Christina Sumners: Welcome to Science Sound Off. I’m Christina Sumners.
Tim Schnettler: And I’m Tim Schnettler.
Christina Sumners: And we’re here today to talk about managing chronic conditions, with Dr. Matthew Smith, with the Texas A&M Center for Population Health and Aging. Welcome, Dr. Smith. What sort of chronic diseases are we talking about?
Matthew Smith: There are so many different types of chronic conditions and so many of these are things that persist over time, not acute things that come and go, like the cold, like the flu, but when we think about things, we talk about heart disease, high blood pressure, high cholesterol, we talk about diabetes, we talk about arthritis or cancer, chronic pain, or even things like HIV or multiple sclerosis, Parkinson’s disease, so many different types of conditions that people can have.
Christina Sumners: And so is the management of these similar? I mean, these seem like such different diseases. Do they have similar management techniques?
Matthew Smith: I’m glad you asked that, because really they do. Obviously when you work with a health care provider, there needs to be a very specialized treatment plan for each type of chronic condition, that hopefully matches that individual and what their needs are. But generally speaking, when we talk about self-management, we’re talking about what a person does outside the healthcare system. So much we talk about healthcare and what’s needed in health care to improve our health, well-being, keep us healthy, keep us safe, but the issue is that only about 1 percent of our time is spent in a health care setting, the other 99 is out in the world. You know, health happens at home. So with that said, we talk about self-care, and when you think about self-care, so much of what you think about are your medication regimens and your treatments, which are universal to all types of chronic conditions. Everyone has some sort of medication, some sort of treatment regimen, physical activity, nutrition, sleep, stress management, work-life balance, communication with others, you know, managing those mental health type issues and some of the emotional strain. So, it is very universal when you think about self-care, even though the nuances of your condition can be quite different.
Tim Schnettler: Seems like chronic care, chronic disease, words like that, it’s such a word that frightens people. Based on what you told us already, I didn’t realize there was such a wide range. Yeah, I mean, it’s an overwhelming term at some point.
Matthew Smith: It really is, and so when you think about it, there’s actually been some shifts. We used to say chronic disease, but we still do, we also say chronic conditions, because it’s not actually a disease, it’s actually a situation, and so with that said, there’s no really great way to say it, but I do know that when we do programming in the community there is a phenomenal, evidence-based program called The Chronic Disease Self-Management Program. It’s very specific as to what it does. But when we think about what its actual term is in the community, live healthy, be healthy, it just sounds better. Right?
Tim Schnettler: Yeah.
Matthew Smith: But I agree, it’s a very daunting term to be told that you have a disease, you have a condition, but the reality is, with our aging society, about one in four adults has at least one chronic condition, and as that age gets older, about 70 percent of individuals 65 and older have one or more chronic conditions.
Tim Schnettler: Well, and like I said, you mentioned so many things that fall under this. I mean, to be honest with you, when I think of arthritis, or stuff like that, I don’t really think of it as a chronic disease. I mean, to hear it termed as a chronic disease is different to me.
Matthew Smith: And the issue is that it’s something that you must deal with and be aware of and treat every single day, at least manage every single day. So it does become a condition, and it has symptoms, and that’s really what we focus on when we think about chronic disease self-management is not managing the condition, so to speak, but a lot of the symptoms that come with it. Because it can cause pain, it can cause fatigue, it can cause, you know, some sort of irritation, some sort of, you know, negative thoughts or depression in some ways, there’s so many different things that come with it, that if we can better manage our lives and the things that we can control, we can lessen the symptomatology and help manage that condition so it doesn’t get worse over time.
Christina Sumners: So is that the main goal, to prevent things from getting worse? Or what is the goal of self-management?
Matthew Smith: Well, the great news about self-management is that so many of these behaviors, like I said, physical activity and nutrition and communication with health care providers are actually preventative.
Christina Sumners: Mm, okay.
Matthew Smith: So they can be preventative, however, if a person already has a chronic condition, it still is preventative, but really it’s managing. So we’re trying to manage that condition, make sure that they don’t progress and have that complication, any kind of intensified ramification. But at the same time, what you’re doing is preventing possibly other chronic conditions, and also preventing that negative consequence. So it’s kind of prevention while managing, because so many of the behaviors are similar. Unfortunately, a lot of older adults, and individuals as we age, collect chronic conditions, and so many of us have these multiple chronic conditions. And the unfortunate part is with the obesity epidemic and so many of the things happening in this country, we’re starting to get chronic conditions younger and younger, meaning that we have more time to live with them, the need to manage them, and of course more time to accumulate more and more chronic conditions, therefore complicating our ability to self-manage effectively. Because if I have heart disease and diabetes and arthritis, if one of those starts to change and progress, it changes the way I need to manage one of those other conditions, and I become a more complex patient, and a more complex self-manager, which means I need skills.
Tim Schnettler: And a lot of that has to do with the medications for those, correct? I mean, the different, ’cause, I have Afib, and so I’m on medicine for Afib, but I also have an Arthritic hip, so can I take this painkiller to help with this and stuff like that.
Matthew Smith: Absolutely, so that’s the whole thing is that so many times with any kind of chronic condition, you’re gonna take medications, and you need to take those medications at the right time, with or without food, and if now all of a sudden you get introduced into a painkiller situation, now all of a sudden, how does that influence the way that you’re eating, your sleeping, that you’re physically active, and if you’re in too much pain and you can’t be physically active, are you actually managing your heart disease? And so all of a sudden, it’s all very intertwined, so you need to be very attuned to those medications. Talk with your providers about those medications, but also make sure that those medications aren’t going to interact with one another and cause negative ramifications. Unfortunately, because so many people collect chronic conditions, you can be on five, 10 different medications, and a lot of times, those aren’t all needed. So you need to be able to talk to your provider. Don’t make those decisions yourself. Talk to your provider, and make sure that you better understand what’s happening with you, that they can do a reconciliation if needed, so that you can truly not, feel that you’re just taking so many medications, but you’re able to manage your conditions, but also feel that you can live the life that you want to, in the way that you want.
Christina Sumners: You mentioned some skills for self-management, what are some of the skills that you can teach people?
Matthew Smith: So many of the things that we can learn are based on your day-to-day. So it’s very interesting when you ask somebody what they’re supposed to do to be physically active, and what’s appropriate for them to be physically active. They might not know all of the answers. They know they’re supposed to be physically active, we talk about it all the time. I should exercise, and I should exercise 30 minutes a day, most days a week, to meet the Surgeon General Guidelines, but what does that mean? What’s appropriate for me? And so a lot of the times, what we do is we try to identify those activities that not only are most beneficial for the individual, but something that they will find pleasurable. If you’re not a swimmer and I tell you, you know what, you should go swimming. You’re probably not gonna keep up that behavior. You weren’t a swimmer.
Christina Sumners: Yeah.
Matthew Smith: But I also can’t go ahead and say, you know, if you’re an individual who has never really ran, why don’t you go run marathons or go ride a bicycle. We really need to meet them where they’re at and try to help them to understand what kind of regimen they should be on that’s safe and doesn’t cause harm, but makes it enjoyable, so they keep it up. The other thing is, is of course, think about nutrition, and all the nuances that go with that. People need education, they need to be able to better understand. Now when we talk about stress relief or you know, for the sake of better terms, guided meditation or any type of, you know, mental health relief, people need to understand those skills to reduce stress. But a lot of times, what it comes down to is universally this. We need people to identify their problems, learn how to problem-solve, learn how to action plan, and set goals to meet those action plans. And if we can train people to understand that, they’re going to become better self-managers, because they’re not necessarily following a script. They’re now able to think. They have that skillset, that toolbox, so that they can identify the problems, think about alternatives, set a goal plan so that they can make action.
Christina Sumners: Why is this important? Why is this important to be able to self-manage rather than just rely on health care provider for all of the things that go into having a chronic disease or a chronic condition?
Matthew Smith: So because so many people don’t necessarily spend a huge proportion of their lives in the clinic, or in a hospital, and thankfully, that’s true, and also because, you know, we have great communication with physicians, but a lot of times, we don’t have as much interaction as we want, very busy individuals, don’t have a lot of office times, don’t have a lot of time with their staff. So we need to get a lot of information conveyed to us in a way that makes sense so that we can leave and then spend the majority of our lives outside of that clinical setting. Well, the issue is, a lot of that comes down to a health literacy issue. Do I really understand what that provider told me and can I use that information to the betterment of my health? Well, part of that becomes can you have that health literacy, but the other thing is can we expand the skills? Can I really understand what it means to be healthy and what it means to manage my conditions effectively? So self-management, in so many ways, is making sure that in my own daily life, I can take the advice, the recommendations, from my health care provider, when they’re out of sight. And also make sure that I can manage my symptoms so that I don’t limit my daily behaviors, that my conditions stay where they are, if not improve, but at least don’t get worse, which would then require maybe more hospitalizations, health care utilizations, medications.
Tim Schnettler: And that a lot of that leads to the cost, as well. Right, it can lead to a reduction in cost for employers, and for the individual as well.
Matthew Smith: Oh, absolutely. And so unfortunately, chronic disease is one of the most expensive, you know, costs that we have in this country. And when you look at our health care cost, relative to other countries, who have better health outcomes, we’re spending more per person, and getting worse outcomes, than others. But I love that you brought up the employers, because so much of what we’re trying to do is make sure that individuals who have chronic conditions at younger stages of life, better understand how to manage because unfortunately, chronic conditions is one of the primary reasons for absenteeism and not showing up for work, but also presenteeism, and people don’t think about this. Just because you are at your desk or you’re at work, are you there? Are you focused? Are you working? Are you efficient? And when you have a chronic condition and you’re mismanaged, you have a lot of other things going on and the presenteeism is actually reduced. Well, depending on what your field is, that could actually cause safety risks. If you’re in a, you know, a machine or heavy machine type or operating heavy vehicles or driving or you know, any kinds of things, even if you’re a pharmacist, I mean, you can make a bad decision if you’re not present, so we really need to focus on that.
Christina Sumners: So, how are you doing that? Are you going into different workplaces and teaching the employees these techniques?
Matthew Smith: So there is a phenomenal suite of programs that were originally developed at Stanford, called the Chronic Disease Self-Management Education Suite, and with that said, there’s a lot of different types of programs. There’s the general ones for chronic disease, but there’s another one that has been translated specifically for use for diabetes, there’s been another one that was specifically for use for arthritis, for chronic pain, for HIV, a lot of these different types of programs, I’ve been fortunate enough to be able to translate that program for use in the workplace. And this is something that was funded by the National Institutes of Health. We have done a randomized trial and have actually shown this translation to be efficacious, so we’re extremely happy. This is now a national program, so we do go to different employer groups and we offer these small group workshop settings so that we can teach the skills to the employees so that they can not only better their health, but also increase their productivity at work.
Christina Sumners: But how much of a time commitment is one of these classes?
Matthew Smith: So these programs last six weeks in length, and depending on the type, it’s about two hours per week for six weeks. So, just about 12 or so hours of a commitment, and the great news, as we always say, is, you know, committing six weeks for the rest of your life, because it’s not that we sit there and we try to educate in terms of content. We do provide content. Like I said, it’s stress-management, it’s sleep, it’s physical activities, nutrition, it’s understanding your medications and your treatment, it’s communication skills. But it’s not content-driven, it’s process-driven, that problem-solving, goal-setting, action-planning, those are really the skills we try to teach in the six weeks so that they can learn, they can try week by week, a safe environment to fail and make some changes in iterations, and then go ahead and come back that next week. So hopefully after the six weeks, really have a skill set that they can apply day-to-day.
Tim Schnettler: I know this may not be something that has been determined, but is there one chronic self-disease, or chronic disease, that’s more prevalent than any other?
Matthew Smith: Oh, absolutely, so, cardiovascular disease, heart disease, and that can be, you know, high blood pressure, that can be high cholesterol, I mean, just general heart disease, is one of the most prevalent conditions in our country. But diabetes is rivaling, so anything that is metabolic in nature and obesity-related. Now the problem is is that heart disease and diabetes, ’cause diabetes is technically considered a cardiovascular disease, or a cardiovascular risk, they’re running mates, and if you have one, you’re much more likely to have the other. And so with that said, this combination now creates a more complex patient, almost immediately. And with that said, we definitely know that the obesity-related conditions in this country are really driving so many of the costs, which are largely preventable.
Christina Sumners: So these costs are even preventable after someone’s been diagnosed, it’s not just preventing the disease itself.
Matthew Smith: That’s right. And sometimes when an individual gets a diagnosis, it’s likely that they will have that diagnosis forever. However, there are some that can be reversible, you can certainly change your lifestyle, you can reduce weight, you can do these things that will almost either get rid of the condition or at least make it to where it’s so manageable that you’re not gonna have those negative ramifications. But the reality is, most people won’t get to that point. But, at least they don’t have to continue on the progression, and we can at least stop where they are and make sure that they can live a healthy, happy life in their current status. Having a chronic condition does not mean your life has to be of diminished quality. You know, when I ask, you know, how healthy do you think you are, and I say, I think I’m really healthy, and then I ask someone with diabetes how healthy do you think you are, that doesn’t necessarily mean that they’re not healthy. They can be very, very healthy and it’s how you feel that really dictates how healthy you are and how well you’re living the life that you’re setting out to live.
Christina Sumners: That’s good to know, just so people, when they hear that they’ve been diagnosed with something like this, they don’t think their life is over.
Matthew Smith: And a lot of that is having that empowerment. Having that control, and understanding that you can control some of those things in your life, you do have a say, it’s not happening to you, it’s actually happening, I guess, with you, in that you can, you can make a change. It’s never too late for intervention. Never too late for changes.
Christina Sumners: Well, that’s a great place to end with that message. Thank you so much, Dr. Smith, for being here.
Matthew Smith: My pleasure, and thanks for having me.
Christina Sumners: And we will see you all next time on Science Sound Off.