title: Chronically ill patients' self-management abilities to maintain overall well-being: what is needed to take the next step in the primary care setting?
abstract: BACKGROUND
  Although widespread problems in patient-professional interaction and insufficient support of patients' self-management abilities have been recognized, research investigating the relationships among care quality, productive interaction, and self-management abilities to maintain overall well-being is lacking. Furthermore, studies have revealed differences in these characteristics among certain groups (e.g., less-educated and older patients). This longitudinal study thus aimed to identify relationships among background characteristics, quality of care, productivity of patient-professional interaction, and self-management abilities to maintain overall well-being in chronically ill patients participating in 18 Dutch disease management programs.
  
  
  METHODS
  This longitudinal study included patients participating in 18 Dutch disease management programs. Surveys were administered in 2011 (T1; n = 2191 (out of 4693), 47 % response rate) and 2012 (T2: n = 1722 (out of 4350), 40 % response rate). A total of 1279 patients completed questionnaires at both timepoints (T1 and T2) (27 % response rate). Self-management abilities to maintain well-being were measured using the short (18-item) version of the Self-Management Ability Scale (SMAS-S), patients' perceptions of the productivity of interactions with health care professionals were assessed with the relational coordination instrument and the short (11-item) version of the Patient Assessment of Chronic Illness Care (PACIC-S) was used to assess patients' perceptions of the quality of chronic care delivery.
  
  
  RESULTS
  Perceived and objective quality of care and the productivity of patient-professional interaction were found to be related to patients' self-management abilities to maintain overall well-being. These abilities were related negatively to and significantly predicted by low educational level, single status, and older age, despite the mediating role of productive interaction in their relationship with patients' perceptions of care quality.
  
  
  CONCLUSIONS
  These findings suggest that patient-professional interaction is not yet sufficiently productive to successfully protect against the deterioration of self-management abilities in some groups of chronically ill patients, although such interaction and high-quality care are important factors in such protection. Improvement of the quality of chronic care delivery should thus always be accompanied by investment in high-quality communication and patient-professional relationships.
authors.affiliation: Institute of Health Policy & Management (iBMG), Erasmus University, Rotterdam, The Netherlands. cramm@bmg.eur.nl.
authors.forename: Jane Murray
authors.initials: JM
authors.lastname: Cramm
authors.affiliation: Institute of Health Policy & Management (iBMG), Erasmus University, Rotterdam, The Netherlands. nieboer@bmg.eur.nl.
authors.forename: Anna Petra
authors.initials: AP
authors.lastname: Nieboer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000628:therapy*; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000379:methods*; D011787:Quality of Health Care; D012648:Self Care; D011795:Surveys and Questionnaires; D055815:Young Adult