Bringing self-management into clinical view: a qualitative study of long-term condition management in primary care consultations.
OBJECTIVE
To understand social processes underpinning support for self-management of long-term conditions in primary care.


METHODS
Comparative analysis of observational and interview data concerning the management of long-term conditions in UK primary-care consultations. Analysis of recordings of primary care consultations (n = 86) was conducted in conjunction with analysis of semi-structured interviews with health professionals (n = 17) and patients (n = 12) living with a long-term condition.


RESULTS
A key finding was the infrequency with which self-management topics became legitimate objects for discussion in consultations. Analysis suggested that the maintenance of self-other relations was a prime objective for both patients and professionals, and the introduction of self-management topics threatened this process. Technology and the division of labour among primary-care professionals reinforced this tension.


CONCLUSIONS
In order for self-management support to become embedded and integrated into primary care, interventions concerning long-term condition management need to take into account this tension underpinning care.
Blakeman
Tom
T
NPCRDC, The University of Manchester Williamson Building, Manchester, UK. tom.blakeman@manchester.ac.uk
Bower
Peter
P
Reeves
David
D
Chew-Graham
Carolyn
C
D000328:Adult; D000368:Aged; D001294:Attitude to Health; D002908:Chronic Disease / Q000628:therapy*; D003142:Communication; D005260:Female; D005500:Follow-Up Studies; D006282:Health Personnel; D006801:Humans; D007407:Interviews as Topic; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000379:methods*; D012017:Referral and Consultation; D012648:Self Care; D006113:United Kingdom