Self-Management

While physicians and care takers play a large role in patient care, it is vital to understand and encourage the importance of patient self-management. It is true that the prevention of chronic disease is, and needs to remain, of highest importance in the United States, with the widespread occurrence of patients with multiple chronic conditions, there must be an emphasis of patient self-management.

Providing optimal care to patients, both those with and without multiple chronic conditions, is for physicians to not only understand the importance of patient involvement, but also for patients to grasp their own roles in self-management. While it may seem like "common sense," there has been little coordination or integration of self-management initiatives to enhance the patient's well-being and promoted health. For self-management to be effective, there is a need to be proactive in the required engagement of physicians, patients, care-givers, and health care organizations. The coordinated approach between all those involved will enhance patient care and more effectively treat patients with multiple chronic conditions.

Self-management plays a crucial role in how and in what time frame patients are able to treat many conditions. Self-management is easier for patients to implement when there is only one condition present, yet it becomes even more imperative for those patients who suffer from multiple chronic conditions. Active participation by patients is paramount in the successful management of chronic conditions which are long-term, fickle, and often degenerative. One of the most necessary components of self-management is that patients have the correct information and skills to actively participate in their health care. Physicians have the responsibility to make sure that patients have information thoroughly regarding their condition(s) and treatment. This involves, and is not limited to:

  • appropriate dietary limitations
  • physical limitations
  • medication side-effects
  • how certain medications interact with other medications
  • warning signs of complications
  • patient problem-solving skills
  • improve self-efficacy
  • knowledge of how to access a network of professions from whom further information can be sought
  • prevention of further complications
  • support through changes to the Medicare, Medicaid, Healthcare System

Physician support of patient self-management is a key element in effective treatment for those with multiple chronic conditions. Patients who are able to effectively self-manage have been proven to reduce the need for hospitalizations, emergency department use, and overall managed care costs. Self-management is defined as the ability of the patient to deal with all that a chronic illness entails, including symptoms, treatment, physical and social consequences, and lifestyle changes.1 With effective self-management, the patient can monitor his or her condition and make whatever cognitive, behavioral, and emotional changes are needed to maintain a satisfactory quality of life.1

The patient suffering from multiple chronic conditions faces more challenges than patients facing only one condition at a time. Physicians who want to provide increased support of their patients' self-management are advised to address three areas: structuring patient-physician interactions to include goal-setting and problem-solving strategies, making office system changes, and providing self-management education by linking patients to community self-management programs. Greater challenges arise when chronic conditions occur as comorbidities. Aggravation of one condition by the symptoms or treatment of another is often the greatest complaint from patients and the greatest barrier of effective self-management.

While the idea of self-management seems ideal, to patients who suffer from multiple chronic conditions it quite often seems impossible. Communication, support, and empathy from physicians is an essential component for successful care. Self-management tools must be made available to patients in order to help both the patient and physician achieve appropriate and successful treatment.

References:
1. Barlow J, Wright C, Sheasby J, Turner A, Hainsworth J. Self-management approaches for people with chronic conditions: a review. Patient Educ Couns. 2002;48:177–87.