Arthritis Self-Management Program Success

There was a modest impact on symptoms, and minimal response in healthcare utilization. Small to moderate improvements were seen in exercise, cognitive symptom management, and communication with their physicians. “I think of these as building blocks,” says Dr. Brady. “They first learn how to be a patient with a chronic disease and then evolve into active disease managers. After that, they start to learn and implement disease-specific skills.”

Oh, Canada

The experience of implementing self-management programs has traveled different pathways in the United States and Canada. In Canada, the country’s Arthritis Society has national responsibility for the self-management program and steady financial support. “ASMP is one of our core programs, and our provincial divisions offer it in their communities,” says Lynn Moore, director of public affairs for the society’s national offices in Toronto. “Much of the infrastructure for the programs runs through the national office. We hold the license, oversee master trainers, and do most of the quality-control work.”

It is left to the divisions to find, train, and use their facilitators. The local offices also find the appropriate places to host the programs, and publicize their availability.

Moore says they have been fortunate to have long-standing and consistent financial support. Grants at the national level pay for about half of their expenses with the rest made up from general revenues and donations. At the divisional level, money to run the program comes from local foundations, community funding, and local corporate money.

Even with all of this, there are major roadblocks to implementing these programs. Last year, there were about 170 programs offered nationally in Canada, with around 1,800 people graduating. “Canada is a large and diverse country and there simply isn’t capacity to give it in every community,” says Moore. “We have to work with our volunteer facilitators, and six weeks is a long commitment. It is also hard to travel to the smaller areas, especially in the winter.”

Variable U.S. Experience

The history of these programs in the U.S. has been varied and subject to periods of feast or famine. “The Arthritis Foundation [AF] a few years ago dropped support of the program and there has been no national infrastructure since,” says Dr. Lorig. “The CDC has funded some state programs, and there are very active programs in these states.”