About self management

Self management is about supporting people (patients and carers) to develop the skills and confidence they need to look after themselves.

Self–management support can be viewed in two ways: as a portfolio of techniques and tools that help patients retain control of their health and care; and a fundamental transformation of the patient– caregiver relationship into a collaborative partnership [1]. For people living with long term conditions, self management support can be an effective intervention for secondary prevention.

A range of initiatives have evolved to support self-management, with passive information provision at one end of the scale and more proactive approaches (such as structured education and one to one support) that more actively seek to support behaviour change and increase self-efficacy at the other. Approaches that tailor support to the person’s level of activation that build skills and confidence, and use peer support have a positive impact on activation as well as other key outcomes including:

  • improved health outcomes
  • better quality of life  and health-related behaviours
  • reduced hospital readmissions
  • reduction in overnight hospital stays
  • appropriate use of the emergency services.

Encouragingly, people who start at the lowest activation levels tend to increase the most, indicating that there is opportunity to challenge health inequalities and the inverse care law. [2]

Evidence of actual cost savings have also been demonstrated through the Expert Patient Programme, which offers peer led, structured educational training and support. A randomised controlled trial of 629 patients found that planned and unplanned hospital attendances dropped by 6%, alongside reductions in the length of stay and use of primary care. Corresponding reductions in the cost of healthcare were at 5%.

However, while there is a growing body of research, many limitations and gaps remain. Although it appears that several different types of interventions are effective, there is no indication which are most effective or which will work best with specific patient populations. This evidence base needs developing. Additionally, a number of innovative strategies have been tested to spread implementation of self-management support in the UK, including the Health Foundation’s Co-Creating Health Programme, and primary amongst the evaluation’s conclusions is that there needs to be a strategic, whole-system approach to implementation. This is not about bolting on - it is about fundamentally reframing clinicians’ and patients’ roles and health service activities. [3]

Self management support services aim to facilitate the opportunity for patients and carers to build skills, knowledge and confidence to manage their own health and care and feel empowered to make decisions. The IPC programme can contribute to embedding self management support.

[1] De Silva D, “Evidence: Helping people help themselves”, The Health Foundation, May 2011

[2]15 Rogers A, Bower P, Gardner C et al. The national evaluation of the pilot phase of the Expert Patient Programme. Final Report, National Primary Care Research and Development Centre, 2007

[3] Evaluation of MAGIC Co-creating Health programme Phase 2: Sustaining and spreading self-management support, The Health Foundation, Sep 2013