Letter to the Editor
Self-management: One size does not fit all

https://doi.org/10.1016/j.pec.2013.02.009Get rights and content

Abstract

Self-management for people with chronic diseases is now widely recognized as an essential part of treatment. Despite the high expectations and the growing body of evidence in terms of its effectiveness, a wide application of self-management programs is inhibited due to several challenges. Worldwide, a variety of complex and multifactorial interventions have been evaluated in very heterogeneous patient populations leaving healthcare professionals in doubt about what works best and what works in whom. In this letter to the editor the authors systematically reflect on the current evidence of patient-specific determinants of success of self-management and argument the urge for increased scientific efforts to establish tailored self-management in patients with chronic disease.

Section snippets

Self-management: is it effective?

Over the past decade many self-management programs were developed and their efficacy studied. Several meta-analyses have been conducted in different chronic conditions, indicating large variance in both quantity and methodological quality of included self-management trials. Table 1 illustrates the pooled evidence indicating that self-management in patients with asthma [12], chronic heart failure [13], COPD [14], diabetes mellitus type-2 (DM-II) [15], hypertension [17], musculoskeletal pain [18]

Self-management: what works best?

Several meta-analyses have attempted to evaluate possible shifts in effect size for different program characteristics but were largely unrevealing [13], [15], [17], [26]. However, in patients with COPD [14] and asthma [12] the addition of action plans for self-treatment of exacerbations seems to result in larger reductions in healthcare utilization. In DM-II, improvements in glycaemic control seem more pronounced when psychosocial behavioral techniques are used [27]. The addition of

One size does not fit all: urge for tailored interventions

A self-management program is not equal to prescribing patients a drug but instead a classic example of a ‘complex intervention’ – a treatment strategy containing several interacting components and varying dimensions of complexity (i.e. variability in delivery, organizational levels, outcomes, etc.) [28]. When applied in subtly different target populations or healthcare settings these interventions can produce substantially variable results. Although one might conclude that on average

Conclusion and future directions

Self-management for people with chronic diseases is now widely recognized as an essential part of treatment. Despite the high expectations and the growing body of evidence in terms of its effectiveness, a wide application of self-management programs is inhibited due to several challenges. Meta-analytic findings indicate that self-management has added value in only a selection of outcome measures and these reports demonstrate a large variance in effect size both between studies and target

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