1. Self-management support: a new approach still anchored in an old model of health care.
- Author
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Johnston SE, Liddy CE, and Ives SM
- Subjects
- Attitude of Health Personnel, Canada, Chronic Disease epidemiology, Comorbidity, Female, Health Services Accessibility, Humans, Male, Ontario, Poverty, Chronic Disease therapy, Health Promotion organization & administration, Health Services Needs and Demand, Patient Care Management organization & administration, Self Care
- Abstract
Background: Studies show the great potential for self-management to improve health outcomes, yet it is carried out in a limited way by patients and providers. This study investigated the provider perspective of existing self-management support resources in a region of 1.2 million people. Participants included physicians, nurses, nurse practitioners, educators, and program managers., Methods: Qualitative study using semi-structured, one-on-one interviews. An iterative immersion/crystallization process identified key themes and new questions and was built on a grounded theory approach. Triangulation was used to validate findings by comparing with data from a related provider workshop and presenting significant findings in follow-up interviews with select individuals., Results: There was a lack of understanding about self-management. Existing programs lacked an evidence-based approach and were often entrenched in a single disease-focus model of care, despite a majority of patients served having multiple chronic conditions. A new approach to self-management support was desired, although often anchored in an old model of revolving doors for patients. Self-management was described as burdensome for patients and providers alike. There was disbelief about program effectiveness and frustration about lack of sustainability., Interpretation: Understanding the perspectives of providers engaged in self-management support is a critical first step in developing regional strategies for such support programs. A better understanding of the comprehensive and long-term nature of self-management support is needed. System reform promoting integration of services is essential to enable providers to offer patient-centred self-management support.
- Published
- 2011