Support for self care for patients with chronic disease

doi:10.1136/bmj.39372.540903.94

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Anne Kennedy, research fellow,
Anne Rogers, professor,
Peter Bower, reader

National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL

Correspondence to: A Kennedy anne.p.kennedy{at}manchester.ac.uk

Accepted 16 September 2007

Anne Kennedy, Anne Rogers, and Peter Bower argue that effective self care requires fundamental changes in professional attitudes and the way health care is delivered

Effectively managing long term conditions and the burden they place on patients, professionals, and services is a major focus of current health policy. Support for self care is increasingly viewed as a core component of the management of long term conditions.1 However, despite the enthusiastic promotion of self care, randomised controlled trials often show modest benefits.2 We examine why current initiatives fail to deliver and suggest what needs to be done.

Potential benefits of self care

Self care is defined as the actions individuals “take to lead a healthy lifestyle; to meet their social, emotional and psychological needs; to care for their long-term condition; and to prevent further illness or accidents.”3 The potential benefits of self care are substantial. According to the proponents of the chronic care model (one of the most comprehensive models of care for long term conditions): “All patients with chronic illness make decisions and engage in behaviours that affect their health (self management). Disease control and outcomes depend to a significant degree on the effectiveness of self-management.”4

The Wanless report into NHS resource requirements identified effective self care as an essential part of the “fully engaged” scenario, which it predicted would bring about the greatest gains in public health.5

Supporting self care in the NHS

In the United Kingdom, the Department of Health views service delivery for long term conditions in three tiers.6 Case management is for patients with multiple, complex conditions, who get intensive, proactive care to avoid admissions. Disease management is for patients at some risk and involves guideline based primary care, facilitated by financial incentives. The final tier is self care support for low risk patients, estimated as 70-80% of those …