title: Is Europe putting theory into practice? A qualitative study of the level of self-management support in chronic care management approaches.
abstract: BACKGROUND
  Self-management support is a key component of effective chronic care management, yet in practice appears to be the least implemented and most challenging. This study explores whether and how self-management support is integrated into chronic care approaches in 13 European countries. In addition, it investigates the level of and barriers to implementation of support strategies in health care practice.
  
  
  METHODS
  We conducted a review among the 13 participating countries, based on a common data template informed by the Chronic Care Model. Key informants presented a sample of representative chronic care approaches and related self-management support strategies. The cross-country review was complemented by a Dutch case study of health professionals' views on the implementation of self-management support in practice.
  
  
  RESULTS
  Self-management support for chronically ill patients remains relatively underdeveloped in Europe. Similarities between countries exist mostly in involved providers (nurses) and settings (primary care). Differences prevail in mode and format of support, and materials used. Support activities focus primarily on patients' medical and behavioral management, and less on emotional management. According to Dutch providers, self-management support is not (yet) an integral part of daily practice; implementation is hampered by barriers related to, among others, funding, IT and medical culture.
  
  
  CONCLUSIONS
  Although collaborative care for chronic conditions is becoming more important in European health systems, adequate self-management support for patients with chronic disease is far from accomplished in most countries. There is a need for better understanding of how we can encourage both patients and health care providers to engage in productive interactions in daily chronic care practice, which can improve health and social outcomes.
authors.affiliation: Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Duboisdomein 30, PO Box 616, 6200 MD, Maastricht, The Netherlands. a.elissen@maastrichtuniversity.nl
authors.forename: Arianne
authors.initials: A
authors.lastname: Elissen
authors.forename: Ellen
authors.initials: E
authors.lastname: Nolte
authors.forename: Cécile
authors.initials: C
authors.lastname: Knai
authors.forename: Matthias
authors.initials: M
authors.lastname: Brunn
authors.forename: Karine
authors.initials: K
authors.lastname: Chevreul
authors.forename: Annalijn
authors.initials: A
authors.lastname: Conklin
authors.forename: Isabelle
authors.initials: I
authors.lastname: Durand-Zaleski
authors.forename: Antje
authors.initials: A
authors.lastname: Erler
authors.forename: Maria
authors.initials: M
authors.lastname: Flamm
authors.forename: Anne
authors.initials: A
authors.lastname: Frølich
authors.forename: Birgit
authors.initials: B
authors.lastname: Fullerton
authors.forename: Ramune
authors.initials: R
authors.lastname: Jacobsen
authors.forename: Zuleika
authors.initials: Z
authors.lastname: Saz-Parkinson
authors.forename: Antonio
authors.initials: A
authors.lastname: Sarria-Santamera
authors.forename: Andreas
authors.initials: A
authors.lastname: Sönnichsen
authors.forename: Hubertus
authors.initials: H
authors.lastname: Vrijhoef
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D005060:Europe; D006801:Humans; D008962:Models, Theoretical; D019982:Organizational Case Studies; D036301:Qualitative Research; D012648:Self Care; D012944:Social Support