1.1: An Introduction to Self-management

David Featherston

Self-management

Chronic disease now accounts for over 70% of the disease burden in Australia⁽¹⁾ and chronic conditions are the leading cause of illness in New Zealand accounting for approximately 80% of all deaths.⁽²⁾ Chronic disease is expected to increase to 80% in Australia by 2020.⁽¹⁾ In response to these statistics the Australian Government has introduced the National Chronic Disease Strategy, with self-management a key action area.⁽¹⁾ Research indicates that effective self-management skills can improve self-efficacy^(3,4) and reduce health care costs through fewer outpatient visits.⁽³⁾

The term self-management is often misunderstood by patient, carer and psychiatrist. The terms ‘self’ and ‘manage’ suggest that the patient has ownership of their condition, and will be responsible for managing their condition in isolation and without assistance. This is not the case. Self-management is the patient working in partnership with others, including health providers and carers to promote their health, manage their signs and symptoms, monitor behaviours and manage the impact of their condition.⁽⁵⁾ A good self-manager knows about their condition and is able to access resources and services to improve their every day quality of life.⁽⁶⁾

An effective partnership or collaborative approach, where a psychiatrist works alongside the patient, carer and other health professionals to support the patient, ensures the best possible outcomes for the patient.⁽⁶⁾

A self-management case study

The following case study has been extracted from research on applying self-management to patients with comorbid mental illness and substance abuse, using person-centred motivational behaviour change tools. The complexity of this patient’s situation would most likely exclude him from a range of therapies and treatments. A full copy of this case study can be found in the paper by Lawn et al.⁽⁷⁾ It is worth noting that in this case study, developing a social network is not covered. Establishing a social network is considered essential in self-management and would be a useful next step.

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References

Jordan JE, Osborne RH. Chronic disease self-management education programs: challenges ahead. Med J Australia 2007; 186(1): 84–7
National Health Committee. Meeting the Needs of People with Chronic Conditions. National Health Committee. Wellington, 2007.
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; 39(11):1217–23.
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 Aging, 2007.
NSW Chronic Care Program – Implementing Rehabilitation for Chronic Disease. NSW Department of Health, Sydney, 2006.
Warren K, Coulthard F, Harvey P. Elements of successful chronic condition self-management program for Indigenous Australians. 8th National Rural Health Conference, Alice Springs, 2005.
Lawn S, Pols RG, Battersby MW. Myth exploded. Working effectively with patients with comorbid mental illness and substance abuse: a case study using a structured motivational behavioural approach. BMJ Case Reports 2009 [doi:10.1136/bcr.08.2008.0674]

Continue to Module 1.2: Defining Terms - 'Chronic' and 'Disease'.