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Support of patient self-management is a key component of effective chronic illness care and improved patient outcomes. Self-management support goes beyond traditional knowledge-based patient education to include processes that develop patient problem-solving skills, improve self-efficacy, and support application of knowledge in real-life situations that matter to patients. This approach also encompasses system-focused changes in the primary care environment. Family physicians can support patient self-management by structuring patient-physician interactions to identify problems from the patient perspective, making office environment changes that remove self-management barriers, and providing education individually and through available community self-management resources. The emerging evidence supports the implementation of practice strategies that are conducive to patient self-management and improved patient outcomes among chronically ill patients. (Am Fam Physician 2005;72:1503-10. Copyright © 2005 American Academy of Family Physicians.)
A global rise in life expectancy and an increase in cultural and environmental risks such as smoking, unhealthy diet, lack of physical activity, and air pollution are associated with an epidemic of chronic illness. Approximately 120 million Americans have one or more chronic illnesses, accounting for 70 to 80 percent of health care costs. Twenty-five percent of Medicare recipients have four or more chronic conditions, accounting for two thirds of Medicare expenditures.1,2 Most patients with chronic conditions such as hypertension, diabetes, hyperlipidemia, congestive heart failure, asthma, and depression are not treated adequately, and the burden of chronic illness is magnified by the fact that chronic conditions often occur as comorbidities.3
Physician support of patient self-management is one of the key elements of a systems-oriented chronic care model.4 Increasing evidence shows that self-management support reduces hospitalizations, emergency department use, and overall managed care costs, although the cost of self-management interventions in individual nonmanaged care practices has yet to be determined.3,5-7 A review7 of 41 studies assessing interventions to improve diabetes outcomes in primary care revealed that adding patient-oriented interventions can lead to improvements in outcomes such as glycemic control. In 36 trials focused on adult asthma, self-management (self-monitoring coupled with medical review and a written action plan) produced greater reductions in nocturnal symptoms, hospitalizations, and emergency department use than did usual care.8 Another community-based group program, designed to increase self-efficacy among patients with diabetes, resulted in improved self-efficacy and A1C levels.9 Despite this encouraging evidence, self-management...