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Biomedical subjects

K Lorig

Publications and source records attributed to K Lorig.

51 records · Page 3Linked to original sources

A multidisciplinary patient education workshop to integrate staff training with program development.

A four session multidisciplinary workshop was held to teach Veterans Administration (VA) Medical Center staff basic patient education design principles. During the sessions, staff, working in teams, designed patient education programs on a wide variety of health care topics. Guidance to teams was provided at each step of program development so that at the end of the workshop, programs were ready for implementation. Medical Center standards for patient education and documentation were integrated into program designs.

California↗

A comparison of lay-taught and professional-taught arthritis self-management courses.

One hundred subjects with arthritis were randomized into lay-taught, or professional-taught 12-h arthritis self-management courses, or a control group. Outcomes, knowledge, exercise, relaxation, disability, pain, and number of physician visits were measured aat baseline and 4 months. Professional-taught groups demonstrated greater knowledge gain while lay-taught groups had greater changes in relaxation (p less than .01) and a tendency toward less disability. Although it is impossible to draw definitive conclusions, this study suggests that lay leaders can teach arthritis self-management courses with results similar to those achieved by professionals.

Arthritis↗

Outcomes of self-help education for patients with arthritis.

Behavioral and health status outcomes of an unreinforced, self-help education program for arthritis patients taught by lay persons were examined in 2 ways: a 4-month randomized experiment and a 20-month longitudinal study. At 4 months, experimental subjects significantly exceeded control subjects in knowledge, recommended behaviors, and in lessened pain. These changes remained significant at 20 months. The course was inexpensive and well-accepted by patients, physicians, and other health professionals.

Adult↗

A workplace health education program that reduces outpatient visits.

A workplace health education program aimed at reducing unnecessary outpatient visits was offered through 22 California employers. A total of 5,200 employees attended a presentation, received self-help books, and completed self-administered questionnaires. All visits for their households were monitored for up to 15 months. The study utilized a quasi-experimental staggered intervention design involving eight different cohorts, before/after comparisons, with statistical adjustment for seasonality and other intervening variables. Visit rates for households insured only by Blue Cross of California were reduced by 17% (P = 0.001), or 2.0 visits per household per year. For all participants, the reduction was 7.2% (P = 0.06), or 0.8 visits. Reductions were seen for all age and educational strata. The program was most effective among households with first dollar fee-for-service insurance coverage. Households with insurance requiring co-payments had less reduction. No reduction was seen among health maintenance organization (HMO) members. The study concludes that a minimal cost, self-care workplace intervention can reduce outpatient visits by important magnitudes.

Adult↗

Some notions about assumptions underlying health education.

By definition, the objective of health education is to change health behavior. One assumption underlying this objective is that changed health behaviors will result in improved health status. Both the objective and its assumption are based largely on experience with acute health problems. However, health education is now changing its focus towards chronic diseases. This paper examines a number of chronic disease health education studies. Investigation reveals that although there is often an improvement in health status, the associations between changed health behaviors and improved health status are not clear and at times do not appear to exist. In light of this evidence, the authors suggest that there is, in some cases, a need to reevaluate the assumptions that underlie health education and a need in health education programs to study factors other than, or in addition to, behavior change as mediators of health status.

Behavior↗

Reasons for the lack of association between changes in health behavior and improved health status: an exploratory study.

Persons with arthritis who attended a 12-hour self-management course generally showed improved health behaviors and improved health status. However, no association was found between the two. We therefore interviewed 54 course participants to determine factors that were associated with positive and negative health-status outcomes. Persons having positive outcomes indicated that they had more control over their disease and had a positive emotional status. Persons with negative outcomes indicated a lack of control and generally had a negative emotional status. These differences were statistically significant.

Arthritis↗

Arthritis self-management. A five-year history of a patient education program.

There are several lessons to be learned from the ASM experience. First, and most outstanding, is the willingness of large numbers of people across the United States to participate in both the ASM course and the research. Second, we have found that lay leaders can be trained to offer a rather complex arthritis course. They have proved to be reliable and, most important, are acceptable to the public and most health professionals. When their acceptance has been questioned, it is usually by persons with little or no experience with either the course or the lay leaders. Third, a national organization, in this case the Arthritis Foundation, has been able to disseminate the course widely and, to some extent, to conduct evaluations. From the national evaluation experience, we have learned that local areas are much more interested in service than evaluation and almost too readily accept an unproven yet hopeful arthritis education program. However, this acceptance of a new innovation before thorough testing is no different than that seen with other new medical technologies from medication to coronary bypass. Finally and most intriguing, we have found that such standard arthritis treatments as exercise and relaxation seem to directly contribute only slightly to the reductions in pain experienced by ASM participants. This unexpected lack of correlation has led us to begin studying other mediating factors such as self-efficacy, depression or both.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Capturing the patient's view of change as a clinical outcome measure.

CONTEXT: Measurement of change in patients' health status is central to both clinical trials and clinical practice. Trials commonly use serial measurements by the patients at 2 points in time while clinicians use the patient's retrospective assessment of change made at 1 point in time. How well these measures correlate is not known. OBJECTIVE: To compare the 2 methods in measurement of changes in pain and disability. DESIGN: Longitudinal survey of patients starting new therapy for chronic arthritis in 1994 and 1995. Surveys were completed at baseline (before intervention) and at 6 weeks and 4 months. SETTING: Community health education program and university medical and orthopedic services. SUBJECTS: A total of 202 patients undertaking self-management education (n = 140), therapy with prednisone or methotrexate (n = 34), or arthroplasty of the knee or hip (n = 28). MAIN OUTCOME MEASURES: Concordance between serial (visual analog scale for pain and Health Assessment Questionnaire for disability) and retrospective (7-point Likert scale) measures, sensitivities of these measures, and their correlation with patients' satisfaction with the change (7-point Likert scale). RESULTS: When change was small (education group), serial measures correlated poorly with retrospective assessments (eg, r=0.13-0.21 at 6 weeks). With greater change, correlations improved (eg, r = 0.45-0.71 at 6 weeks). Average agreement between all pairs of assessments was 29%. Significant lack of concordance was confirmed in all 12 comparisons by McNemar tests (P = .02 to <.001) and by t tests (P = .03 to <.001). Retrospective measures were more sensitive to change than serial measures and correlated more strongly with patients' satisfaction with change. CONCLUSION: The 2 methods for measuring health status change did not give concordant results. Including patient retrospective assessments in clinical trials might increase the comprehensiveness of information gained and its accord with clinical practice.

Aged↗