title: Self-management support: a new approach still anchored in an old model of health care.
abstract: BACKGROUND
  Studies show the great potential for self-management to improve health outcomes, yet it is carried out in a limited way by patients and providers. This study investigated the provider perspective of existing self-management support resources in a region of 1.2 million people. Participants included physicians, nurses, nurse practitioners, educators, and program managers.
  
  
  METHODS
  Qualitative study using semi-structured, one-on-one interviews. An iterative immersion/crystallization process identified key themes and new questions and was built on a grounded theory approach. Triangulation was used to validate findings by comparing with data from a related provider workshop and presenting significant findings in follow-up interviews with select individuals.
  
  
  RESULTS
  There was a lack of understanding about self-management. Existing programs lacked an evidence-based approach and were often entrenched in a single disease-focus model of care, despite a majority of patients served having multiple chronic conditions. A new approach to self-management support was desired, although often anchored in an old model of revolving doors for patients. Self-management was described as burdensome for patients and providers alike. There was disbelief about program effectiveness and frustration about lack of sustainability.
  
  
  CONCLUSIONS
  Understanding the perspectives of providers engaged in self-management support is a critical first step in developing regional strategies for such support programs. A better understanding of the comprehensive and long-term nature of self-management support is needed. System reform promoting integration of services is essential to enable providers to offer patient-centred self-management support.
authors.affiliation: Department of Family Medicine, University of Ottawa, Ottawa, ON. sjohnston@bruyere.org
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Johnston
authors.forename: Clare E
authors.initials: CE
authors.lastname: Liddy
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Ives
mesh_terms: D001291:Attitude of Health Personnel; D002170:Canada; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D015897:Comorbidity; D005260:Female; D006293:Health Promotion / Q000458:organization & administration*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D009864:Ontario; D010346:Patient Care Management / Q000458:organization & administration*; D011203:Poverty; D012648:Self Care