The challenge of integrating self-management support into clinical settings.
Best practice diabetes mellitus clinical treatment and education takes place in the medical clinic, however, patient outcomes are largely mediated through their own behaviour and lifestyle that occurs after they leave the clinical setting. Once they return home, people usually continue to engage in the social, cultural and lifestyle behaviours that had contributed to having diabetes in the first place. Although a host of factors (e.g. economic, health care team and system, condition and client-related) can impact a client's capacity to self-manage, there are client, organizational and community level strategies that may partially mitigate these difficulties. To address client behaviour, clinicians are increasingly becoming skilled to incorporate self-management support including behavioural counselling interventions into routine practice. At the organizational level, the operation and structure of the clinical setting may create difficulty for staff to provide self-management support. Sustaining benefits on a day-to-day basis presents an additional challenge. This article will review several common implementation barriers to self-management support and describe strategies and techniques used elsewhere to successfully integrate self-management support as a core care component for persons with diabetes.
Professor, School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada. Electronic address: pmcgowan@uvic.ca.
Patrick
P
McGowan
D003920:Diabetes Mellitus / Q000628:therapy*; D037001:Directive Counseling / Q000379:methods*; D006801:Humans; D008019:Life Style; D062405:Motivational Interviewing; D012648:Self Care; D012657:Self-Help Groups
behavioural change strategies; continuity of care; continuité des soins; formation du personnel; organizational level strategies; self-management support; soutien à la prise en charge autonome; staff education; stratégies de changement de comportement; stratégies sur le plan organisationnel