Patient Self-management of Chronic Disease in Primary Care

TLDR

Patients with chronic conditions increasingly self‑manage their illnesses through a partnership with professionals that emphasizes problem‑solving skills and self‑efficacy beyond traditional information‑only education. Controlled trials show that self‑management programs outperform information‑only education, improve outcomes and lower costs for arthritis and possibly asthma, and that multi‑condition programs may further enhance outcomes and cost savings, suggesting a future role in high‑quality primary care.

Abstract

Patients with chronic conditions make day-to-day decisions about--self-manage--their illnesses. This reality introduces a new chronic disease paradigm: the patient-professional partnership, involving collaborative care and self-management education. Self-management education complements traditional patient education in supporting patients to live the best possible quality of life with their chronic condition. Whereas traditional patient education offers information and technical skills, self-management education teaches problem-solving skills. A central concept in self-management is self-efficacy--confidence to carry out a behavior necessary to reach a desired goal. Self-efficacy is enhanced when patients succeed in solving patient-identified problems. Evidence from controlled clinical trials suggests that (1) programs teaching self-management skills are more effective than information-only patient education in improving clinical outcomes; (2) in some circumstances, self-management education improves outcomes and can reduce costs for arthritis and probably for adult asthma patients; and (3) in initial studies, a self-management education program bringing together patients with a variety of chronic conditions may improve outcomes and reduce costs. Self-management education for chronic illness may soon become an integral part of high-quality primary care.