Self-Management Barriers & Resources Among Vulnerable Elders

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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.