The challenge of self-management

Prevention is better than cure is a well-worn idiom, but sadly not one that many seem to heed.

According to a 2011 report by the Department of Health, more than 15 million people were suffering from a long term condition and with an ever-ageing population this will only increase.

• Getting better by degrees

Highlighting need

The same DH report reveals that people with long term conditions account for 29 per cent of the population, but use 50 per cent of all GP appointments and 70 per cent of all inpatient beds.

These figures underline the necessity for the development of a well-coordinated healthcare system that is integrated, places an emphasis on prevention and vitally provides service users with the tools and knowledge to manage some, or perhaps even all, of their care.

At the School of Health Sciences, City University London, we have been working on a number of studies to develop interventions for secondary prevention, empowering people with the knowledge and tools to manage their care.

One such study is the Coronary Heart Disease Risk in Type 2 Diabetes (CORDIA) project, where patients are randomised into three different groups:

1. Standard care: the participant’s GP practice and/or practice nurse will provide care as normal for their patient.
2. Standard care + self management intervention: the participant’s GP and/or practice nurse will provide care as per normal procedures. In addition the participant will be referred to participate in a self management intervention designed to train them to better manage their condition.
3. Standard care + self management intervention + personalised genetic cardiovascular profile: these patients will have care as normal and the self management group sessions. In addition, prior to the self management session, this group will receive personalised feedback about the results of a genetic test taken from a saliva sample which will indicate their genetic and lifestyle risk for developing coronary heart disease.

‘Encouring a cultural change on the scale required is a formidable challenge’

This study will help us understand the extent to which we can change behaviour in people with diabetes, and the possible additional role of providing information regarding environmental and genetic risk.

Encouraging a cultural change to promote increased patient self-management on the scale required to sustain our already straining healthcare system is a formidable challenge.

It is vital that, through studies such as CORDIA, we provide the evidence base to create the foundations for the change needed to address the increasing prevalence of chronic conditions.

It is also vital that, using the evidence, we take the next step to translate this into practice.

Professor Stanton Newman is dean of the school of health sciences at City University London