Videos - Why self-manage?
Self-management works. The evidence base is growing but already we know enough to say that it can help patients feel better and avoid emergency hospital admissions - but only with the right support and intervention...Via crowdhealth
If a health authority’s view of self-management is to stick someone in their kitchen armed only with a mobile phone, then failure will be the likely outcome. On the other hand, if a patient is encouraged and supported through a realistic, agreed plan and given the right knowledge and skills, then there is a decent chance that his or her health outcomes and quality of life can be improved.
Enough good quality data exists to suggest that self-management is a path well worth pursuing. A Health Foundation review of 550 pieces of research looked at programmes ranging from handing out leaflets to tele-monitoring via intensive telephone coaching and structured education. Perhaps unsurprisingly, the review shows that some approaches are significantly more effective than others but it concludes that self-management works, particularly if support focuses on actively changing patients’ behaviour and on helping them become effective managers of their condition. Passively just giving them information about healthy living is, however, unlikely to be enough in many cases.
For example, a Cochrane review of 36 randomised trials of asthma self-management programmes found those which enabled people to adjust their medication using a written action plan were more effective than others.
On a more technical level, one trial in Germany found that an electronic self-monitoring blood glucose device for people with diabetes improved glycaemic control and general wellbeing, an approach which has also shown benefits in people with high blood pressure.
But approaches need to take different circumstances into consideration: people with diabetes, say, may also benefit from education on how to eat, exercise and take their medication. On the other hand those with depression or chronic pain might require more cognitive and behavioural interventions, the Foundation’s analysis finds, while acknowledging that these approaches may be equally valuable for people with diabetes – a reminder that self-management as a formal concept is in its infancy.
Overall, the evidence suggests ‘that there is likely to be a relationship between supporting self-management and clinical outcomes’.
A report from the Department of Health similarly suggests outcmes in research trials of self-management are 'predominantly positive', with the best showing increases in life expectancy, better quality of life, fewer hospital admissions and reduction of the need for GP appointments.
Since the 30% of patients with long-term conditions currently account for 70% of NHS spending – and since, the DH says, 39% of GPs’ time is spent dealing with self-treatable minor ailments, and 75% of A&E attendances are for minor cases - then the potential is clear.
It would be wrong to suggest that this bright picture means that all doctors currently know exactly how to help all patients in all cases – but it does mean that the paths towards self-management are being actively sought and, increasingly, found.
People make choices - escalator or stairs, car or walk, burger or salad – relating to their health every day. With more targeted help, this can be extended to make a real, tangible difference.
January Thu, 1970 - 12:01 AM
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