Self-management support empowers patients, improves their experience of care and clinical outcomes and aligns with national policy.
Enabling and empowering patients
Self-management support is about putting people living with long term conditions in ‘the driving seat’. It enables people to choose how they want to live with their condition(s) by setting their own quality of life goals, creating plans to reach those goals and putting in place the infrastructure and support of their healthcare team and others necessary to enable people to live their lives differently.
Improving patient experience
People who self manage report better communication with providers, increased confidence in their ability to navigate the healthcare system, greater satisfaction with care, better physical functioning and reduced anxiety.
Improving clinical outcomes
There is an increasing body of evidence that structured self-management support improves clinical outcomes. Examples include:
- Arthritis: a 12% reduction in pain and a 7% reduction in disability, as well as improvements in coping skills.
- Diabetes: reduction in levels of HbA1c, improvements in diet and in the amount of exercise taken.
- Hypertension: blood pressure was lowered (with an average 20% reduction in systolic blood pressure).
Aligning services with national policy
The Department of Health has recently produced a Mandate for NHS England which includes an objective to ensure that “by 2015 far more people will have developed the knowledge, skills and confidence to manage their own health, so they can live their lives to the full” with a related indicator (2.1: Proportion of people supported to manage their own condition). In Scotland, Gaun Yersel is the NHS Scotland self-management strategy for long term conditions. This is a unique document because it is developed not by the Scottish Government but by the Long Term Conditions Alliance informed by the lived experiences of people with long term conditions.
Cochrane reviews on self-management strategies for COPD, diabetes and arthritis have demonstrated evidence of decreased presentations to hospital, improved clinical indicators (such as HBA1C) and increased self-efficacy and wellbeing.
For example, studies have found:
- Asthma: patients had greater confidence in managing their symptoms and more appropriate use of their medication; increased adherence to preventative medication; lower use of reliever medicines.
- Asthma and COPD: controlled trial studies show triple interventions (patient, clinician and organisational) led to at least one less hospital admission.
- Rheumatoid and osteo-arthritis: supported self-management significantly reduced GP visits and sick days by 52%.
- Coronary Heart Disease: 50-85% reduction in admissions and follow-up visits.