The Health Foundation conducted a research in 2011 aimed at determining the effectiveness of supporting people to self-manage. The study examined more than five hundred pieces of literature and derived a conclusion that “self-management works.” Self-management includes all the actions employed by people in recognizing, treating and managing individual health independently or through partnering with the healthcare system. Encouraging patient self-management makes gain more confidence and such patients feel more engaged in their health matters. Therefore, one of the key ways of prioritizing person-centered care is through supporting patient self-management. (Turner et.al., 2015).
Self-management is one way of improving patient health outcomes especially patients with chronic illnesses. The healthcare system is excessively burdened and the time to be at the clinic is limited. It is for this reason that most health care professionals consider patient self-management as the only area that has the capacity to improve the quality of care. In addition reducing the cost for health care.
Importance of Patient Self-Management
High percentage of people living with chronic conditions
According to research conducted in the United States in 2014, 60% of the residents are living with chronic conditions with 42% reporting multiple chronic conditions. The chronic patients requires personalized support which helps in managing their health and social care resources. The self-management programs helps the patients to easily access their healthcare records. (Hibbard et.al., 2016)
Self-management helps to reduce health care costs
Supporting patients to be actively involved in the management of their health conditions assists in reducing service usage. In the United Kingdom, the NHS spends about 70% of its budget in caring for patients with long-term conditions. Research shows that the UK economy is likely to direct 16 billion sterling pounds in the next 10 years towards the care of people with heart diseases, diabetes and stroke. The care for people with chronic diseases in UK is mostly accomplished by the patients themselves, their life partners, family members and caregivers. However, if the patients could carry out the care for themselves, without requiring urgent care or hospital admissions, then this would make NHS more sustainable hence reducing the costs of care.
Chronic-disease patients require different types of support
The care requirements for people with chronic diseases are different from the casualties of emergency department. The patients with chronic diseases requires motivation, skills, information and confidence in making decisions which relate to their health. For instance, asthma patients require knowledge on the use of inhalers. Diabetic patients need skills of managing blood sugar levels and arthritic patients require information regarding pain management. Therefore, self-management are important because they teach the patients some of the skills mentioned above. (Bourbeau et al., 2016)
Patient require more support to self-manage
Almost every person wants to make the necessary efforts in maintaining and improving personal health, but an advice is needed to enable the process. According to a national survey conducted by NHS, many people are not getting sufficient support which is crucial in enabling them look after themselves effectively. Approximately 40% of the patients reported that they are not provided with written or printed information concerning what the measures they are supposed to take after leaving the hospital. Furthermore, the healthcare professionals do not provide patients with information regarding the side effects and dangers of prescribed medications. Self-management programs are crucial because they provide patients with the required information concerning medications.
Impact of not implementing the best practices.
Failure to implement patient self-management will lead to increase in mortality rates. Currently, the leading causes of mortality is chronic diseases which account for 60% of all deaths worldwide. The burden of chronic diseases is likely to increase in future due to present life-style patterns, aging population, diagnostic changes, and demographic trends. The failure to implement patient self-management will lead to increase in mortality because the patients will not have the skills required in managing the diseases.
Morbidity is the percentage of patients per given unit population suffering from a particular disease within a year. According to research, 60% of the residents in the United States are living with chronic diseases and failure to implement patient self-management will lead to increase of the morbidity rate.
Patient self-management improves the efficiency of health services by minimizing other kinds of utilization mainly hospital use and primary care. However, lack of implementing patient self-management forces the patients to rely on primary care and hospitals for drugs, medical advice and diagnosis which increases the financial costs.
Most self-management programs involve a support staff. This creates a situation where the patient interact closely with their care givers. This will result to a healthier patient who will be more involved and in control of his or her health and leading a more productive lifestyle. Being healthier and able to live productively is the desire of the patient and their satisfaction is when they can achieve this. Lack of patient self-management means the patient fully relies on the physicians and has to visit the hospital often or be on admission. This is costly and affects the patient’s productivity and thus the patient’s satisfaction.
Self-management as a best practice
Self-management does meet the conditions to be regarded as an evidence based exercise. It assists the learning patient to understand how to handle their health condition on their own and to embrace useful habits in handling their condition. The interventions help the patients make different the right and bad health habits. They guide patient to correctly record and monitor their habits thus enabling patient to handle their health on a daily basis. With time as the patient becomes more conversant with the system, some implementation responsibilities can be left to the patient. (Lorig et.al., 2014).
Practice guideline from Cochrane systematic review
Guidelines for good practice recommend the patients are fully educated about the details of their medical condition. They should receive regular checkups and observe their conditions with symptoms or a documented action plan. Interventions should be designed and personalized for each patient. They should aim to motivate, involve and support patient to adopt healthy habits positively. Action plans are regarded as an important part of these interventions and as way of evaluating the efficacy of the interventions. Self –management is known to improve the patients’ health outcome and quality of life as compared to the normal medical care.
Barriers of best practice in patient self-management.
Lack of clear mechanisms for primary care practices.
Compensations plans for external patient self- management support are put in place through means of contract. However there are no contracts currently arranged to negotiate with most of the organization that provide primary care. There are current compensation processes. However, they do not allow direct compensation of the primary health care staff that are involved in supporting the patients through self –management. Local primary care providers are mostly never compensated for their services.
Employer buyers can use their contracts to buy the services that support self- management or they can buy the services direct from the disease management vendors. However they cannot buy through direct contract with the physician groups or clinics.
Self-management support staff
The support staff are involved in supporting the patients. The responsibilities of self-management is given to a non-physician example a nurse who commit their time to support the patient. Nurses are seen to have the necessary knowledge to properly support the patient and they are greatly accepted by physicians. The professional nurses are however expensive to pay in the long term. They are also few nurses making it difficult for some patients to find personal nurses.
Nurses training often does not put much emphasis in interventions for behavior change. There is also need for more particularization in self-management, differentiating tasks for self-management and having various persons for different duties. The qualifications of a nurse are related to the cost. More specialization will demand for a higher cost in self-management Been-Dahmen et.al, 2015).
Implementation strategies to overcome barriers.
Preparation of the self-management system
This involves a collaborative engagement to make sure that the system is implemented in a way that is effective and efficient. The team could include the physicians the learning patient and others who provide services.
Teaching of the patient on how to use the self-management system.
The patient or the support staff should be understand the targeted changes in behaviors and be able to implement them.
Implementation of the self-management system
The physician should be able to provide the patient with the materials necessary for use or they can help them to collect the materials on their own and to initiate the self-management system on their own.
Promotion of independence with the system
The physician should conduct regular checks to check whether the patients continues to correctly self-record and gaining support to ensure they continue implementing the system correctly.
Patient self-management interventions go far beyond just simply giving patients the information. It also entails commitment to the patient care. Commitment to the patient involves giving clear information that is useful to the patient, assisting the patient to set goals and make personal plans to live a healthier life. Commitment also entails forming a team of medical practitioners and support staff who clearly understand their responsibilities. Follow up is also important and it can be done through phone calls, messaging or texting to continue supporting the patient.
Been-Dahmen, J.M., M., Staa, A., and Ista, E. (2015) Nurses views on patient self-management a qualitative study. Journal of advanced nursing, 71(12) 2834-3845
Bourbeau, J., Casan, P., Tognella, S., Haidl, P., Texereau, J. B., & Kessler, R. (2016). An international randomized study of a home-based self-management program for severe COPD: the COMET. International journal of chronic obstructive pulmonary disease, 11, 1447.
Hibbard, J.H, Greene, J., Sacks, R., Overton, V., and Parrotta, C, D (2016) Adding a measure of patient self-management capability to risk assessment can improve prediction of high costs. Health affairs 35.3 489-494
Lorig, K., Ritter, P. L., Pifer, C., & Werner, P. (2014). Effectiveness of the chronic disease self-management program for persons with a serious mental illness: a translation study. Community mental health journal, 50(1), 96-103.
Turner, A., Anderson, J. K., Wallace, L. M., & Bourne, C. (2015). An evaluation of a self-management program for patients with long-term conditions. Patient education and counseling, 98(2), 213-219.