Self-Management Barriers & Resources Among Vulnerable Elders

病人教育和自我管理的支持是新兴慢性病护理的核心组成部分 模型因此，研究，以确定病人的喜好，障碍和资源，自我管理， 提供者/系统对自我管理教育和支持的障碍，将是实施的关键 新兴的慢性病护理模式。 我们有一个很好的机会来检查自我管理的偏好，障碍和资源， 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 （恩典）。使用循证指南，每个患者都接受标准化的自我管理 任何已确定的老年综合征的建议。启动并尝试特定护理 建议，参与GRACE的提供者和患者具有关于 自我管理的偏好、障碍和资源。这项拟议研究的目的是 捕捉和系统化这些知识，并将其转化为一个有效的定制干预计划。我们 集中在三个共同的，相关的条件，在老年人中挑选出来的研究所 医学作为优先研究领域：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庭/朋友照顾者偏好、障碍和教育资源 和自我管理的支持;以及3）根据这些发现，确定改善教育的干预措施 支持自我管理。干预思路和目标将通过5A的流程构建， 护理模式和来自Hiss（2001）和格拉斯哥（2003）的实施概率的八个标准。 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 辅以对家庭和邻近环境的直接观察。恩典 供应商也将接受采访。焦点小组将被用来从护理人员那里获得信息， 初级保健提供者（目标2）。为了实现目标3，我们将借鉴目标1和2的结果， 经验和护理模式的过程。根据以社区为基础的参与性理念， 研究、患者和提供者将在确定和评估干预措施方面发挥核心作用。 想法，并将从一套适合他们偏好和情况的策略中汲取。名义焦点小组 与患者和提供者的合作将用于确定这些干预想法并对其进行优先排序。潜在 目标3的干预措施包括患者和提供者的协作护理教育和培训，以及 开发自我管理评估工具。

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 interventon 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.