Patients who take part in managing their chronic conditions, instead of leaving care entirely to medical providers, can enjoy a higher quality of life and a feeling of control over their health.1,2 Conditions such as asthma, diabetes and hypertension (high blood pressure) respond dramatically to lifestyle changes, as well as to medications.
Self-management is a key component of the patient-centered medical home (PCMH). By engaging patients in their care, the PCMH team empowers them. This is extremely important for those living with chronic disease. Rather than feeling helpless and hopeless, patients with ongoing conditions who know how to care for themselves can feel activated, motivated and confident.
Self-management support is not the same as patient education, cautions Kathleen Reims, MD, a family medicine physician and quality expert. “Self-management support begins with the patient’s self-identified problems. A teacher — who can be either a healthcare professional or a peer — helps the patient with problem-solving skills that apply to any chronic condition.”
Patient education begins with the provider, Reims says. “The doctor, nurse or another health professional determines a patient’s need for education about a condition or illness. She or he gives the patient information and technical skills, such as how to perform an insulin injection. Patient education aims to make patients compliant with prescribed care; it’s often given in the belief that knowledge leads to behavior change, which is false,” Reims says. Research shows that information motivates people to alter behavior only 10 percent of the time.3
Self-efficacy is what leads to change. To support patients and their families in self-efficacy to improve health, the care team must facilitate self-management support. Reims recommends a few key steps to accomplish this:
- Involve your whole team – Train physicians, nurses and medical assistants in self-management goal-setting, brief action planning
- Enlist clinical leaders – They must get practice wide recognition that self-management support is an essential part of care and lead by example
- Provide additional support to patients after the visit – Particularly for complicated, high-needs cases, use follow-up calls, texts, e-mails for coaching; focus on removing barriers, offer information
- Look beyond assumptions – Self-management failure may be due to literacy issues, undiagnosed mental health problem, cultural barriers, patient ambivalence or too-ambitious goals
“Because the PCMH does not operate in isolation, look for partners outside your walls to help patients in their self-management efforts,” Reims says. Community organizations, public health, schools, employers, and social and peer support networks can greatly augment the medical practice’s efforts. The more resources a patient has at his/her disposal, the greater the chances for ongoing self-management of chronic illness.
Sources
1. Lorig KR, Sobel DS, Stewart A, et al. Evidence Suggesting That a Chronic Disease Self-Management Program Can Improve Health Status While Reducing Hospitalization: A Randomized Trial. Jan 1999; Medical Care;37(1):5-14.
2. Norris SL, Engelgau MM, Narayan KM. Effectiveness of Self-Management Training in Type 2 Diabetes.
A systematic review of randomized controlled trials. Diabetes Care, March 2001;24(3):561-587.
3. Miller WR, Rollick S. Motivational Interviewing: Preparing People for Change. 2002, 2nd ed. New York; Guilford Press.