Active patient programme for diabetic patients

Good practice:

Overlap the aims of staff engagement with patient adherence

BASQUE COUNTRY  / Active Patient Programme:  234/1800 58/122

Chronic diseases are the dominant epidemiological pattern in the Basque Country. The incidence of type 2 diabetes mellitus has increased in our region in recent years. The prediction is that prevalence of DM2 may reach up to 12% in the population over 30 years of age. Mortality and morbidity in DM2 patients are known to be higher than those in the general population. The mortality rate ranges from 13 to 30 deaths per 100,000 people. It is estimated that diabetes accounts for as much as 6.3 to 7.4% of health expenditure in our health system.

Customer's need

The main priority around the world is to improve the prognosis of patients with DM, and reduce its high morbidity. It requires an integrated action on risk factors.

The solution

Health systems need to provide more efficient and coordinated care to patients with chronic conditions. This will help decrease rates of deterioration, and improve the quality of life for patients and their families. To achieve this, a new strategy for chronic patient care has been launched. Featuring new organisational models, one important element is self-care promotion and population education.

The active patient programme provides information and trains patients skills in self care and disease management. Educational sessions help patients better understand their disease, and take responsibility for their health.

Keys to success

  • Programme prioritised by Department of Health and linked to the funding of the health care provider.
  • Training in the methodology of Spanish Diabetes Self-Management Programme (SDSMP) to diabetic patients and health professionals.
  • A programme manager devoted to the programme and in charge of the deployment and implementation of the programme, the engagement of professionals and the evaluation of the programme.

Good practice: Overlap the aims of staff engagement with patient adherence

Good practice description

Best practice for staff engagement within ACT is identified as ongoing, holistic and inclusive workforce development. The fact that the Active Patient workforce development programme is also offered to patients is unique. Staff and patients undergo the same education. As a result, they are able to share experiences and ideas. This overlap between the two aims is now considered as good practice. 

The sessions are taught by patients and caregivers who have experienced the same difficulties. Participants acquire knowledge and skills related to the disease and its management. Strong emphasis is placed on proactive tools. These help achieve healthier lifestyles, and better control of their symptoms.

“I took a course to prepare myself…not only from a nurse’s point of view, but also as a person who can improve their lifestyle habits. It was aimed at nurses and chronic patients.”

Good practice example

The Basque Active Patient programme stands out as an appropriate model of good practice in workforce development. The activities described by staff suggest that delivery is ongoing. With an initial training course supplemented by follow-up events. The content of the sessions appear broad and holistic. They encompass the aims of the programme, and consider the impact it may have on healthy lives for patients.

The program

The Active Patient programme for diabetic patients is based on the Stanford methodology, which provides workshops in self management of diabetes. The programme is led by care professionals (GP and primary care nurse) and patients who suffer from the same disease.

The educational training consisted of six sessions once a week for six weeks (each session lasts 2.5 hours and involves 8 to 15 people). Each group is supervised by two leaders previously trained and certified in the Spanish Diabetes Self Management Programme (SDSMP). At least one of the leaders is required to be a diabetic patient or a caregiver. The other leader should be a healthcare professional. Healthcare professionals introduce themselves to participants in the sessions as SDSMP leaders. They do not refer to their professional position. This promotes peer-learning, which is recommended in the implementation manual of the SDSMP. Patients do not complete the intervention until they attend at least four sessions.

The objective of each session is to enable participants to acquire knowledge and skills related to the disease and its management. Emphasis is placed on tools for enhancing proactive self care to achieve healthier lifestyle behaviours. These include improvements in diet, physical activity patterns, emotional management, and medication adherence. 

In the sessions, patients are trained to set their own targets and solve problems related to their condition. Sharing their feelings helps them communicate more effectively with their relatives and healthcare professionals. This helps them play a more active role in the management of their disease. The main goal is to promote changes towards healthier lifestyles. All the sessions were supported by educational material that is developed specifically for the programme: books, leaflets, and CDs.

Contact information

Javascript needed

Estibaliz Gamboa

Sources and references:

  • Moreno EG, Perez AS, Vrotsou K, Ortiz JCA, del Campo E, de Retana LO, et al. Impact of a self-care education programme on patients with type 2 diabetes in primary care in the Basque Country. BMC Public Health. 2013; 13(1):521. 
  • Compartiendo el Avance de la Estrategia de Cronicidad. Administración de la Comunidad Autónoma del País Vasco, Departamento de Sanidad y Consumo. 2012.

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