The Theory behind Chronic Condition Self-Management
A significant number of Medicare recipients have more than four chronic conditions such as hypertension, congestive heart failure, diabetes, depression and asthma that account for about seventy-five percent of the total Medicare expenditures (Hoffman, Rice & Sung, 1996). Studies have shown that most patients are not adequately treated, magnifying the burden of chronic illness. Evidence indicates that self management support reduces cases of hospitalization, use of emergency departments, and general managed care costs.
Self-management can be referred to as the ability of a patient to deal and contain all that a chronic illness entails. These include chronic illness symptoms, treatment, physical challenges, social challenges, and lifestyle changes (Wagner, 2001). The patient can effectively monitor their conditions and make behavioral and emotional changes that are needed in maintaining quality life if they employ effective self-management. The theory behind chronic condition self-management awareness states that self efficacy or a patient’s inherent belief in their own ability to achieve a reduction in symptoms will influence improved clinical outcomes. Therefore, self-management support from medical practitioners and stakeholders will expand the role of healthcare professionals from mere delivery of information to helping patients make choices that will lead to effective self-management and better outcomes.
Evidence for Chronic Condition Self-Management
The evidence for Chronic Condition Self-management is enshrined in the elements of chronic condition management. The Chronic Condition Management describes the health system as part of the wider community and practice as part of the larger health organization (Rothman & Wagner, 2003). Therefore, an effective self-management requires an effectively linked delivery system connected with complementary community resources that can be availed outside of the organization.
Effective links to patient-oriented community resources will assist in informing patients and their patients to cope up with challenges that living and treating chronic conditions presents. Traditional patient education only dwelt on knowledge acquisition and informative counseling. However, evidence shows that while such practices increased knowledge, they did not successfully change behaviors of patients, nor did it improve disease control and related outcomes (Anderson, Funnell & Butler, 1995). In recent times, studies have shifted focus from the patient’s knowledge on diseases and their treatment to increased confidence and skills in managing their conditions. Interventions from these studies have strengthened patients’ roles in managing their conditions, which has helped many to set goals for improving their management for illness.
Secondly, most practices do not have consistent approaches for collecting, analyzing and evaluating individual or aggregate patient data in order to facilitate healthcare (Glasgow, Funnell, Bonomi, Davis, Beckham & Wagner, 2002). Otherwise, effective programs would ensure access to timely and appropriate data for individual and aggregate patients from clinical information systems. For instance, a computerized chronic disease registry that has critical information on individual patients can enable care teams to deliver planned care, receive feedback and call patients with specific needs.
Thirdly, there are barriers to successful self-management in which chronic conditions normally occur in the form of comorbidities. When chronic diseased patients are asked to identify barriers to self management, they often give instances of aggravation of one condition by symptoms of another, as well as complications created by multiple medication regimens (Corbin & Strauss, 1988). For instance, a patient with asthma and diabetes has limited ability to do exercises needed for diabetes mitigation, since he has to focus on reducing A1C levels. These barriers are supposed to be addressed appropriately by healthcare providers.
Lastly, effective chronic condition self-management requires a delivery system design that enables productive interactions. Multiple tasks involved are likely to be accomplished through delegation of healthcare services from physicians to others in the team. Empirical studies have shown that additional benefits brought by ready access to nurse case managers and other skilled professionals are achieved in optimal self-management assistance with disease control (Lorig et al. 2001).
References
Anderson, R.M., Funnell, M.M. & Butler, P.M. (1995). Patient empowerment. Results of a randomized controlled trial. Diabetes Care. Vol, 18, pp. 943–9.
Bodenheimer, T., Lorig, K., Holman, H. & Grumbach, K. (2002). Patient self-management of chronic disease in primary care. JAMA. Vol. 288 pp.2469–75.
Corbin, J.M., & Strauss, A.L. (1988). Unending Work and Care: Managing Chronic Illness at Home. San Francisco: Jossey-Bass.
Glasgow, R.E., Funnell, M.M., Bonomi, A.E., Davis, C., Beckham, V. & Wagner, E.H. (2002). Self-management aspects of the improving chronic illness care breakthrough series: implementation with diabetes and heart failure teams. Ann Behav Med. Vol. 24 pp.80–7.
Hoffman, C., Rice D. & Sung, H.Y. (1996). Persons with chronic conditions. Their prevalence and costs. JAMA. Vol. 276, pp. 1473–9.
Lorig, K.R., Ritter, P., Stewart, A.L., Sobel, D.S., Brown, B.W., Bandura, A. et al. (2001). Chronic disease self-management program: 2-year health status and health care utilization outcomes. Med Care. Vol.39 pp. 1217–23.
Rothman, A.A., & Wagner, E.H. (2003). Chronic illness management: what is the role of primary care?. Ann Intern Med. Vol. 138 pp. 256–61.
Wagner, E.H. (2001). Meeting the needs of chronically ill people. BMJ. Vol. 323, pp.945–6.
