Implementing practical interventions to support chronic illness self-management.
BACKGROUND
Self-management support (SMS) is the area of disease management least often implemented and most challenging to integrate into usual care. This article outlines a model of SMS applicable across different chronic illnesses and health care systems, presents recommendations for assisting health care professionals and practice teams to make changes, and provides tips and lessons learned. Strategies can be applied across a wide range of conditions and settings by health educators, care managers, quality improvement specialists, researchers, program evaluators, and clinician leaders. Successful SMS programs involve changes at multiple levels: patient-clinician interactions; office environment changes; and health system, policy, and environmental supports. PATIENT-CLINICIAN INTERACTION LEVEL: Self-management by patients is not optional but inevitable because clinicians are present for only a fraction of the patient's life, and nearly all outcomes are mediated through patient behavior. Clinicians who believe they are in control or responsible for a patient's well-being are less able to adopt an approach that acknowledges the central role of the patient in his or her care.


CONCLUSIONS
Self-management should be an integral part of primary care, an ongoing iterative process, and patient centered; use collaborative goal setting and decision making; and include problem solving, outreach, and systematic follow-up.
Glasgow
Russell E
RE
Clinical Research Unit, Kaiser Permanente Colorado, Denver, USA. russg@ris.net
Davis
Connie L
CL
Funnell
Martha M
MM
Beck
Arne
A
D002908:Chronic Disease / Q000628:therapy*; D019033:Delivery of Health Care, Integrated; D019468:Disease Management; D005246:Feedback; D015438:Health Behavior; D006801:Humans; D017146:Models, Organizational; D010349:Patient Compliance; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods; D017064:Process Assessment, Health Care; D011788:Quality of Life; D012648:Self Care / Q000379:methods*; D012944:Social Support