1.4: Evidence-based Research for Chronic Condition Self-management I
Research evidence to support self-management
Early research work on the effectiveness of self-management was conducted at the Stanford Patient Education Research Center, led by Professor Kate Lorig.(1) Through extensive studies, Lorig and her team developed a Chronic Disease Self-management Program (CDSMP). The CDSMP has proven positive health outcomes for patients with generic as well as illness-specific conditions. This includes reduced emergency department and outpatient visits, reduced health distress and increased self-efficacy.(2) A review of CDSMP studies by Gordon et al found strong evidence to support a beneficial effect on physical and emotional outcomes and improvements in health-related quality of life.(3) The authors reviewed studies in a wide variety of chronic illnesses and found that CDSMP patients show consistently greater energy/reduced fatigue, exercise more, have fewer social role limitations, have increased psychological well-being, have enhanced partnerships with physicians, display improved health status and have greater self-efficacy.(3)
In the United Kingdom, the Expert Patients Programme is central to the chronic disease management policy.(4) Like many other models now available, such as the Living a Healthy Life Course in New Zealand, the program is an adaptation of the CDSMP.(5)
In Australia, the Flinders Program of Self-management is gaining significant recognition and has been endorsed by a number of Australian State Departments of Health and health service sectors as part of their efforts to reduce the burden of chronic disease.(6,7) The program, underpinned by cognitive behaviour therapy, is administered by the clinician and includes a semi-structured assessment of self-management strengths and barriers and sets goals. A twelve-month care plan is created and agreed upon by the patient and the clinician, which incorporates medical and self-management actions.(8)
Recent work by Lawn et al using the patient-centred Flinders program offers weight to self-management care planning being applicable to patients with mental illness.(8) A feasibility study indicated that the Stanford CDSMP was applicable and acceptable to patients with serious mental illnesses as part of an overall self-management strategy resulting in an improvement in self-management and mental functioning at three to six months follow-up.
Summary of research studies
To view a summary of the research studies please click here.
Patient-centred care
Health care that is person- or patient-centred is focused on the needs, goals, beliefs and concerns of that individual rather than the needs of the system or health professionals. In this approach, the patient feels understood, appreciated and involved in the management of their condition. Research supports the notion that people are empowered by learning skills and having the ability to gain control of their lives and that this is preferable to others taking responsibility.(9)
In New Zealand, ‘people-centred’ is referred to in the Improving Quality document as
“…the extent to which a service involves people, including consumers, their families and whanau and is receptive to their needs and values.”(10)
Common themes in patient-centred care have been identified as:
- informing and involving patients
- eliciting and respecting patient preferences
- engaging patients in the care process
- treating patients with dignity
- designing care processes to suit patient needs, not providers
- ready access to health information – both paper and electronic
- continuity of care.(11)
There is growing evidence to support a patient-centred approach. Benefits have been determined as:
- improved patient satisfaction
- improved patient compliance and engagement in health process
- reduced anxiety
- improved quality of life
- improved efficiency of care.(11)
References
- Stanford Patient Education Research Center. Stanford School of Medicine, 2009. Available from: http://patienteducation.stanford.edu/
- Lorig KR, Sobel DS, Stewart AL et al. Chronic disease self-management program : 2-year health status and health care utilization outcomes. Medical Care 2001;38:121-3.
- Gordon C, Galloway T. Review of findings on Chronic Disease Self-Management Program (CDSMP) Outcomes: Physical, emotional & health related quality of life, healthcare utilization and costs. National Council on Ageing, 2007. http://patienteducation.stanford.edu/research/Review_Findings_CDSMP_Outcomes1%208%2008.pdf
- EPP CIC Self-management courses. Expert Patients Programme website, 2009. Available from: http://www.expertpatients.co.uk
- Common models of chronic disease self-management support: Fact sheet for primary care partnerships. Department of Health, Victoria. Available from: http://www.health.vic.gov.au/communityhealth/downloads/fact_sheet5.pdf.
- NSW Chronic Care Program Phase Three: 2006–2009. NSW Health. Available from: http://www.health.nsw.gov.au
- Chronic disease. General Practice Queensland. http://www.gpqld.com.au/page/Programs/Chronic_Disease
- Lawn S, Battersby MW, Pols RG, Lawrence J, Parry T, Urukalo M. The mental health expert patient: findings from a pilot study of a generic chronic condition self-management programme for people with mental illness. Int J Soc Psychiatry 2007;53(1): 63-74
- Lawn S, Battersby MW. Skills for person-centred care: health professionals supporting chronic condition preventions and self-management, in D’Cruz HM, Jacobs SW, Schoo A (Eds). Knowledge-in-practice in the caring professions: Multidisciplinary perspectives. Ashgate Publishing Ltd, England, 2009.
- Minister of Health. Improving Quality (IQ): A systems approach for the New Zealand Health and Disability Sector. Wellington, New Zealand, 2003.
- Robb G, Seddon M. Quality improvement in New Zealand healthcare. Part 6: keeping the patient front and centre to improve healthcare quality. The New Zealand Medical Journal 2006;119(1242):U2174.
