The theory and evidence behind self management

1. The theory and evidence behind self management Natalie Grazin Assistant Director The Health Foundation

2. Why support self-management? Life with a long term condition: the person’s perspective Problem solving: Time limited consultation/s providing motivational support Interactions with the service: planned or unplanned Care planning: A system of regularscheduled appointments, providing proactive structured support Care pathways: providing specific interventions NB : People may also be accessing a wide variety of other support e.g. from within their communities

3. What is self-management support? “Self management support can be viewed in two ways: as a portfolio of techniques and tools that help patients choose healthy behaviours; and a fundamental transformation of the patient-caregiver relationship into a collaborative partnership.” Bodenheimer T, MacGregor K, Shafiri C (2005). Helping Patients Manage Their Chronic Conditions. California: California Healthcare Foundation.

4. The Chronic Care Model • The problems: • Lack of care coordination • Lack of active follow-up • Patients inadequately trained to manage their illnesses ‘Overcoming these deficiencies will require nothing less than a transformation of health care, from a system that is essentially reactive - responding mainly when a person is sick - to one that is proactive and focused on keeping a person as healthy as possible.’

5. The Chronic Care Model ‘Overcoming these deficiencies will require nothing less than a transformation of health care, from a system that is essentially reactive - responding mainly when a person is sick - to one that is proactive and focused on keeping a person as healthy as possible.’ Understanding have role; confident and capable in role Supporting people on their journey of activation Developed by the MacColl Institute ACP-ASIM Journals and Books

6. The evidence Evidence for supporting self management grows every year. • Research is up to date • Internationally, studies are consistently positive • Research has used a range of methodologies. • Studies are from small to large scale. It shows that supporting self-management can improve: • self confidence / self efficacy • self management behaviours • quality of life • clinical outcomes • patterns of healthcare use

7. Active support works best Research shows that more active support focused on self-efficacy (confidence) and behaviour works best to improve outcomes. Information and knowledge alone are not enough.

8. Active support works best Approaches that focus on whether people are ready to change work well. Source: Prof Judy Hibbard, University of Oregon

9. Examples of improvement • Self monitoring and agenda setting reduce hospitalisations, A&E visits, unscheduled visits to the doctor and days off work or school for people with asthma (Gibson et al 2004). • Goal setting for older women with heart conditions reduces days in hospital and overall healthcare costs (Wheeler et al 2003). • Telephone support may improve self care behaviour, glycaemic control, and symptoms among vulnerable people with diabetes (Piette et al 2000). • Motivational interviewing improve self efficacy, patient activation, lifestyle change and perceived health status (Linden et al 2010). • Individual education and group sessions improve symptoms for people with high blood pressure (Boulware et al 2001).

10. More information Visit our self management support resource centre on the Health Foundation’s website: www.health.org.uk/sms