Why Self Management?

The UK Health Agenda

The large majority (60%) of hospital beds in England are used to manage chronic disease or it's complications [4].

Looking at the integration of services within NHS hospitals, a Cochrane review found where daily, structured, hospital team ward rounds, in which nurses, doctors and other professionals made care decisions jointly, the average length of hospital stay was shortened and hospital costs reduced [9].

There is also evidence that multidisciplinary follow up after discharge can reduce reliance on hospital care, helping to shift the focus of care still closer to home.  While looking at substituting skills, there is good evidence that service users themselves can support others.  For instance, peer-led self-management programmes have been found to improve health outcomes and help people feel more confident to manage their own care [9].

Manage-Able™ courses have been specifically developed with these facts in mind.  The programme teaches participants how to use proven techniques and systems such as action planning, problem solving, communication and decision-making.  This enables all participants to practise and develop the specific skills that enable them to better comment on and contribute to their own self-management.  Consumers themselves are then a sustainable, cooperative driving force in promoting the integration of services and more effective multidisciplinary follow up, while by default implementing skills as discussed above; be that for themselves or with others.

An underpinning facet of the Department of Health's strategy for shifting more care into the community is the principle that many people know as much or more about their condition and their needs as health and social care professionals [9].  Perhaps as a result of this, educational sessions to help people learn about how to manage their condition more effectively have gained increasing popularity in recent years.

However, while 'clinical education sessions' focus on providing information about conditions themselves, 'self-management education' sessions aim to help people learn how to manage their own care, including when to use different healthcare services and how better to communicate with professionals.  This difference is important in the context of Manage-Able™ course delivery being a lay led affair.

It seems that participants who attend clinician led information classes leave such classes knowledgeable about their condition and how best to manage it yet implement very few if any changes in the way they look after themselves.  However, those who attend lay led classes, run by facilitators who themselves live with a long term condition, are generally far more proactive in implementing lifestyle changes for the better in terms of their chronic condition.

Although the UK Health Development Agency / National Institute for Health and Clinical Excellence suggested that there is little quantifiable evidence about the impact of lay-led courses on unplanned admissions or length of hospital stay, some empirical information is available.  For instance, a five-year randomised trial with more than 1,000 people in the UK found that self-management education reduced the number of days spent in hospital.

Closely linked to self-management education is self-monitoring, whereby people monitor their symptoms in order to track their progress, modify their behaviours or medications accordingly, and assess when to seek help from health professionals.

A cost analysis in the US found that self-monitoring and self-care significantly reduced monthly Medicare expenditures over a one-year period [9].