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Canadian Journal of Public Health

, Volume 102, Issue 1, pp 68–72 | Cite as

Self-management Support: A New Approach Still Anchored in an Old Model of Health Care

  • Sharon E. JohnstonEmail author
  • Clare E. Liddy
  • Sarah M. Ives
Qualitative Research
  • 1 Downloads

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.

Key words

Self-management SMS chronic disease co-morbidities 

Résumé

Contexte

Des études démontrent l’immense potentiel de l’autogestion des soins pour améliorer les résultats de santé. Pourtant, les patients et les fournisseurs de soins utilisent cette approche de façon limitée. La présente étude s’est penchée sur la perspective du fournisseur de soins quant aux ressources d’appui actuelles en matière d’autogestion dans une région de 1,2 million d’habitants. Les participants englobaient des médecins, du personnel infirmier, des infirmières praticiennes, des pédagogues, et des gestionnaires de programmes.

Méthode

Étude qualitative faisant appel à des entrevues semistructurées et individuelles. Grâce à un processus itératif d’immersion/de cristallisation, fondé sur une approche théorique reposant sur les faits, de nouvelles questions et des sujets-clés ont été identifiés. Nous avons procédé par triangulation pour valider les résultats en établissant des comparaisons avec des données provenant d’un atelier connexe et en présentant les conclusions importantes tirées dans le cadre d’entrevues de suivi avec quelques personnes désignées.

Résultats

On comprend mal ce qu’est l’autogestion des soins. Les programmes actuels n’ont pas une approche fondée sur les preuves et sont souvent limités à un modèle de soins axé sur une seule maladie et cela, même si, en majorité, les patients ciblés sont atteints de plusieurs conditions chroniques. Une nouvelle approche d’appui à l’autogestion est souhaitée, même si l’autogestion est enracinée dans le vieux phénomène de la « porte tournante » pour les patients. Le programme d’autogestion des soins est jugé coûteux tant pour les patients que pour les fournisseurs, et suscite du scepticisme quant à son efficacité et de la frustration face à son manque de viabilité.

Interprétation

Une première étape fondamentale consiste à bien cerner la perspective des fournisseurs qui soutiennent l’autogestion afin d’élaborer des stratégies régionales relatives aux programmes d’appui. Une meilleure connaissance de la nature polyvalente et à long terme de l’appui à l’autogestion est nécessaire. Une réforme du système qui encourage l’intégration des services est indispensable pour permettre aux fournisseurs d’offrir un soutien en autogestion axé sur le patient.

Mots clés

autogestion soutien de l’autogestion maladie chronique comorbidités 

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Copyright information

© The Canadian Public Health Association 2011

Authors and Affiliations

  • Sharon E. Johnston
    • 1
    • 2
    Email author
  • Clare E. Liddy
    • 1
    • 2
  • Sarah M. Ives
    • 2
  1. 1.Department of Family Medicine, Élisabeth Bruyère Research InstituteUniversity of OttawaOttawaCanada
  2. 2.CT Lamont Primary Health Care Research CentreÉlisabeth Bruyère Research InstituteOttawaCanada

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