In the Netherlands self-management for chronic disease patients has been adopted in routine care in both primary and secondary care. Evidence suggests high variance in succes of self-managment exposure. In our quest to unravel success of this therapeutic stimulus, in a prospective cohort study we aim at assessing both patient- and intervention- specific effect modifiers of success of self-management. To assess patient-profiles and direction and size of effectiveness will not be much of a problem. Otherwise, assessing both content, mode and intensity (dose) of routine care self-management exposure is a larger issue. Do you have any suggestions how we can screen/measure this hybrid type of exposure ? What is your opinion on providers (mostly nurses) self-reporting content/mode/dose of their own consultations in our longitudinal cohort study ?
I would say it depends on how you are defining self-management so that would be my first consideration. If you are limiting it to adherence to recommended treatment and lifestyle changes, then healthcare professionals could record the patient education and information they have provided using a checklist. In the UK computer templates are used for consultations that allow the user to tick when they have given advice about diet or exercise or stopping smoking for example. But there is obviously much more to facilitating self-management as it depends on lots of factors such as the therapeutic relationship (which is affected by patient-centredness and relational continuity), communication skills, skill in goal setting or negotiating management plans, and addressing health literacy issues, To get at those factors will probably require more qualitative work involving recording of consultations, although there are measures that can be completed by patient and/or healthcare professional or used to apply to recordings. It seems to me that the interaction with the patient is the most important part and that has to be judged by the patient as well as the healthcare professional. The healthcare professional may think she has reached an agreement with the patient about a course of action only to find that the patient does not implement it or did not understand or take in the information. Tricky!
Sir, we all know that chronic disease is not just limited to medicine, joint pains, hypertension, strokes, psoriasis, neurological disorders, and many more will only reaffirm that many if not all will one day be a victim of chonic disease.
Self management is done only after proper consultations, and limited to a few manageable situations.
http://scholar.google.co.in/scholar_url?hl=en&q=http://masonbay.com/clients/dev4/chl/wp-content/uploads/2012/07/Hispanic-chronic-disease-self-management-a-randomized-community-based-outcome-trial.pdf&sa=X&scisig=AAGBfm1XR4Q_SueBPbmHZEZx7APOSecheA&oi=scholarr&ei=j-7pUrb5EMnJiAeI8IDoAg&ved=0CCkQgAMoAjAA