The importance of effective self-management

As we all know chronic illness is a major part of the work in general practice - cardiovascular disease, diabetes and asthma comprise 25% of the total burden of disease and 22% of encounters in general practice.

There has been increasing interest in the idea of people with chronic disease becoming more active partners in their own care. Chronic disease self-management refers to the actions people take themselves to manage their own conditions. Self-management does not mean dispensing with health professional advice or taking over the role of the doctor. Rather it means working effectively in partnership with health care providers. Everyone self-manages in that they make decisions about things like diet and exercise, expose themselves to risks like tobacco smoking and excessive alcohol and the extent to which they comply with treatments for illness such as taking medication. The question is how well they do it and whether education and support can help them to do it better. As Bodenheimer and Grumbach1 point out, good self-managers need to possess considerable knowledge, multiple skills including problem solving, and an inner motivation to put their knowledge and skills to work on a daily basis.

Effective self-management is crucial to both metabolic and macrovascular risk factor control in type 2 diabetes. As described in the RACGP/Diabetes Australia publication General practice management of type 2 diabetes 2014–152, self-management involves the person with diabetes working in partnership with their carers and health professionals so they can:

  • understand their condition and various treatment options
  • contribute to, review and monitor a plan of care (e.g. care plan)
  • engage in activities that protect and promote health
  • monitor and manage the symptoms and signs of the condition
  • manage the impact of the condition on physical functioning, emotions and interpersonal relationships.

Key issues are not only diet and exercise but also medicines adherence, and regular attendance for management and assessment for development of complications. Chronic disease self-management support has been defined as “the systematic provision of education and supportive interventions to increase patients' skills and confidence in managing their health problems, including regular assessment of progress and problems, goal setting, and problem solving support”3. General practice is a key place for such support to be provided in a way that is effective, sustainable and connected to the existing health system.

Article submitted by Nicholas Zwar MBBS, MPH, PhD, FRACGP. Nicholas Zwar is Professor of General Practice, School of Public Health and Community Medicine, University of New South Wales. He is also a director of the UNSW Centre for Primary Health Care and Equity and a GP at the UNSW University Health Service.

References
Bodenheimer T, Grumback K. Improving Primary Care. Lange Medical Books/McGraw Hill 2007.
RACGP/Diabetes Australia. General practice management of type 2 diabetes 2014–15.
Institute of Medicine. Priority Area for National Action: Transforming Health Care Quality. Washington. 2003.