Effect of a self-management program on patients with chronic disease.
BACKGROUND
For patients with chronic disease, there is growing interest in "self-management" programs that emphasize the patients' central role in managing their illness. A recent randomized clinical trial demonstrated the potential of self-management to improve health status and reduce health care utilization in patients with chronic diseases.


OBJECTIVE
To evaluate outcomes of a chronic disease self-management program in a real-world" setting.


METHODS
Before-after cohort study.


METHODS
Of the 613 patients from various Kaiser Permanente hospitals and clinics recruited for the study, 489 had complete baseline and follow-up data.


METHODS
The Chronic Disease Self-Management Program is a 7-week, small-group intervention attended by people with different chronic conditions. It is taught largely by peer instructors from a highly structured manual. The program is based on self-efficacy theory and emphasizes problem solving, decision making, and confidence building.


METHODS
Health behavior, self-efficacy (confidence in ability to deal with health problems), health status, and health care utilization, assessed at baseline and at 12 months by self-administered questionnaires.


RESULTS
At 1 year, participants in the program experienced statistically significant improvements in health behaviors (exercise, cognitive symptom management, and communication with physicians), self-efficacy, and health status (fatigue, shortness of breath, pain, role function, depression, and health distress) and had fewer visits to the emergency department (ED) (0.4 visits in the 6 months prior to baseline, compared with 0.3 in the 6 months prior to follow-up; P = 0.05). There were slightly fewer outpatient visits to physicians and fewer days in hospital, but the differences were not statistically significant. Results were of about the same magnitude as those observed in a previous randomized, controlled trial. Program costs were estimated to be about $200 per participant.


CONCLUSIONS
We replicated the results of our previous clinical trial of a chronic disease self-management program in a "real-world" setting. One year after exposure to the program, most patients experienced statistically significant improvements in a variety of health outcomes and had fewer ED visits.
Lorig
K R
KR
Stanford University School of Medicine, Calif, USA. lorig@stanford.edu
Sobel
D S
DS
Ritter
P L
PL
Laurent
D
D
Hobbs
M
M
D002140:California; D002908:Chronic Disease / Q000628:therapy*; D015331:Cohort Studies; D003657:Decision Making; D019468:Disease Management; D005260:Female; D006266:Health Education; D006801:Humans; D008297:Male; D015397:Program Evaluation; D019984:Quality Indicators, Health Care; D012648:Self Care; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States