Clinical support for patient self management is rhetoric rather than reality

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Posted on 12 June 2013

Professor Carolyn Chew-Graham and Dr Joanne Protheroe, pictured, Primary Care and Health Sciences, were among a team of researchers who found that intervening in primary care to support primary care practitioners to help people to self-manage their illnesses does not lead to improved patient outcomes.

Self-management support aims to increase the patient's ability to take ownership over their condition and to self-manage. It is seen as critical to ensure the sustainability of health services. Although potentially effective, patient based interventions can be limited as not all patients engage with them. However, embedding self-management support discussions and decisions into everyday clinical practices is thought to encourage patients to become more actively involved in their care.

The study, carried out in the North West of England by and published in the BMJ, assessed a whole system intervention, which attempted to implement self-management support, led by the health service, for patients with diabetes, chronic obstructive pulmonary disease or irritable bowel syndrome. Despite undertaking training, feedback and assessments showed that while practices engaged with the training, they did not use the approach to improve shared decision-making with patients or encourage the take-up of self-management support.  The study was funded by National Institute for Health Research Programme Grants for Applied Research Programme and The National Primary Care Research and Development Centre.