The UK ''Expert Patient Program'' and self-care in chronic disease management: An analysis

Abstract The increase in chronic illness and co-morbidity has resulted in a shift in responsibility and self-care initiatives to the patient and away from the caregivers. The notion of self-care is internationally being recognized as a component of chronic disease management. In the recent decade, public health policymaker's and health services researchers likewise have been advocating a change in relationship between individual's health needs and responsibilities and the state. The Chronic Disease Self-Management Program, developed in the USA and adopted in UK as the Expert Patients Program, has an overall objective to encourage patients suffering from chronic conditions to become more involved in their own treatment process. Despite its potential in empowering patients, the Expert Patients Program has failed to reach those most in need and recognized as perpetuating the traditional orthodox medical model. The idea of “The Expert Patient” as is now faced with a number of contextual problems including clinicians’ lack of engagement with the program, recruitment, lack of course materials specifically designed for particular chronic condition. Additionally, the EPP has been blamed for its inability to foster alliance between professional and patient. The unanswered question is that if the current popularity in “Self Care” trend is an outcome of uniquely broken healthcare systems desperately seeking a fix or a genuine effort in resurrection of “patient-provider alliance” for a better chronic disease care outcome?

[1]  C. Plews.  Expert Patient Programme: managing patients with long-term conditions. , 2005, British journal of nursing.

[2]  P. Bower,et al.  Predicting who will benefit from an Expert Patients Programme self-management course. , 2008, The British journal of general practice : the journal of the Royal College of General Practitioners.

[3]  T. Bodenheimer,et al.  Patient self-management of chronic disease in primary care. , 2002, JAMA.

[4]  Gene Feder,et al.  Randomised controlled trial of a lay-led self-management programme for Bangladeshi patients with chronic disease. , 2005, The British journal of general practice : the journal of the Royal College of General Practitioners.

[5]  L. Whitehead,et al.  Evolution of the concept of self-care and implications for nurses: a literature review. , 2009, International journal of nursing studies.

[6]  P. Wilson,et al.  A policy analysis of the Expert Patient in the United Kingdom: self-care as an expression of pastoral power? , 2001, Health & social care in the community.

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

[8]  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.

[9]  Angela Robinson,et al.  Variability in patient preferences for participating in medical decision making: implication for the use of decision support tools , 2001 .

[10]  P. Bower,et al.  What makes a successful volunteer Expert Patients Programme tutor? Factors predicting satisfaction, productivity and intention to continue tutoring of a new public health workforce in the United Kingdom. , 2009, Patient education and counseling.

[11]  C. Griffiths,et al.  How effective are expert patient (lay led) education programmes for chronic disease? , 2007, BMJ : British Medical Journal.

[12]  A. Kennedy,et al.  Assessing the introduction of the expert patients programme into the NHS: a realistic evaluation of recruitment to a national lay-led self-care initiative , 2005, Primary Health Care Research & Development.

[13]  K. Lorig,et al.  Effect of a self-management program on patients with chronic disease. , 2001, Effective clinical practice : ECP.

[14]  From Patient to Consumer in the Medical Marketplace , 2006, Cambridge Quarterly of Healthcare Ethics.

[15]  A. Kennedy,et al.  From patients to providers: prospects for self-care skills trainers in the National Health Service. , 2005, Health & social care in the community.

[16]  S. May,et al.  Self-management of chronic low back pain and osteoarthritis , 2010, Nature Reviews Rheumatology.

[17]  J. Dixon,et al.  Rethinking management of chronic diseases , 2004, BMJ : British Medical Journal.

[18]  P. Tengland.  Empowerment: A goal or a means for health promotion? , 2007, Medicine, health care, and philosophy.

[19]  Isabelle Aujoulat,et al.  Reconsidering patient empowerment in chronic illness: a critique of models of self-efficacy and bodily control. , 2008, Social science & medicine.

[20]  P. Tengland.  Empowerment: A Conceptual Discussion , 2008, Health Care Analysis.

[21]  S. Kendall,et al.  The Expert Patients Programme: a paradox of patient empowerment and medical dominance. , 2007, Health & social care in the community.

[22]  A. Turner,et al.  The expert patients programme (EPP): a resource for GPs treating chronic disease and co-existing common mental health problems? , 2007 .

[23]  M. Bury,et al.  Lay-led self-management in chronic illness: a review of the evidence , 2006, Chronic illness.

[24]  Fiona Jones,et al.  Strategies to enhance chronic disease self-management: How can we apply this to stroke? , 2006, Disability and rehabilitation.

[25]  C. Keller,et al.  A review of the efficacy of the self-management model on health outcomes in community-residing older adults with arthritis. , 2009, Worldviews on evidence-based nursing.

[26]  M. Koelen,et al.  Making healthy choices easy choices: the role of empowerment , 2005, European Journal of Clinical Nutrition.

[27]  David G. Taylor,et al.  Chronic illness, expert patients and care transition. , 2007, Sociology of health & illness.

[28]  J M Anderson,et al.  Empowering patients: issues and strategies. , 1996, Social science & medicine.

[29]  E. Walters,et al.  Self-management education for patients with chronic obstructive pulmonary disease. , 2007, The Cochrane database of systematic reviews.

[30]  R. Tattersall.  The expert patient: a new approach to chronic disease management for the twenty-first century. , 2002, Clinical medicine.

[31]  Sarah Squire,et al.  The Expert Patients Programme , 2006 .

[32]  P. Bower,et al.  The United Kingdom Expert Patients Programme: results and implications from a national evaluation , 2008, The Medical journal of Australia.

[33]  Y. Fujiwara,et al.  [Public participation and empowerment in Health Promotion]. , 2002, Nihon eiseigaku zasshi. Japanese journal of hygiene.

[34]  Carmel M Martin,et al.  The social construction of chronicity--a key to understanding chronic care transformations. , 2009, Journal of evaluation in clinical practice.

[35]  P. Wilson.  The UK Expert Patients Program: Lessons learned and implications for cancer survivors’ self-care support programs , 2008, Journal of cancer survivorship : research and practice.

[36]  G Foster,et al.  Self-management education programmes by lay leaders for people with chronic conditions. , 2007, The Cochrane database of systematic reviews.