Read below to learn why patient self-management is central to the development of new patient-provider relationships and how the six topics in the “Health Care Providers” section of the website can help you support patient self-management.
What is Self-Management Support (SMS)?
Patients with chronic conditions must manage and cope with their illness every day. In order to manage their conditions, patients need
Self-management support is the assistance caregivers give patients with chronic disease in order to encourage daily decisions that improve health-related behaviors and clinical outcomes. [It] can be viewed in two ways: as a portfolio of techniques and tools that help patients choose healthy behaviors; and a fundamental transformation of the patient-caregiver relationship into a collaborative partnership.”
T Bodenheimer, et al; Helping Patients Manage Their Chronic Conditions, www.chcf.org.
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to master many skills, including: monitoring their condition; taking medications and administering treatments; evaluating and managing symptoms; making adjustments in physical activity and diet; coping with the emotional aspects of having a chronic condition; and learning how to overcome obstacles to performing important social roles as workers, students or members of a family. Simply providing information, writing prescriptions, offering information and making referrals to educational programs are not enough to help patients manage all of these aspects of having a chronic condition. Research has demonstrated that didactic educational programs alone are not sufficient to achieve improved self-management. On the other hand, there is substantial research evidence indicating that patients who become more actively engaged in managing their condition are not only more confident; they achieve better clinical and functional outcomes.
The Role of Teams and Systems in SMS
According to the Institute of Medicine, self-management support is accomplished by systematically using education and supportive interventions to increase patients' skills and confidence in managing their health problems. This definition of self-management support implies that no one clinician is responsible for insuring that patients are able to become effective self-managers. Rather, systems are needed to help clinical teams to provide self-management support to patients and/or family members. Self-management support is not an event or a course or a program; it is a process that recurs over the course of a patient’s illness.
Over time, with the assistance of their clinical care team, patients gradually develop all the skills and competencies needed to address the challenges of having a chronic condition.
Provider Skills and Competencies
Research has indicated that successful self-management support interventions include the following key elements:
- Patient-centered approaches that build trust, shared understanding and strong provider-patient relationships
- Individualized assessment of patient needs, values and preferences
- Collaborative goal setting and action planning
- Skill building and problem-solving
- Linkage to community resources and programs
- Repeated follow-up contacts
Thus, in order to provide effective self-management support, clinicians need to develop specific skills or competencies in each of these elements. Though not every clinician needs to become expert in supporting the development of these core competencies, those providers who are primarily responsible for self-management support need training to help them do this well. Moreover, as noted previously, all members of the clinical team need to be engaged in this work, and the clinical systems we depend on will most likely need to be modified to help clinical teams efficiently deliver SMS within the context and flow of routine clinical care.
An Example of Delivery System Redesign
Particularly in primary care settings, teamwork is needed to share the responsibility and burden of providing self-management support across team members. Thus, for example, in some settings medical assistants will engage the patient and complete initial assessment of needs and identification of self-management goal preferences; a primary care clinician will then collaborate with the patient in setting a specific goal; and a nurse or health educator will develop a detailed action plan and provide follow-up to review progress and help solve problems as necessary. This may require delivery system redesign or adoption of innovative ways to integrate self-management support into existing chronic care visits.
Helpful Resources
Health care teams have developed several useful tools and resources to enhance the process of self-management support. These include assessment tools, goal-setting and action planning forms, and educational materials to help patients understand the value of not simply of engaging in but of continually striving to enhance their self-management activities.
Tools for evaluating patients’ experience with self-management support are quite useful as teams strive to improve care. When incorporated into electronic medical records or other information systems, these tools can also be used to document goals and objectives, to keep track of patient progress and as prompts for both team members and patients.
Michael G. Goldstein, M.D.
Associate Director, Institute for Healthcare Communication
Adjunct Professor, Alpert Medical School of Brown University
Faculty Chair, New Health Partnerships Learning Community
This introduction is based on a piece by Dr. Goldstein first published in HealtheBytes, 12/07.Reprinted here, with permission.