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.