Modelling self-management pathways for people with diabetes in primary care.
BACKGROUND
Self-management support to facilitate people with type 2 diabetes to effectively manage their condition is complex to implement. Organisational and system elements operating in relation to providing optimal self-management support in primary care are poorly understood. We have applied operational research techniques to model pathways in primary care to explore and illuminate the processes and points where people struggle to find self-management support.


METHODS
Primary care clinicians and support staff in 21 NHS general practices created maps to represent their experience of patients' progress through the system following diagnosis. These were collated into a combined pathway. Following consideration of how patients reduce dependency on the system to become enhanced self-managers, a model was created to show the influences on patients' pathways to self-management.


RESULTS
Following establishment of diagnosis and treatment, appointment frequency decreases and patient self-management is expected to increase. However, capacity to consistently assess self-management capabilities; provide self-management support; or enhance patient-led self-care activities is missing from the pathways. Appointment frequencies are orientated to bio-medical monitoring rather than increasing the ability to mobilise resources or undertake self-management activities.


CONCLUSIONS
The model provides a clear visual picture of the complexities implicated in achieving optimal self-management support. Self-management is quickly hidden from view in a system orientated to treatment delivery rather than to enhancing patient self-management. The model created highlights the limited self-management support currently provided and illuminates points where service change might impact on providing support for self-management. Ensuring professionals are aware of locally available support and people's existing network support has potential to provide appropriate and timely direction to community facilities and the mobilisation of resources.
Southampton General Hospital, Mailpoint 11, AA72, South Academic Block, Tremona Road, Southampton, SO16 6YD, UK. M.L.Penn@soton.ac.uk.
Marion L
ML
Penn
NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Faculty of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK. a.kennedy@soton.ac.uk.
Anne P
AP
Kennedy
NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Faculty of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK. I.I.Vassilev@soton.ac.uk.
Ivaylo I
II
Vassilev
Research Institute, Primary Care & Health Sciences, and NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) West Midlands, Keele University, Keele, Staffordshire, ST5 5BG, UK. c.a.chew-graham@keele.ac.uk.
Carolyn A
CA
Chew-Graham
Research Institute, Primary Care & Health Sciences, and NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) West Midlands, Keele University, Keele, Staffordshire, ST5 5BG, UK. j.protheroe@keele.ac.uk.
Joanne
J
Protheroe
NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Faculty of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK. a.e.rogers@soton.ac.uk.
Anne
A
Rogers
Southampton General Hospital, Mailpoint 11, AA72, South Academic Block, Tremona Road, Southampton, SO16 6YD, UK. thomas.monks@soton.ac.uk.
Tom
T
Monks
D019091:Critical Pathways / Q000458:organization & administration; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000628:therapy*; D006801:Humans; D017146:Models, Organizational; D011320:Primary Health Care / Q000379:methods; D012648:Self Care; D013222:State Medicine; D006113:United Kingdom