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Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

Supporting patients to self-manage chronic disease: clinicians’ perspectives and current practices

Rebecca L. Phillips A C , Alison Short B , Paul Dugdale A , Peter Nugus B and David Greenfield B
+ Author Affiliations
- Author Affiliations

A Centre for Health Stewardship, Building 54, The Australian National University, Acton, ACT 0200, Australia.

B Centre for Clinical Governance Research, Australian Institute of Health Innovation, AGSM Building, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia.

C Corresponding author. Email: rebecca.phillips.consulting@gmail.com

Australian Journal of Primary Health 20(3) 257-265 https://doi.org/10.1071/PY13002
Submitted: 13 June 2012  Accepted: 23 April 2013   Published: 23 May 2013

Abstract

This study investigated: clinicians’ perspectives of the scope of self-management, which self-management support initiatives are used, and the factors clinicians consider when deciding which initiative to use with individual patients. Three phases of data collection were used. First, clinicians were interviewed about their attitudes toward self-management (n = 14). Second, clinicians and managers completed a survey about the support initiatives they use (n = 38). Third, in interviews clinicians described the applications of initiatives (n = 6). Data were descriptively and thematically analysed. Clinicians believed that supporting self-management involved a holistic approach. However, some also thought that not all patients had the capacity to self-manage. This idea may be at odds with the underlying notion of self-management and impact on the support provided. Clinicians reported using 54 initiatives to support self-management and identified a range of situations when each initiative may or may not be suitable. This suggests that clinicians need to be familiar with a range of support initiatives as one will not suit everyone. Deciding which initiative is most appropriate may be aided by the development of guidelines.

Additional keywords: chronic disease, health personnel, qualitative research, questionnaires, self care.


References

Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J (2002) Self-management approaches for people with chronic conditions: a review. Patient Education and Counseling 48, 177–187.
Self-management approaches for people with chronic conditions: a review.Crossref | GoogleScholarGoogle Scholar | 12401421PubMed |

Barlow JH, Bancroft GV, Turner AP (2005) Self-management training for people with chronic disease: a shared learning experience. Journal of Health Psychology 10, 863–872.
Self-management training for people with chronic disease: a shared learning experience.Crossref | GoogleScholarGoogle Scholar | 16176963PubMed |

Battersby M, Harvey P, Mills PD, Kalucy E, Pols RG, Frith PA, McDonald P, Esterman A, Tsourtos G, Donato R, Pearce R, McGowan C (2007) SA HealthPlus: a controlled trial of a statewide application of a generic model of chronic illness care. The Milbank Quarterly 85, 37–67.
SA HealthPlus: a controlled trial of a statewide application of a generic model of chronic illness care.Crossref | GoogleScholarGoogle Scholar | 17319806PubMed |

Burns KE, Duffett M, Kho ME, Meade MO, Adhikari NK, Sinuff T, Cook DJ (2008) A guide for the design and conduct of self-administered surveys of clinicians. Canadian Medical Association Journal 179, 245–252.
A guide for the design and conduct of self-administered surveys of clinicians.Crossref | GoogleScholarGoogle Scholar | 18663204PubMed |

Chodosh J, Morton SC, Mojica W, Maglione M, Suttorp MJ, Hilton L, Rhodes S, Shekelle P (2005) Meta-analysis: chronic disease self-management programs for older adults. Annals of Internal Medicine 143, 427–438.
Meta-analysis: chronic disease self-management programs for older adults.Crossref | GoogleScholarGoogle Scholar | 16172441PubMed |

Corbin J, Strauss A (1988) ‘Understanding work and care: managing chronic illness at home.’ (Jossey-Bass: San Francisco)

Curtis S, Gesler W, Smith G, Washburn S (2000) Approaches to sampling and case selection in qualitative research: examples in the geography of health. Social Science & Medicine 50, 1001–1014.
Approaches to sampling and case selection in qualitative research: examples in the geography of health.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c7nslCjtg%3D%3D&md5=23cf00bdad96e21e31f52dc1a0698c82CAS |

Driedger SM, Gallois C, Sanders CB, Santesso N (2006) Finding common ground in team-based qualitative research using the convergent interviewing method. Qualitative Health Research 16, 1145–1157.
Finding common ground in team-based qualitative research using the convergent interviewing method.Crossref | GoogleScholarGoogle Scholar | 16954531PubMed |

Foster G, Taylor SJ, Eldridge SE, Ramsay J, Griffiths CJ (2007) Self-management education programmes by lay leaders for people with chronic conditions. Cochrane Database of Systematic Reviews 17, CD005108

Hogden A, Short A, Taylor R, Dugdale P, Nugus P, Greenfield D (2012) Health coaching and motivational interviewing: evaluating the chronic disease self-management toolbox as a resource for person-centered healthcare. The International Journal of Person Centered Medicine 2, 520–530.

Iversen MD, Hammond A, Betteridge N (2010) Self-management of rheumatic diseases: state of the art and future perspectives. Annals of the Rheumatic Diseases 69, 955–963.
Self-management of rheumatic diseases: state of the art and future perspectives.Crossref | GoogleScholarGoogle Scholar | 20448289PubMed |

Jones A, Pill R, Adams S (2000) Qualitative study of views of health professionals and patients on guided self management plans for asthma. BMJ (Clinical Research Ed.) 321, 1507–1510.
Qualitative study of views of health professionals and patients on guided self management plans for asthma.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M7isVWqug%3D%3D&md5=5d17040609b21361e1bff194215839faCAS |

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.
Seeking the views of health professionals on translating chronic disease self-management models into practice.Crossref | GoogleScholarGoogle Scholar | 19733460PubMed |

Lawn S, Schoo A (2010) Supporting self-management of chronic health conditions: common approaches. Patient Education and Counseling 80, 205–211.
Supporting self-management of chronic health conditions: common approaches.Crossref | GoogleScholarGoogle Scholar | 19931372PubMed |

Lawn S, McMillan J, Pulvirenti M (2011) Chronic condition self-management: expectations of responsibility. Patient Education and Counseling 84, e5–e8.
Chronic condition self-management: expectations of responsibility.Crossref | GoogleScholarGoogle Scholar | 20705412PubMed |

Liamputtong P (2009) ‘Qualitative research methods.’ (Oxford University Press: Sydney)

Lindner H, Menzies D, Kelly J, Taylor S, Shearer M (2003) Coaching for behaviour change in chronic disease: a review of the literature and the implications for coaching as a self-management intervention. Australian Journal of Primary Health 6, 1–9.

Lorig KR, Holman HR (2003) Self-management education: history, definition, outcomes, and mechanisms. Annals of Behavioral Medicine 26, 1–7.
Self-management education: history, definition, outcomes, and mechanisms.Crossref | GoogleScholarGoogle Scholar | 12867348PubMed |

Lorig KR, Sobel DS, Stewart AL, Brown BW, Bandura A, Ritter P, Gonzalez VM, Laurent DD, Holman HR (1999) Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial. Medical Care 37, 5–14.
Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1MzjvFOgsA%3D%3D&md5=b0b21d52f0dbdf1b4dab3403667cf033CAS | 10413387PubMed |

Murray C, Lopez A (2002) ‘World Health Report 2002, reducing risks, promoting healthy life.’ (World Health Organization: Geneva)

NHPAC (2006) ‘National chronic disease strategy.’ (Australian Government Department of Health and Ageing: Canberra)

Nugus P, Greenfield D, Travaglia J, Westbrook J, Braithwaite J (2010) How and where clinicians exercise power: interprofessional relations in health care. Social Science & Medicine 71, 898–909.
How and where clinicians exercise power: interprofessional relations in health care.Crossref | GoogleScholarGoogle Scholar |

Osborne RH, Jordan JE, Rogers A (2008) A critical look at the role of self-management for people with arthritis and other chronic diseases. Nature Clinical Practice. Rheumatology 4, 224–225.
A critical look at the role of self-management for people with arthritis and other chronic diseases.Crossref | GoogleScholarGoogle Scholar | 18301410PubMed |

Patton MQ (2002) ‘Qualitative research and evaluation methods.’ (SAGE Publications: Thousand Oaks, California)

Rogers A, Kennedy A, Nelson E, Robinson A (2005) Uncovering the limits of patient-centeredness: implementing a self-management trail for chronic illness. Qualitative Health Research 15, 224–239.
Uncovering the limits of patient-centeredness: implementing a self-management trail for chronic illness.Crossref | GoogleScholarGoogle Scholar | 15611205PubMed |

Wagner EH (1998) Chronic disease management: what will it take to improve care for chronic illness? Effective Clinical Practice 1, 2–4.

Williams A, Harris M, Daffurn K, Powell Davies G, Pascoe S, Zwar N (2007) Sustaining chronic disease management in primary care: lessons from a demonstration project. Australian Journal of Primary Health 13, 121–128.
Sustaining chronic disease management in primary care: lessons from a demonstration project.Crossref | GoogleScholarGoogle Scholar |