1. Active support for self management

What is it?

Self-management support can be viewed in two ways: as a portfolio of techniques and tools to help patients choose health behaviours; and a fundmental transformation of the patient-caregiver relationship into a collaborative partnership.

Why is it important?

• Around 15 million people in England have one or more long-term conditions. The number of people with multiple long-term conditions is predicted to rise by a third over the next ten years (Department of Health 2011a).
• People with long-term conditions are the most frequent users of health care services, accounting for 50 per cent of all GP appointments and 70 per cent of all inpatient bed days. Treatment and care of those with long-term conditions accounts for 70 per cent of the primary and acute care budget in England (Department of Health 2011a).
• At the heart of the chronic disease management model (Wagner et al 1996) is the informed, empowered patient with access to continuous self-management support.
• Around 70-80 per cent of people with long-term conditions can be supported to manage their own condition (Department of Health 2005).
• Around 70-80 per cent of people with long-term conditions can be supported to manage their own condition (Department of Health 2005).

What is the impact?

• Self-management has potential to improve health outcomes in some cases, with patients reporting increases in physical functioning (Challis et al 2010).
• Self-management can improve patient experience, with patients reporting benefits in terms of greater confidence and reduced anxiety (Challis et al 2010).
• Self-management programmes have been shown to reduce unplanned hospital admissions for chronic obstructive pulmonary disease (COPD) and asthma (Purdy 2010) and to improve adherence to treatment and medication (Challis 2010), but evidence that this translates into cost savings is more equivocal. A cost analysis performed in the United States did indicate that expenditure in other parts of the system can be reduced (Stearns et al 2000).

How to do it

There are a number of well-established self-management programmes. Any of the following could be offered as a stand-alone intervention or as part of a package of care:

• patient and carer education programmes
• medicines management advice and support
• advice and support about diet and exercise
• use of telecare and telehealth to aid self-monitoring
• psychological interventions (eg, coaching)
• telephone-based health coaching
• pain management
• patient access to their own records
• systematic training for GPs in consultation skills that help engage patients.

Many of these interventions are provided by professionals from within the health care team, but some can be delivered by other patients or the voluntary and community sector (Campbell et al 2004). Commissioners can draw on a range of existing examples, such as the DESMOND programme introduced widely across the NHS for people with diabetes.

Useful resources

• The self-management website is a new resource for all those involved in the self-management community: tutors, assessors and trainers of tutors, delivery organisations and health professionals.
• The Health Foundation has launched a self-management support resource centre that includes research reports and practical tools and approaches.
• Birmingham University has a useful webpage that introduces the DAPHNE and DESMOND diabetes education programmes.

For more information