In England we are seeing a rapid increase in services that also now have an element of patient education included in them. However it is not clear if this is the best approach.
A recent study looking at providing self management support in primary care (Kennedy et al.,BMJ 2013) found that the intervention had no effect compared to the control group. The authors concluded that this may have been due to clinicians not giving enough time to self management support within the consultation.
If we begin to explore this further a number of weaknesses arise around self management support within the pathway or being disease specific. The amount of time a person spends with a clinician each year is counted in minutes, at most a few hours, yet for many managing their health is a daily struggle.
In addition many people report that what they find most useful is other peoples experiences, this combined with the fact that many people are dealing with more than one condition calls into question how much can be achieved within the care setting.
The House of Care model (www.kingsfund.org.uk/publications) provides an excellent blue print for how services can be organised around person centred care, however the question always remains – what support is available for when the person leaves the consulting room.
Currently most person centred care-planning, shared decision making is reliant on the individual already having the confidence and skills to engage in these processes. For the person with very low health literacy, dealing with undiagnosed depression, anxious about the future the ability to engage in this without additional support is limited.
When we have run courses for people with long term health conditions the issues are never specific to their diabetes or heart disease, they are about dealing with the impact on their day to day lives, staying in work, changing diet, staying active. They are common to all. If anything we need to be moving people away from an over association with a particular condition to a more holistic view of being a person who lives with a health condition.
Self management support is about our day to day lives. Disease specific approaches, whilst important at some stages have a danger of medicalising what is a psycho-social issue.
He has a background in psychotherapy as well as having trained in self management at Stanford University. He helped set up the Expert Patient programme in the England and Wales and has advised on and developed a range of self-management support services. He is a regular contributor to health journals and a speaker at conferences in the UK and abroad. He is also a Director of the UK Quality Institute for Self-Management Education and Training (QISMET).