Abstract
BackgroundAlthough widespread problems in patient–professional interaction and insufficient support of patients’ self-management abilities have been recognized, research investigating the relationships among care quality, productive interaction, and self-management abilities to maintain overall well-being is lacking. Furthermore, studies have revealed differences in these characteristics among certain groups (e.g., less-educated and older patients). This longitudinal study thus aimed to identify relationships among background characteristics, quality of care, productivity of patient–professional interaction, and self-management abilities to maintain overall well-being in chronically ill patients participating in 18 Dutch disease management programs.MethodsThis longitudinal study included patients participating in 18 Dutch disease management programs. Surveys were administered in 2011 (T1; n = 2191 (out of 4693), 47 % response rate) and 2012 (T2: n = 1722 (out of 4350), 40 % response rate). A total of 1279 patients completed questionnaires at both timepoints (T1 and T2) (27 % response rate). Self-management abilities to maintain well-being were measured using the short (18-item) version of the Self-Management Ability Scale (SMAS-S), patients’ perceptions of the productivity of interactions with health care professionals were assessed with the relational coordination instrument and the short (11-item) version of the Patient Assessment of Chronic Illness Care (PACIC-S) was used to assess patients’ perceptions of the quality of chronic care delivery.ResultsPerceived and objective quality of care and the productivity of patient–professional interaction were found to be related to patients’ self-management abilities to maintain overall well-being. These abilities were related negatively to and significantly predicted by low educational level, single status, and older age, despite the mediating role of productive interaction in their relationship with patients’ perceptions of care quality.ConclusionsThese findings suggest that patient–professional interaction is not yet sufficiently productive to successfully protect against the deterioration of self-management abilities in some groups of chronically ill patients, although such interaction and high-quality care are important factors in such protection. Improvement of the quality of chronic care delivery should thus always be accompanied by investment in high-quality communication and patient–professional relationships.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-015-0340-8) contains supplementary material, which is available to authorized users.
Highlights
Widespread problems in patient–professional interaction and insufficient support of patients’ selfmanagement abilities have been recognized, research investigating the relationships among care quality, productive interaction, and self-management abilities to maintain overall well-being is lacking
Patients’ background characteristics affect care quality and self-management abilities, with stable and dynamic characteristics determining their ability to maintain well-being [29, 30] and old age, single status, and low educational level expected to result in the delivery of lower-quality chronic care, occurrence of fewer productive interactions, and deterioration of self-management abilities. This longitudinal study included patients participating in 18 Dutch disease management programs implementing care based on the chronic care model (CCM), characterized as collaborations between care sectors [e.g., between general practitioners (GPs) and hospitals] or within primary care settings
We found that self-management abilities to maintain wellbeing deteriorated significantly over time (4.18 ± 0.80 at T1 vs. 3.98 ± 0.74 at T2; p < 0.001)
Summary
Widespread problems in patient–professional interaction and insufficient support of patients’ selfmanagement abilities have been recognized, research investigating the relationships among care quality, productive interaction, and self-management abilities to maintain overall well-being is lacking. Ill patients require self-management support beyond traditional acute care delivery, including the strengthening of problem-solving skills and improvement of self-efficacy and the ability to deal with real-life situations that matter to them [5]. Such care incorporates the whole person, not merely the object of disease [6], and should aim to strengthen abilities to maintain overall well-being [7, 8]. Functional decline and subsequent deterioration of well-being will occur only when self-management abilities are poor
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