title: Twelve evidence-based principles for implementing self-management support in primary care.
abstract: BACKGROUND
  Recommendations to improve self-management support and health outcomes for people with chronic conditions in primary care settings are provided on the basis of expert opinion supported by evidence for practices and processes. Practices and processes that could improve self-management support in primary care were identified through a nominal group process. In a targeted search strategy, reviews and meta-analyses were then identifed using terms from a wide range of chronic conditions and behavioral risk factors in combination with Self-Care, Self-Management, and Primary Care. On the basis of these reviews, evidence-based principles for self-management support were developed.
  
  
  RESULTS
  The evidence is organized within the framework of the Chronic Care Model. Evidence-based principles in 12 areas were associated with improved patient self-management and/or health outcomes: (1) brief targeted assessment, (2) evidence-based information to guide shared decision-making, (3) use of a nonjudgmental approach, (4) collaborative priority and goal setting, (5) collaborative problem solving, (6) self-management support by diverse providers, (7) self-management interventions delivered by diverse formats, (8) patient self-efficacy, (9) active followup, (10) guideline-based case management for selected patients, (11) linkages to evidence-based community programs, and (12) multifaceted interventions. A framework is provided for implementing these principles in three phases of the primary care visit: enhanced previsit assessment, a focused clinical encounter, and expanded postvisit options.
  
  
  CONCLUSIONS
  There is a growing evidence base for how self-management support for chronic conditions can be integrated into routine health care.
authors.affiliation: Flinders Human Behaviour and Health Research Unit, Margaret Tobin Centre, Flinders University, Adelaide, Australia. malcolm.battersby@flinders.edu.au
authors.forename: Malcolm
authors.initials: M
authors.lastname: Battersby
authors.forename: Michael
authors.initials: M
authors.lastname: Von Korff
authors.forename: Judith
authors.initials: J
authors.lastname: Schaefer
authors.forename: Connie
authors.initials: C
authors.lastname: Davis
authors.forename: Evette
authors.initials: E
authors.lastname: Ludman
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Greene
authors.forename: Melissa
authors.initials: M
authors.lastname: Parkerton
authors.forename: Edward H
authors.initials: EH
authors.lastname: Wagner
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D003299:Cooperative Behavior; D019317:Evidence-Based Medicine; D019983:Guideline Adherence; D006801:Humans; D010353:Patient Education as Topic / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration*; D011369:Professional-Patient Relations; D012648:Self Care / Q000379:methods*; D020377:Self Efficacy