Is Europe putting theory into practice? A qualitative study of the level of self-management support in chronic care management approaches

Abstract

BackgroundSelf-management support is a key component of effective chronic care management, yet in practice appears to be the least implemented and most challenging. This study explores whether and how self-management support is integrated into chronic care approaches in 13 European countries. In addition, it investigates the level of and barriers to implementation of support strategies in health care practice.MethodsWe conducted a review among the 13 participating countries, based on a common data template informed by the Chronic Care Model. Key informants presented a sample of representative chronic care approaches and related self-management support strategies. The cross-country review was complemented by a Dutch case study of health professionals’ views on the implementation of self-management support in practice.ResultsSelf-management support for chronically ill patients remains relatively underdeveloped in Europe. Similarities between countries exist mostly in involved providers (nurses) and settings (primary care). Differences prevail in mode and format of support, and materials used. Support activities focus primarily on patients’ medical and behavioral management, and less on emotional management. According to Dutch providers, self-management support is not (yet) an integral part of daily practice; implementation is hampered by barriers related to, among others, funding, IT and medical culture.ConclusionsAlthough collaborative care for chronic conditions is becoming more important in European health systems, adequate self-management support for patients with chronic disease is far from accomplished in most countries. There is a need for better understanding of how we can encourage both patients and health care providers to engage in productive interactions in daily chronic care practice, which can improve health and social outcomes.

Effects of a patient oriented decision aid for prioritising treatment goals in diabetes: pragmatic randomised controlled trial

“…Of the people with diabetes and identified as potentially eligible in the electronic medical records of the 18 …”

“…16 17 Although the concept of a collaborative approach is widely acknowledged, it is not yet an integral part of daily practice. 18 Decision aids or support systems can encourage patient-provider discussions about disease management by presenting available treatment options and expected outcomes for each patient. 19 Most aids, however, focus on one specific treatment choice, whereas people with diabetes are often confronted with multiple clinical domains (glucose, blood pressure, lipids) for which treatment is indicated.…”

Physiotherapists supporting self-management through health coaching: a mixed methods program evaluation

“…Recent research demonstrates that selfmanagement support continues to be the most challenging aspect of care to enact within the context of the PHC care team (Elissen et al, 2013).…”

Disease Management: The Need for a Focus on Broader Self-Management Abilities and Quality of Life

“…The findings of this study are not typical for the Netherlands alone. A qualitative study conducted by Elissen and colleagues 34 showed that self-management support for patients with chronic diseases is far from adequate in most European countries, and that approaches to such support appear to be the least implemented and most challenging among the elements of the Chronic Care Model. 35 These findings emphasize the need for a better understanding of how we can encourage patients and health care professionals to engage in productive interactions, thereby improving mental and physical quality of life outcomes.…”