标2的研究结果、先前的经验和护理过程模型。按照以社区为基础的参与性研究的理念，病人和提供者将在确定和评价干预想法方面发挥核心作用，并将借鉴一套符合其偏好和情况的战略。与患者和提供者的名义焦点小组将用于确定和优先考虑这些干预想法。目标3的潜在干预措施包括对患者和提供者进行协作护理方面的教育和培训，以及开发自我管理评估工具。

DESCRIPTION (provided by applicant): Patient education and support for self-management is a central component of emerging chronic care models. Thus, research to identify patient preferences, barriers and resources for self-management and provider/system barriers to the education and support of self-management, will be critical to implementing emerging chronic care models. We have an excellent opportunity to examine self-management preferences, barriers and resources by capitalizing on our ongoing NIA-funded study, Geriatric Resources and Collaborative Care of Elders (GRACE). Using evidenced-based guidelines, each patient receives standardized self-management recommendations for any identified geriatric syndrome. Having activated and attempted specific care recommendations, providers and patients participating in GRACE have experiential knowledge regarding preferences, barriers, and resources for self-management. The objective of this proposed study is to capture and svstemitize that knowledge, and to translate it into an efficient tailored intervention program. We concentrate on three common, related conditions among older adults that were singled out by the Institute of Medicine as areas of research priority: medication management, chronic pain, and depression. Specific aims are to: 1) identify patient preferences, barriers, and resources for self-management; 2) identify primary care provider and family/friend caregiver preferences, barriers and resources for education and support of self-management; and 3) based on these findings, identify interventions to improve education and support of self-management. Intervention ideas and targets will be structured by the 5A's process of care model and eight criteria for implementation probability drawn from Hiss (2001) and Glasgow (2003). To identify patient Preferences, barriers and resources (Aim 1), we will use in-home interviews supplemented with direct observation of the home and immediate neighborhood environments. GRACE providers will also be interviewed. Focus groups will be used to obtain information from caregivers and primary care providers (Aim 2). To accomplish Aim 3, we will draw on findings from Aims 1 and 2, prior experience, and a process of care model. In keeping with the philosophy of community-based participatory research, patients and providers will have a central role in the identification and evaluation of intervention ideas and will draw from a set of strategies that fit their preferences and sitaution. Nominal focus groups with patients and providers will be used to identify and prioritize these intervention ideas. Potential interventions for Aim 3 include patient and provider education and training in collaborative care, and the development of a self-management assessment tool.