Self Management Support is the systematic provision of education and supportive interventions by health care staff to increase patients’ skills and confidence in managing their health problems, including:
- Regular assessment of progress and problems
- Goal setting
- Problem-solving support
- Provision of culturally-appropriate educational materials
- Referral to supportive community resources as necessary
(Institute of Medicine. Priority areas for national action: transforming health care quality. Washington, DC: National Academies Press; 2003.)
A private, non-profit corporation of nine community medical centers provides preventive and primary care services in a rural, underserved area. The centers began by developing self-management support services in 1999 for patients with diabetes. They now have hired 15 "care managers" who provide self-management support for multiple conditions (such as asthma, cardiovascular disease, depression, and diabetes) and for prevention and lifestyle issues. A care manager meets with a patient in the primary care setting, and they work together to set a self-management goal that is "actionable and time framed," according to the program. Group visits are used as well as office visits and phone calls. The goal of the program is to have every patient seen by a care manager, and for 97 percent of all patients to set an annual self-management goal. The care managers follow up with the patients (in-person or by telephone) to see how they are doing at meeting their goals. They also will contact the person prior to a scheduled visit to ask what problems he or she would like to discuss during the visit. Problem solving is seen as the foundation of self-management support.
The care manager interacts with the patient’s primary care clinicians through a team structure that includes regular team "huddles." Program management evaluates the effectiveness of the self-management support program with measures of patients’ confidence in their ability to manage their conditions. These measures use patient-reported data collected with an anonymous written survey. Patient Self-Management Support Programs: An Evaluation. AHRQ Publication No. 08-0011. November 2007. pg 18.
A self - management support program can provide the following:
• Increased health care professional satisfaction
• Increased patient satisfaction
₀ Patient have a more active role in managing their care/partnership with health care
team
₀ Focus is on well care versus sick care
₀ Better health outcomes
₀ Patient becomes a self-advocate
• Increased patient engagement and accountability
• An effective tool for managing chronic disease
• Improved outcomes and performance measurement
• Increased income: several payers offer reimbursement and/or performance incentives