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 healthy behaviours; and as a fundamental transformation of the patient-caregiver relationship into a collaborative partnership (de Silva 2011).

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 2011c).
  • 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 2011c).
  • 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).

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 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 that aim to empower patients to improve their health. A review of the evidence has highlighted the importance of ensuring the intervention is tailored to the condition (de Sliva 2011). For example, structured patient education can be beneficial for people with diabetes, while people with depression may benefit more from cognitive and behavioural interventions.

Recent work conducted by the Richmond Group of Charities and The King's Fund (2012) called for patients to be offered the opportunity to co-create a personalised self-management plan which could include the following:

  • 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.

Useful resources

For more information