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11/13/20

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BENEFITS OF THE CHRONIC DISEASE SELFMANAGEMENT PROGRAM IN LOW-INCOME


AFRICAN AMERICAN WOMEN WITH SYSTEMIC
LUPUS ERYTHEMATOSUS: RESULTS OF A PILOT
TEST

I have no financial
or other relationship to disclose

Cristina Drenkard, MD, PhD

Background
Systemic lupus erythematosus (SLE) is a
autoimmune chronic inflammatory disease that
can involve any organ system and follows a
relapsing and remitting course
SLE prevalence rates, Atlanta

2002 African American females:


200/100,000 White females: 60/100,000

50% of patients have organ damage or comorbid

conditions within 5 years of diagnosis

Background
People living with SLE need to deal with multiple
self-management activities
Fatigue, pain
SLE flare-up symptoms
Difficult emotions
Multiple medications
Comorbidities
Communicate effectively with health care providers

Racial minorities, low socioeconomic status and low

education are potential risk factors for poor outcomes

Background
Across chronic conditions, self-management interventions
have demonstrated to be feasible, effective and lead to
sustainable improvements in health outcomes

The Chronic Disease Self-Management


Program (CDSMP)
Group-based program that seeks to enhance

patients self-efficacy and skills to better self-manage


their chronic conditions

A long standing unmet need of SLE patients:


effective and widely available self-management intervention

Whether an accessible self-management program that is


effective for people with chronic diseases would be
beneficial to minority patients with SLE?

The CDSMP contributes to improvements of health

status, self-efficacy and selected health behaviors in


people with common chronic conditions
Low cost and widely available
Stanford Patient Education Research Center
http://patienteducation.stanford.edu/programs/cdsmp.htm l

The CDSMP

Objective

Workshop-based format (10-15 participants)


Led by certified peer facilitators
Curriculum:

Pilot test the acceptability and benefits of the


CDSMP among low-income African American
women with SLE

Coping with difficult emotions


Relaxation and symptoms management
Fatigue management
Exercising and healthy eating
Medication management
Communicating effectively with family and health

professionals
Decision making

Patients and Methods


Recruitment:
African American females with SLE from the Grady Health

System Lupus Clinic: provides outpatient care to


uninsured and underinsured SLE patients from
metropolitan Atlanta, GA,US

CDSMP Workshops:

Aim: to examine the short-term benefits of the


CDSMP on four general outcomes:
1) health status
2) self-efficacy
3) self-management behaviors
4) health services utilization

Patients and Methods


One group pre-post intervention design
Patient Reported Outcomes: at baseline and 4
months
Health Status

o SF-36: physical health (PCS) and mental health (MCS)


o Center for Epidemiology Studies Depression Scale (CES-D)

led by 2 trained African American leaders, one of them

Self-efficacy for Managing the Chronic Disease

with SLE
6 weekly sessions of 2.5 hours

Self-management behaviors
o Cognitive Symptom
Management o Exercise

Behaviors
o Communication with Physician
o Self-reported Medication-taking

Patients and Methods

Recruitment

Health Care System Utilization Outcomes: 6-month


before intervention, 6-month after intervention completion

Grady Health electronic records


Visits to the Grady Lupus Clinic and the Grady
Emergency Room
Admissions to Grady Hospital

Sample size: 40 participants


87% power to demonstrate improvement of SD of the

physical and mental health measures (MCS and PCS)

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