A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions

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Published in the NIHR Journals Library and featuring research commissioned by HS&DR, this study involved a rapid, systematic overview of the evidence on self-management support in people with 14 diverse, exemplar long term conditions.  It is the most comprehensive, systematic study of the area to date.  

It found that effective self-management support interventions are multifaceted, and need to be tailored to the individual, their culture and beliefs, as well as a time-point within their condition.  It also found that effective self-management support needs to be underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Although the research identified many components to self-management support, no single component stood out as more important than any other. The authors conclude that supporting self-management is inseparable from the high-quality care for LTCs and that commissioners and health-care providers should promote a culture of actively supporting self-management as a normal,expected, monitored and rewarded aspect of care.

 The study reviewed evidence for self-management support in stroke, asthma, type 2 diabetes (T2DM), depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and T1DM. Evidence is synthesised and presented separately for each LTC with overarching syntheses across the conditions. The report also includes an original systematic review of studies examining the implementation of self management support interventions across all the LTCs.

The key findings of the research are:

  • Supporting self-management is inseparable from high quality care for people with LTCs
  • Supported self-management must be tailored to the individual, their culture and beliefs, and the time-point in the condition
  • Self-management support is a complex intervention and overall no single component of such interventions stood out as more important than any other. Core components include
    • Provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their condition.
    • Psychological strategies to support adjustment to life with a LTC.
    • Strategies specifically to support adherence to treatments.
    • Practical support tailored to the specific LTC, including: support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks.
    • Social support as appropriate.
  • Implementation requires a whole systems approach which intervenes at the level of the patient, the health care professional (HCP) and the organisation.
  • The healthcare organisation is responsible for providing the means (both training, and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes.
  • More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.

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