PRIMARY CARE TEAM TOOLKITS
Patient-Centered Self-Management
About Patient-Centered Self-Management
Patient-centered self-management support makes use of tools to promote patient activation and recovery from co-occurring physical and/or behavioral conditions with adaptations for language, literacy, economic status, and cultural norms. A major strategy for patient-centered self-management support is tailoring patient/family education on health conditions to be appropriate for the patient/family across multiple levels (language, literacy, social needs, etc.). Patient-centered self-management also utilizes tools and strategies for co-developing and monitoring health goals and treatment plans. Click on each box below for tools and resources that will advance patient-centered self-management in your practice.
PATIENT-CENTERED SELF-MANAGEMENT TOOLKITS
Guidelines/toolkits on patient-centered self-management to help promote patient activation and recovery.
Additional Toolkits and Resources
My Action Plan
AHRQ
The Action Plan is a tool used to engage patients in behavior-change discussion with a clinician or health coach. Using an action plan, patients set a goal for behavior that they wish to change, and clinicians/coaches engage patients in a discussion of an action plan that can help the patient fulfill the goal.
Coaching Patients for Successful Self-Management
California Health Care Foundation
This clip is a preview of a 14-minute video discussing how to both develop an action plan to support healthy behavior change and ensure patients are taking their medications appropriately.
Self-Management Education: Managing Chronic Conditions Beyond Medications
CDC
Hear a doctor discuss the importance of self- management education (SME) programs for people with ongoing health conditions like arthritis, diabetes, heart or lung disease, or depression.
Goal Setting and Action Planning
Respect for patient needs and preferences is a key element of patient-centered self-management care. By working in partnership with the patient to collaboratively set goals and create realistic action plans to achieve those goals – plans that factor in the patient’s social needs and resources, values, and goals – primary care teams can deliver high-quality patient-centered care.
Health Literacy and Teach Back
Communicating with Patients
How to Create Actionable and Engaging Patient Communication
Lifeology
Interactive development tool to help you create tailored and engaging patient education materials.
Choosing Effective Patient Education Materials
Medline Plus
Guidelines for selecting patient education materials.
Develop and Test Health Literacy Materials From the Centers for Disease Control
CDC
This resource helps with understanding your audience, visual communication, and testing messages and materials when developing a wide array of health information.
Ask Me 3
Institute for Health Improvement
Designed by health literacy experts, Ask Me 3 is intended to help patients become more active members of their health care team, and provide a critical platform to improve communications between patients, families, and health care professionals
The TeachBack Method
The TeachBack Method
UNC Health Sciences
Video explaining the basics and details of the TeachBack Method.
TeachBack Strategy
AHRQ
In this video, Kelly Smith, Ph.D., describes the Teach-Back intervention, which is one strategy of AHRQ’s Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families.
Always Use TeachBack Training Toolkit
TeachBackTraining
The purpose of this toolkit is to help all healthcare providers learn to use teach-back—every time it is indicated—to support patients and families throughout the care continuum, especially during transitions between healthcare settings.
Health Literacy Universal Precautions Toolkit
AHRQ
Great toolkit to help primary care practices reduce the complexity of healthcare, increase patient understanding of health information, and enhance support for patients of all health literacy levels.
Motivational Interviewing
Motivational interviewing is a method of communication that helps facilitate and engage motivation within a patient to change behavior. MI is a patient-centered, goal-oriented style of communication for eliciting behavior change by helping patients explore and resolve ambivalence to health behavior change. Motivational interviewing is a key method for providing high-quality patient-centered self-management support.
Motivational Interviewing Toolkit
Sunovoin Health Insights
This resource provides a library of videos demonstrating core concepts and skills of Motivational Interviewing, as well as a MI Skills Companion Guide, Best Practices Guide, and Strategic Implementation Guide.
OARS Model: Essential Communication Skills
RHNTC
OARS is a skills-based, client-centered model of interactive techniques. These skills include verbal and non-verbal responses and behaviors that need to be culturally sensitive and appropriate.
Motivational Interviewing Reminder Card: Am I Doing This Right
Case Western Reserve University Center for Evidence-Based Practices
Use the back of this card to build self-awareness about your attitudes, thoughts, and communication style as you conduct your work. Keep your attention centered on the people you serve. Encourage their motivation to change.
Readiness Ruler Tool
Case Western Reserve University Center for Evidence-Based Practices
The readiness ruler tool helps you lead the conversation with your patient about how important is the change for them and how confident they are about making the change.
Motivational Interviewing: 30+ Tools, Affirmations, and More.
Positive Psychology
This article looks at the key MI techniques of open questioning, affirmation, reflective listening, summarizing, considering ways to elicit change talk, and examples of affirmations.
Motivational Interviewing Resource Guide
Community Care of North Carolina
Tools and techniques for motivational interviewing.
Patient and Family Engagement
Engaging patients and family members as active partners in health care is one key to effective patient-centered self-management. There are a number of strategies practices can use to promote patient and family empowerment and shared decision-making.
Compendium of Patient and Family Engagement Tools
CMS
This resource provides in one location an organized collection of PFE resources, highlighting select resources deemed to be most practical and user-friendly for TCPI purposes.
Person and Family Engagement Toolkit
CMS
This resource provides essential information and resources for measure developers to improve, or establish, PFE processes across their organizations.
Toolkit for Patients and Family Engagement
Patient-Centered Primary Care Collaborative
Resource for improving practices, achieving quality payment program standards, and positioning patients and families as essential partners within care teams.
Patient and Family Engagement in Primacy Care Case Studies
AHRQ
These case studies describe the experiences of several exemplary practices that have increased patient and family engagement in primary care and affected patient safety.
Shared Decision Making: Improving Patient Safety, Education, and Empowerment: Guide for Providers
AHRQ
Guide for providers for effective shared decision-making with their patients.
