Abstract
In this article, we provide a review of the literature on self-management interventions
and we are giving some thought to how, when, and by whom they should be offered to
patients. The present literature based on randomized clinical trials has demonstrated
benefits (reduced hospital admissions and improved health status) for chronic obstructive
pulmonary disease (COPD) patients undergoing self-management interventions, although
there are still problems with the heterogeneity among interventions, study populations,
follow-up time, and outcome measures that make generalization difficult in real life.
Key to the success, self-management intervention has to target behavior change. Proper
self-management support is a basic prerequisite, for example, techniques and skills
used by health care providers “case manager” to instrument patients with the knowledge,
confidence, and skills required to effectively self-manage their disease. To improve
health behaviors and engagement in self-management, self-management interventions
need to target enhancing intrinsic motivation to change. This will best be done using
client-centered communication (motivational communication) that encourages patients
to express what intrinsically motivates them (e.g., consistent with their values or
life goals) to adopt certain health behavior, with the goal of helping them overcome
their ambivalence about change. Finally, if we want to be able to design and implement
self-management interventions that are integrated, coherent, and have a strong likelihood
of success, we need to take a more careful look and give more attention at the case
manager, the patient (patient evaluation), and the quality assurance.
Keywords
COPD - self-management - behavior change - case manager - quality assurance
