CSIRO Publishing blank image blank image blank image blank imageBooksblank image blank image blank image blank imageJournalsblank image blank image blank image blank imageAbout Usblank image blank image blank image blank imageShopping Cartblank image blank image blank image You are here: Journals > Australian Journal of Primary Health   
Australian Journal of Primary Health
  The issues influencing community health services and primary health care
blank image Search
blank image blank image
blank image
  Advanced Search

Journal Home
About the Journal
Editorial Structure
Online Early
Current Issue
Just Accepted
All Issues
Special Issues
Sample Issue
Call for Papers
For Authors
General Information
Submit Article
Author Instructions
Open Access
Awards and Prizes
For Referees
Referee Guidelines
Review an Article
Annual Referee Index
For Subscribers
Subscription Prices
Customer Service
Print Publication Dates
Library Recommendation

blue arrow e-Alerts
blank image
Subscribe to our email Early Alert or RSS feeds for the latest journal papers.

red arrow Connect with CP
blank image
facebook twitter logo LinkedIn

red arrow Connect with La Trobe
blank image
facebook twitter LinkedIn


Article << Previous     |     Next >>   Contents Vol 18(3)

What distinguishes clinicians who better support patients for chronic disease self-management?

Sue E. Kirby A B, Sarah M. Dennis A, Pat Bazeley A and Mark F. Harris A

A Centre for Primary Health Care and Equity, School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
B Corresponding author. Email: s.kirby@student.unsw.edu.au

Australian Journal of Primary Health 18(3) 220-227 http://dx.doi.org/10.1071/PY11029
Submitted: 8 March 2011  Accepted: 23 August 2011   Published: 2 December 2011

PDF (199 KB) $25
 Export Citation

Many frequent readmissions due to acute exacerbations of chronic disease could be prevented if patients self-managed. This study explored factors involved in patient activation for chronic disease self-management by qualitative analysis of interview data from hospital and community-based clinicians and patients. All clinicians reported that many frequently readmitted patients did not readily take up referral to chronic disease self-management services. This reluctance was compounded by system or access barriers. Clinicians who had a defined role in chronic disease management and patient-centred and behaviour change skills reported that although some patients were more resistant than others, patients could be persuaded to adopt self-management behaviours. Hospital clinicians and GPs were more inclined to attribute blame to clinical, social and personal patient factors, such as difficulty with support at home, social circumstances and reluctance to take responsibility. Investment in extending the skills and role of hospital clinicians and GPs to take a more supportive role in patient uptake of referrals to chronic disease self-management services would reduce hospital readmissions. Improvements in access to chronic disease self-management and GP services are also needed to address failure to take up chronic disease self-management.


Ajzen I (1991) The theory of planned behavior. Organizational Behavior and Human Decision Processes 50, 179–211.
CrossRef |

Ampt AJ, Amoroso C, Harris MF, Mckenzie SH, Rose VK, Taggart JR (2009) Attitudes, norms and controls influencing lifestyle risk factor management in general practice. BMC Family Practice 10, 59–68.
CrossRef | PubMed |

Andersen RM (1995) Revisiting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior 36, 1–10.
CrossRef | CAS | PubMed |

Andersen R, Newman JF (1973) Societal and individual determinants of medical care utilization in the United States. The Milbank Memorial Fund Quarterly: Health and Society 51, 95–124.
CrossRef | CAS |

Assal JP (1999) Revisiting the approach to treatment of long-term illness: from the acute to the chronic state. A need for educational and managerial skills for long-term follow-up. Patient Education and Counseling 37, 99–111.

Australian Government Department of Health and Ageing (2009) ‘Capabilities for supporting prevention and chronic condition self-management: a resource for educators of primary health care professionals.’ Australian Government and Flinders University: Canberra.

Australian Government Department of Health and Ageing (2011) ‘MBS primary care items, chronic disease management (CDM) Medicare items.’ Available at http://www.health.gov.au/internet/main/publishing.nsf/Content/ mbsprimarycare-chronicdiseasemanagement [Verified 15 November 2011]

Bandura A (1977) Self-efficacy: toward a unifying theory of behavioral change. Psychological Review 84, 191–215.
CrossRef | CAS | PubMed |

Blakeman T, Macdonald W, Bower P, Gately C, Chew-Graham C (2006) A qualitative study of GPs’ attitudes to self-management of chronic disease. The British Journal of General Practice 56, 407–414.

Bourbeau J, Bartlett SJ (2008) Patient adherence in COPD. Thorax 63, 831–838.
CrossRef | CAS | PubMed |

Brisbane South Division of General Practice. Co-creating care programme. Available at http://www.brisbanesouth.com.au/page/Services__Programs/Partners_in_Health/ [Verified 15 November 2011]

Government of South Australia (2004) ‘Hospital avoidance and demand management business case.’ Metropolitan Health Division, Department of Health, Government of South Australia.

Government of Victoria Department of Health (2011) ‘Hospital admission risk program.’ Available at http://www.health.vic.gov.au/harp/about.htm [Verified 15 November 2011]

Harris MF, Williams AM, Dennis SM, Zwar NA, Davies GP (2008) Chronic disease self-management: implementation with and within Australian general practice. The Medical Journal of Australia 189, S17–S20.

Hibbard JH, Mahoney E (2010) Toward a theory of patient and consumer activation. Patient Education and Counseling 78, 377–381.
CrossRef | PubMed |

Kirby SE, Dennis SM, Jayasinghe UW, Harris MF (2010) Patient related factors in frequent readmissions: the influence of condition, access to services and patient choice. BMC Health Services Research 10, 216–224.
CrossRef | PubMed |

Kvale S (Ed.) (2007) ‘Doing interviews.’ (Sage: Los Angeles)

Lake AJ, Staiger PK (2010) Seeking the views of health professionals on translating chronic disease self-management models into practice. Patient Education and Counseling 79, 62–68.
CrossRef | PubMed |

Laws RA, Kirby SE, Davies GPP, Williams AM, Jayasinghe UW, Amoroso CL, Harris MF (2008) ‘Should I and can I?’: a mixed methods study of clinician beliefs and attitudes in the management of lifestyle risk factors in primary health care. BMC Health Services Research 8, 44
CrossRef | PubMed |

Laws RA, Kemp LA, Harris MF, Davies GP, Williams AM, Eames-Brown R (2009) An exploration of how clinician attitudes and beliefs influence the implementation of lifestyle risk factor management in primary healthcare: a grounded theory study. Implementation Science; IS 4, 66
CrossRef | PubMed |

Macdonald W, Rogers A, Blakeman T, Bower P (2008) Practice nurses and the facilitation of self-management in primary care. Journal of Advanced Nursing 62, 191–199.
CrossRef | PubMed |

Nagelkerk J, Reick K, Meengs L (2006) Perceived barriers and effective strategies to diabetes self-management. Journal of Advanced Nursing 54, 151–158.
CrossRef | PubMed |

National Health Priority Action Council (2006) ‘National Chronic Disease Strategy.’ (Australian Government Department of Health and Aging: Canberra)

NSW Health (2010) ‘Connecting care (severe chronic disease program).’ Available at http://www.health.nsw.gov.au/cdm/severe_chronic_disease_management_program.asp [Verified 15 November 2011]

O’Connell T (2008) Redesign for hospital avoidance. Available at http://www.changechampions.com.au/resource/Tony_OConnell.pdf [Verified 15 November 2011]

Powell R, Powell H, Baker L, Greco M (2009) Patient partnership in care: a new instrument for measuring patient–professional partnership in the treatment of long-term conditions. Journal of Management & Marketing in Healthcare 2, 325–342.

Rogers A, Kennedy A, Nelson E, Robinson A (2005) Uncovering the limits of patient-centeredness: implementing a self-management trial for chronic illness. Qualitative Health Research 15, 224–239.
CrossRef | PubMed |

Thille PH, Russell GM (2010) Giving patients responsibility or fostering mutual response-ability: family physicians constructions of effective chronic illness management. Qualitative Health Research 20, 1343–1352.
CrossRef | PubMed |

Thorne SE, Paterson BL (2001) Health care professional support for self-care management in chronic illness: insights from diabetes research. Patient Education and Counseling 42, 81–90.
CrossRef | CAS | PubMed |

Thorne SE, Ternulf Nyhlin K, Paterson BL (2000) Attitudes toward patient expertise in chronic illness. International Journal of Nursing Studies 37, 303–311.
CrossRef | CAS | PubMed |

Von Korff M, Gruman J, Schaefer J, Curry S, Wagner E (1997) Collaborative management of chronic illness. Annals of Internal Medicine 127, 1097–1102.

Wagner EH, Austin BT, Von Korff M (1996) Organizing care for patients with chronic illness. The Milbank Quarterly 74, 511–544.
CrossRef | CAS | PubMed |

Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A (2001) Improving chronic illness care: translating evidence into action. Health Affairs (Project Hope) 20, 64–78.
CrossRef | CAS |

Weeks A, Mcavoy B, Peterson C, Furler J, Walker C, Swerissen H, Belfrage J (2003) Negotiating ownership of chronic illness: an appropriate role for health professionals in chronic illness self-management programs. Australian Journal of Primary Health 9, 25–33.
CrossRef |

Subscriber Login

Legal & Privacy | Contact Us | Help


© CSIRO 1996-2016