Novo Nordisk's Søren Skovlund Speaks to Pharma IQ about Best Practice Approaches to Patient Education and Self-Management

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Søren Skovlund is director of global patient research, advocacy and support in Novo Nordisk and oversees the global DAWN (Diabetes Attitudes Wishes & Needs) study led by Novo Nordisk. In this interview he joins Helen Winsor from Pharma IQ, to discuss best practice approaches to patient education and self-management.

Pharma IQ: How do you and your organisation approach the issue of patient education and self-management? Who are your key partners in developing and delivering such programmes?

S Skovlund: Well, first of all, patient self-management and education is considered a cornerstone of improving outcomes of diabetes management today. We consider it with a very high priority in all our efforts across the product areas and development, as well as in corporate relation activities. Our key partners in developing these programmes are patient organisations and the scientific societies, and the expert within the field that are delivering these kinds of programmes on an everyday basis. Of course, with some patient organisations, we rely very much on having people that have the condition, that provide their perspective on what needs to be improved, and how people prefer to be supported in managing their condition.

Pharma IQ: What is your approach to various aspects of developing and delivering effective self-management programmes? The first aspect that I’d like to look at is the assessment of self-management capacity.

S Skovlund
: I think that’s a rather tricky question. I think that the question of assessment of self-management capacity is really a question of collaboratively discussing with each individual or evaluating with each individual what the areas of improvement are that one seeks, and working from there. Obviously there are multiple validated instruments that are also applied and various contexts to assess patients’ self-report ability to manage different things. That’s called self-efficacy, and self-confidence related to these things can also be helpful to pinpoint the capacity of patients. An individual perspective needs to be attained, and no validated assessment can really do the full trick.

Pharma IQ: I guess it’s a case of collaborative problem identification with patients and patient groups, would you say?

S Skovlund: Exactly, I think that is really the approach, and the way. So when you raise it to the level of patient groups rather than the individual patient, I think it’s very important that discussions are taken at the level of patient advocacy groups. Trying to define jointly what are the priority areas, where there is a mutual gain between, in this case, the industry and patient advocacy organisations. Or it could it also be other organisations, and the approach that we seek to take in relation to such patient associations is starting off with the patient benefits. Looking at what are the particular benefits for patients that we are jointly seeking to achieve, and defining those. And those benefits may be filling gaps in the current provision of ongoing self-management support or psycho-social support, or achieving better outcomes and so forth. But in addition to identifying those patient benefits and goals in collaboration, it’s very important that we seek a way of doing this that maintains the independence and integrity of the organisations in question, respects the differences and respects the unique contributions of each, and ensures that there’s full transparency around how such collaborations are set up to maximise the opportunity for these, for the outcomes of such initiatives to be applied on a large scale subsequently.

Pharma IQ: Are you able to elaborate some more on the particulars of integrated care planning and motivational techniques used in the actual treatment process itself?

S Skovlund: Again, the notion of motivational techniques and integrated care planning is still very specific, and I think that it will be applied in different ways in different countries and different cultures. I think that the principal component in these active motivational techniques is really, again, ensuring that the patients’ agenda is highlighted as the starting point for much of the discussion pertaining to treatment plan development, collaborative goal-setting and so forth. I think I would not come with any attempts at providing one method versus another one here. The fundamental method strategy is really to encourage the patients into an environment where the patients are involved, encouraged, to be as actively involved as the patient is wishing to be, and is capable of being.
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Pharma IQ: That was a useful insight on your approach. Leading on from that, how can patient education and self-management programmes deal with patient-specific challenges to help deal with problems such as frustration, fatigue, pain and isolation? I guess this leads on from the motivational techniques.

S Skovlund: Yes, I think the key in this question you’re posing is really, I think, the individual part of it - how do patient education programmes deal with individual concerns, rather than general issues? And I think that comes back to how these programmes are delivered, and what are the most effective programmes. An increasing amount of research is supporting the fact that the semi-structured programmes that have large gaps of time where the agenda and the content of the discussions is decided by the patients, by the participants rather than just being already pre-designed. That is one of the key ways by which it can be ensured that self-management programmes address these specific challenges. So programmes that are group-based, which include a psychologist or educator and which have specific time points where these topics of emotional issues are raised. And where there’s then time for people to exchange and share, and ask questions, and the content of the educational session be guided by patients own questions. That’s one way of ensuring that these things are addressed to the extent so it’s most relevant for the individuals.

Pharma IQ: How difficult is it to gauge the effectiveness of patient education programmes and how are you trying to overcome these difficulties?

S Skovlund: I think within the last few years, it’s become increasingly manageable to evaluate these programmes. I think ten years ago there were almost no programmes that were evaluated appropriately, and I think today we have the measurement systems that are needed to evaluate these programmes. Now the main challenge really is about commitment from the various healthcare providers and systems - to put in proper, ongoing assessment systems. We have the measurement tools that allow us to do a proper evaluation, both in terms of impact on quality of life, on self-efficacy, on education, on skills, on clinical outcomes and so forth. So I think we’re pretty well-set here; we’re simply waiting for some greater resources and systems to do general evaluation of these components of care. 

Pharma IQ: Finally, looking again at challenges, what are the challenges in implementing self-management techniques, and what factors influence patient’s ability to manage their use?

S Skovlund: The first question is about the challenges in implementing this, and I think that we still have, one of the main challenges being raised by many, is still the matter of time. The basic question that many health professionals have very little, limited time to speak with their patients, and I think one of the challenges is that we are not yet leveraging the use of interactive media, telemedicine and internet in a sufficient way, and in an appropriate way for patients. So I think, moving forward, that will be one of the things that can help us reach more patients with individually-relevant self-management education and information at the time they need it, in a cost-effective way. So I think there are some significant positives and opportunities moving forward here and I think that in terms of factors influencing patients’ ability to manage their disease, obviously the key one is the availability of information and support, both emotional and social support when they need it. But also, the kind of proper educational support at the time of diagnosis and key turning points in their condition, so that it gives them the tools and problem-solving skills that they need to manage their condition on their own, during everyday life. I think those are some of the key factors that are currently posing as barriers for many people with Diabetes to managing their condition optimally.

Pharma IQ: Yes, some great points there Soren, thanks very much. Now, obviously you’re going to be delivering a presentation at the Patient Adherence and Compliance Conference in September. What are you looking forward to most from taking part in this event, and what key topics do you think will be hot topics at the event this year?

S Skovlund: Well, I actually think that the key questions that we’ve just been through now are pivotal issues that I think everybody in the healthcare and communication arena needs to be focused around. And I think that we need to look at, I’m looking forward to discussions about how we innovate in the way we work together across sectors, across disciplines, with the patients needs in mind. So I think that’s, for me, going to be the main thing that I’m hoping to get out of this.

 

IQPC

Please note that we do all we can to ensure accuracy within the translation to word of audio interviews but that errors may still understandably occur in some cases. If you believe that a serious inaccuracy has been made within the text, please contact +44 (0) 207 368 9425 or email helen.winsor@iqpc.co.uk
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