Patient Education In the Department of Medicine

Positive Self-Management Program for HIV (PSMP)

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The Positive Self-Management Program is a workshop for people with HIV given two and a half hours, once a week, for seven weeks, in community settings such as senior centers, churches, libraries and hospitals. Workshops are facilitated by two trained leaders, one or both of whom are non-health professionals with HIV. The PSMP is available in English, Spanish, and Japanese.

Subjects covered include: 1) how to best integrate medication regimens into daily life so they can be taken consistently, 2) techniques to deal with problems such as frustration, fear, fatigue, pain and isolation, 3) appropriate exercise for maintaining and improving strength, flexibility, and endurance, 4) communicating effectively with family, friends, and health professionals, 5) nutrition, 6) evaluating symtoms, 7) advanced directives, and 8) how to evaluate new or alternative treatments.

Each participant in the workshop may also receive a copy of the companion book, Living Well With HIV and AIDS, 3rd Edition, and a relaxation CD.

It is the process in which the program is taught that makes it effective. Classes are highly participative, where mutual support and success build the participants' confidence in their ability to manage their health and maintain active and fulfilling lives.

Does the Program replace existing programs and treatments?

The Positive Self-Management Program will not conflict with existing programs or treatment. It is designed to enhance regular treatment and HIV-specific education. The program gives them the skills to coordinate all the things needed to manage their health, as well as to help them keep active in their lives.

How was the Program developed?

While at Stanford University, Dr. Allen Gifford received a grant from the Robert Wood Johnson Foundation to develop and pilot a community-based self-management program to assist people with HIV. The study was completed in 1997.

The original research project had several investigators, including Allen Gifford, M.D., currently Professor of Health Policy & Management at Boston University School of Public Health. and co-director of the Veterans Administration HIV/Hepatitis QUERO Program in Bedford MA.; Kate Lorig, Dr.P.H., Stanford Professor Emeritus of Medicine; and Margaret Chesney, Ph.D., of the University of California, San Francisco . The Program was written by Dr. Gifford, Dr. Lorig, Virginia González, M.P.H., and Diana Laurent, M.P.H.. Dr. Lorig, Ms. González, and Ms. Laurent were all from the Stanford Patient Education Research Center.

How was the Program evaluated?

Over 200 people with HIV have now participated in an randomized, controlled test of the Program, and were followed for six months each.

What were the results?

Patients randomized to the PSMP were found to have improvements in their symptoms in the original developmental study. More recently, we have found that HIV patients in PSMP who are using antiretroviral medications have significantly better medication adherence and have better HIV suppression in the blood after 6 months. In spite of this, they have no more side effects than non-PSMP participants.**

How can my facility offer the Program?

Trainings for representatives of health care organizations are 4½ days. We offer a 1-day cross-training at Stanford for those who have already been trained to offer the Chronic Disease Self-Management Program. See our Training Page for more information.

*Living Well With HIV and AIDS (3rd edition) by Gifford, Lorig, Laurent, and González (2005) can be ordered from Bull Publishing.

**Results reported in:

"Pilot randomized trial of education to improve self-management skills of men with symptomatic HIV/AIDS" by Gifford AL, Laurent DD, González VM, Chesney MA, & Lorig KR. Journal of Acquired Immune Deficiency Syndrome and Human Retrovirology, 18(2):136-144, 1998.

"Effects of Group HIV Patient Education on Adherence to Antiretrovirals: A Randomized Controlled Trial" by Gifford AL, Bormann JE, Shively MJ, Lee M, Capparelli EV, Richman DD & Bozzette SA. Paper presented at the 8th Conference on Retroviruses and Opportunistic Infections, Chicago IL, 2001.

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