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Self care and support for all – reaching the housebound patient

Background

The main aim of this pilot, funded by the Regional Innovation Fund, was to provide self-management support through personal health planning to patients living with COPD who have difficulty with mobility outside the home.  We have provided self-management and pulmonary rehabilitation programmes locally for mobile patients; however we cannot provide self-management support effectively to housebound patients who are the most vulnerable group. 

What we did

This pilot project provided patients with access to ‘The Prevention Plan', an online package from UK Preventive Medicine focusing on health promotion and chronic disease management, together with nurse coach support.  Patients completed a health risk assessment and worked with the nurse to develop personalised action plans in support of patient-led goals.  Laptop and internet connectivity was provided for those with no access to IT.

Impact

Initial findings suggest that this approach has potential to improve confidence for self management and reduce anxiety and fatigue.  We also conducted an extensive qualitative evaluation, the data from which are currently being analysed.  Early indications suggest that patients most likely to benefit from this intervention are those who wished to make changes and self manage more but were struggling to do so and lacked support.  Patients who were not yet ready to change seemed to derive less benefit.