Patient self-management of chronic disease in primary care.

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.

[1]  Anselm L. Strauss,et al.  Unending work and care: Managing chronic illness at home. , 1989 .

[2]  M. Funnell,et al.  Empowerment: An Idea Whose Time Has Come in Diabetes Education , 1991, The Diabetes educator.

[3]  E. Taal,et al.  Group education for patients with rheumatoid arthritis. , 1993, Patient education and counseling.

[4]  K. Lorig,et al.  Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. , 1993, Arthritis and rheumatism.

[5]  K. Lorig.  Living a healthy life with chronic conditions : self-management of heart disease, arthritis, stroke, diabetes, asthma, bronchitis, emphysema & others/ Kate Lorig ... [et al.] , 1994 .

[6]  J. Hewett,et al.  Effects of stress management on clinical outcomes in rheumatoid arthritis. , 1995, Arthritis and rheumatism.

[7]  Adrian Bauman,et al.  Evaluation of a community arthritis program in Australia: dissemination of a developed program. , 1995, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[8]  M. Funnell,et al.  Guidelines for Facilitating a Patient Empowerment Program , 1995, The Diabetes educator.

[9]  R. Glasgow,et al.  How Generalizable are the Results of Diabetes Self-Management Research? The Impact of Participation and Attrition , 1996, The Diabetes educator.

[10]  J. Barlow,et al.  Group education for people with arthritis. , 1996, Patient education and counseling.

[11]  J. Nilsson,et al.  A problem-based education program for patients with rheumatoid arthritis: evaluation after three and twelve months. , 1997, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[12]  K. Brandt,et al.  Effects of self-care education on the health status of inner-city patients with osteoarthritis of the knee. , 1997, Arthritis and rheumatism.

[13]  J. Schaefer,et al.  Collaborative Management of Chronic Illness , 1997, Annals of Internal Medicine.

[14]  A. Bandura.  Self-Efficacy: The Exercise of Control , 1997, Journal of Cognitive Psychotherapy.

[15]  J. Fries,et al.  Patient education in arthritis: randomized controlled trial of a mail-delivered program. , 1997, The Journal of rheumatology.

[16]  E. Taal,et al.  Coordinated individual education with an arthritis passport for patients with rheumatoid arthritis. , 1997, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[17]  Pierre-Andre La Chance,et al.  Long-term effects and costs of brief behavioural dietary intervention for patients with diabetes delivered from the medical office. , 1997, Patient education and counseling.

[18]  Suzanne G. Leveille,et al.  Preventing Disability and Managing Chronic Illness in Frail Older Adults: A Randomized Trial of a Community‐Based Partnership with Primary Care , 1998, Journal of the American Geriatrics Society.

[19]  The role of self-treatment guidelines in self-management education for adult asthmatics. , 1998, Respiratory medicine.

[20]  O Wiegman,et al.  Determinants of compliance with medication in patients with rheumatoid arthritis: the importance of self-efficacy expectations. , 1999, Patient education and counseling.

[21]  W. Bailey,et al.  Asthma self-management: do patient education programs always have an impact? , 1999, Archives of internal medicine.

[22]  P. Helliwell,et al.  A 12-month randomized controlled trial of patient education on radiographic changes and quality of life in early rheumatoid arthritis. , 1999, Rheumatology.

[23]  P. Bakke,et al.  Quality of life assessment after patient education in a randomized controlled study on asthma and chronic obstructive pulmonary disease. , 1999, American journal of respiratory and critical care medicine.

[24]  K. Lorig,et al.  Community-based Spanish language arthritis education program: a randomized trial. , 1999, Medical care.

[25]  R. Glasgow,et al.  In diabetes care, moving from compliance to adherence is not enough. Something entirely different is needed. , 1999, Diabetes care.

[26]  A. Stewart,et al.  Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. , 1999, Medical care.

[27]  D. Baucom,et al.  Spouse-assisted coping skills training in the management of knee pain in osteoarthritis: long-term followup results. , 1999, Arthritis care and research : the official journal of the Arthritis Health Professions Association.

[28]  S. Edworthy,et al.  Improving medication adherence through patient education distinguishing between appropriate and inappropriate utilization. Patient Education Study Group. , 1999, The Journal of rheumatology.

[29]  R. Glasgow,et al.  Evaluating the public health impact of health promotion interventions: the RE-AIM framework. , 1999, American journal of public health.

[30]  Robert M. Anderson,et al.  The Problem With Compliance in Diabetes , 2000 .

[31]  C. Wright,et al.  A randomized controlled study of the Arthritis Self-Management Programme in the UK. , 2000, Health education research.

[32]  L. Boulet,et al.  Influence of asthma education on asthma severity, quality of life and environmental control. , 2000, Canadian respiratory journal.

[33]  Robert M. Anderson,et al.  Compliance and Adherence are Dysfunctional Concepts in Diabetes Care , 2000, The Diabetes educator.

[34]  M. Hopman-Rock,et al.  The effects of a health educational and exercise program for older adults with osteoarthritis for the hip or knee. , 2000, The Journal of rheumatology.

[35]  Kate Lorig,et al.  Patients as partners in managing chronic disease , 2000, BMJ : British Medical Journal.

[36]  E. Groessl,et al.  A Cost Analysis of Self-Management Programs for People with Chronic Illness , 2000, American journal of community psychology.

[37]  J. Bland,et al.  A randomized controlled evaluation of specialist nurse education following accident and emergency department attendance for acute asthma. , 2000, Respiratory medicine.

[38]  S. Flocke,et al.  Facilitating Participatory Decision-Making: What Happens in Real-World Community Practice? , 2000, Medical care.

[39]  H. Sintonen,et al.  Long-term economic evaluation of intensive patient education during the first treatment year in newly diagnosed adult asthma. , 2001, Respiratory medicine.

[40]  S. Norris,et al.  Effectiveness of self-management training in type 2 diabetes: a systematic review of randomized controlled trials. , 2001, Diabetes care.

[41]  J. Pichert,et al.  A taxonomy for diabetes educational interventions. , 2001, Patient education and counseling.

[42]  A. Stewart,et al.  Chronic Disease Self-Management Program: 2-Year Health Status and Health Care Utilization Outcomes , 2001, Medical care.

[43]  Toward a Research Agenda for the American Association of Diabetes Educators , 2001, The Diabetes educator.

[44]  R. M. Anderson.  Using the empowerment approach to help patients change behavior , 2002 .

[45]  Thomas Bodenheimer,et al.  Improving primary care for patients with chronic illness. , 2002, JAMA.

[46]  M J Hensley,et al.  Self-management education and regular practitioner review for adults with asthma. , 2002, The Cochrane database of systematic reviews.

[47]  A. Hammond,et al.  The long-term outcomes from a randomized controlled trial of an educational–behavioural joint protection programme for people with rheumatoid arthritis , 2001, Clinical rehabilitation.