It seems rather obvious that if patients can be taught to take care of some of their own basic health needs–taking blood pressure and other measures, giving themselves insulin and other medicines, doing wound care, etc., it saves money by avoiding provider visits. And it may help patients feel more engaged and in control of their health and otherwise lead to better outcomes. A study published in the British Journal of Medicine examined self-care in the context of medical practices in the United Kingdom that were trained to encourage and support patients in self-management of chronic conditions. (BMJ Study) The researchers used a “whole systems” quality improvement intervention designed to both support primary care practices and help patients with a self-management initiative. The patients had diabetes, COPD or irritable bowel syndrome. Providers were trained in providing patient support and assessing patients’ readiness and needs for self-care. The outcomes were staff views on the training and system, shared decision making, self-efficacy, and health related quality of life. Most data was self-reported, and included some data on utilization. About 5600 patients were included in the study, and about half the primary care practices were trained on the intervention. While most staff attended the training, use of the self-managment support tools was uneven. In terms of patient outcomes, measured at 6 and 12 months after study start, the only significant difference was in the use of shared decision making at 6 months. But no difference was seen in self-efficacy or self care activity, nor did utilization of resources differ significantly. It is unclear if staff were not fully committed to the use of the support tools or if patients were generally uninterested in being more involved. The concept seems good, so maybe it is just a matter of finding the right way to engage providers and consumers in having patients with chronic illnesses take more responsibility for their care.
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About this Blog
The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected].
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