“The bottom line is that Kate has always exhibited a passion for helping people help themselves,” says Michele Boutaugh, BSN, MPH, group vice president for programs and services for the Arthritis Foundation (AF) in Atlanta. Boutaugh has worked with Dr. Lorig since 1981, when the AF first field-tested the Arthritis Self-Management program. Through the AF, the program has reached thousands of people. “Like the parable about teaching people to fish rather than giving them fish, Kate’s life’s work has been about helping people learn skills and how to manage their disease so that they can handle any challenge that comes their way,” notes Boutaugh.
The Arthritis Self-Management Program focuses on the need for changing behaviors and learning new health habits that will help people on a day-to-day basis with their arthritis. Pain management and relaxation techniques are taught throughout the six-week course so that participants have the opportunity to learn and practice these skills over time. Building self-efficacy, also a core theme of the course, “gives it a much more powerful outcome than a traditional didactic course,” notes Boutaugh.
Extended Acceptance
Dr. Lorig began to challenge mainstream medicine again in the early 1990s, when she wondered whether the tenets of patient self-management could be extended to all chronic diseases. She recalls an seminal lecture given by Len Syme, a professor of epidemiology while she was at Berkeley. “That had been in the back of my mind: could you put people with different chronic illnesses together? If someone is living in the community, they may have two or three chronic conditions, so you really have to consider them as a whole if you’re going to help that individual. At that point, I really wanted to expand out and try that. Thankfully, Hal was willing to let me try.” She and several investigators, many of whom had collaborated on the Arthritis Self-Management Program, set out to test whether a Chronic Disease Self-Management Program (CDSMP) would be effective.
Randomized controlled trials of interventional modalities are challenging enough. Studies in groups of people with different chronic conditions pose additional obstacles, says Dr. Lorig. “In groups of people with mixed conditions, not everyone has the same symptoms, such as shortness of breath, fatigue, or depression, so this mutes the effects that can be seen.” Nevertheless, the evidence began to show that the CDSMP could improve health status as well as reduce utilization costs.2,3 When the project began, says Laurent, who along with Dr. Lorig and Virginia González wrote the program, “It was like the old days all over again! We had to convince a whole other group of health professionals. But, we know that the way to convince people is to give them evidence.” As studies began to reveal positive results from the CDSMP, the Administration on Aging began funding the program, which is now in 26 states.
