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Promoting effective self-management programmes to improve COPD

Posted Aug 31 2009 11:01pm

The recent priority focus on integrated chronic care is not
surprising given the burden of chronic disease. This
focus has led to the development of integrated care
programmes for chronically ill patients. Despite important
heterogeneity in these programmes, there is a commonality of
objectives i.e. to reduce fragmentation of care, and to increase
continuity and coordination of care. Self-management
interventions are an important component of integrated
chronic care and the most commonly mentioned.

An increasing number of healthcare professionals agree that
patients with chronic disease should receive support to help
them self-manage their disease as effectively as possible.

Current evidence in chronic diseases suggests that patients
with effective self-management skills make better use of
healthcare professionals’ time and have enhanced self-care

Through their daily decisions about medication, selfmeasurements
and exercise, people with chronic diseases play
a central role in determining the course of their disease.

Unfortunately, what is already common practice in other
chronic diseases is not yet applied in chronic obstructive
pulmonary disease (COPD). We now urgently need to tackle
COPD and ensure that effective self-management interventions,
as an important part of integrated chronic care, are
implemented when present.

COPD SELF-MANAGEMENT: THE EVIDENCE

We now have sufficient scientific evidence to recommend selfmanagement
interventions for patients with COPD. Two
recent systematic reviews have shown positive outcomes for
patients with COPD. In the most recent update of the
Cochrane Database of Systematic Reviews, it was demonstrated
that self-management programmes reduce the probability of
COPD-related hospital admissions. Another systematic
review demonstrated a significant reduction in healthcare
utilisation (unscheduled/emergency centre visits, number of
hospitalisations and length of hospital stay) in trials that
implemented self-management with other components of the
chronic care model compared to trials with self-management
alone. Self-management also holds promise of positive
economic benefits in light of increased patient case loads and
rising costs of hospitalisations, but more evidence is
urgently needed.

We may be enthusiastic about recent results but there remains
uncertainty about what aspects of self-management programmes
are most effective, mainly due to the wide variety
in the way self-management programmes are designed,
delivered and evaluated. In the past, failure to recognise this
wide variety has led not only to inappropriate conclusions
about the effectiveness of these programmes but also to a high
likelihood of inappropriate application of research results in
clinical practice.

SELF-MANAGEMENT PROGRAMMES ARE MORE THAN
PATIENT EDUCATION

Self-management interventions involve collaboratively helping
patients acquire and practice the skills needed to carry out
disease-specific medical regimens, change their health behaviour
to adjust their roles for optimal function, improve day-today
control of their disease, and improve their well-being.

Self-management also includes assessment of progress and
problems, goal setting, and problem-solving. While patient
education is necessary, as it is essential that patients develop
knowledge, alone it is insufficient. Patient education means
giving patients information (materials and instruction) regarding
their condition and possible management. In itself,
education is not a self-management intervention, as it does
not achieve patient behavioural change and does not let them
acquire and practice skills. Therefore, the term ‘‘education’’
should be used with caution.

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