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Support of patient self-management is a key component of effective care and improved patient outcomes. Self-management support goes beyond traditional knowledge-based patient education to include processes that develop patient problem-solving skills, improve self-efficacy, and support application of knowledge in real-life situations that matter to patients. There is evidence from studies that:
- Programmes teaching self-management skills are more effective than information-only patient education in improving clinical outcomes.
- Self-management education can improve outcomes and can reduce costs for patients with chronic diseases.
- Self-management education programmes bringing together patients with a variety of chronic conditions can improve clinical outcomes and reduce costs.
However, more research is needed to explore long-term outcomes and the impact of self-management on clinical outcomes, and to identify responders and non-responders.
Expert patients are defined as people living with a long-term health condition who are able to take more control over their health by understanding and managing their conditions, leading to an improved quality of life. Becoming an expert patient is empowering for people with chronic conditions.
According to research, people who have trained in self-management tend to be more confident and less anxious. Self-management programmes have been shown to have benefits for patients with some diseases (eg, chronic obstructive pulmonary disease).However, there has been no evidence found for the benefit of self-management for other diseases (eg, osteoarthritis).
The concept of the expert patient has been considered for specific chronic conditions for many years and has now taken on a high profile within the NHS as a whole. Self Management UK provides courses which are designed to help patients with long-term conditions - to give people the tools, techniques and confidence to manage their condition better on a daily basis.
The aim is that expert patients should:
- Feel confident and in control of their lives.
- Aim to manage their condition and its treatment in partnership with healthcare professionals.
- Communicate effectively with professionals and be willing to share responsibility for treatment.
- Be realistic about the impact of their disease on themselves and their family; and
- Use their skills and knowledge to lead full lives.
Expert patient courses run for six weeks (two and a half hours per week). They are delivered by people who live with a long-term condition or by people who have direct experience of living with someone who has a long-term condition. There are a number of accredited bilingual tutors who can deliver the courses in community languages in a culturally appropriate manner. There are also courses for parents of children with chronic conditions and interactive web-based courses are being developed to learn to manage the day-to-day issues associated with living with a long-term health condition. In these programmes, people learn a variety of relevant skills, which include:
- Setting goals.
- Writing an action plan.
- Problem-solving skills.
- Fitness and exercise.
- Better breathing (participants are taught diaphragmatic breathing).
- Fatigue management.
- Healthy eating.
- Relaxation skills.
- Communication with family.
- Working better with healthcare professionals, including communicating more effectively with them.
- Making better use of medications.
Information on courses is available on the Self Management UK website.
Further reading and references
Shaw J, Baker M; "Expert patient"--dream or nightmare? BMJ. 2004 Mar 27328(7442):723-4.
Coleman MT, Newton KS; Supporting self-management in patients with chronic illness. Am Fam Physician. 2005 Oct 1572(8):1503-10.
Bodenheimer T, Lorig K, Holman H, et al; Patient self-management of chronic disease in primary care. JAMA. 2002 Nov 20288(19):2469-75.
Franek J; Self-management support interventions for persons with chronic disease: an evidence-based analysis. Ont Health Technol Assess Ser. 2013 Sep 113(9):1-60. eCollection 2013.
Lorig KR, Ritter P, Stewart AL, et al; Chronic disease self-management program: 2-year health status and health care utilization outcomes. Med Care. 2001 Nov39(11):1217-23.
Zwerink M, Brusse-Keizer M, van der Valk PD, et al; Self management for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2014 Mar 193:CD002990. doi: 10.1002/14651858.CD002990.pub3.
Kroon FP, van der Burg LR, Buchbinder R, et al; Self-management education programmes for osteoarthritis. Cochrane Database Syst Rev. 2014 Jan 151:CD008963. doi: 10.1002/14651858.CD008963.pub2.