Promoting and supporting self-care management for adults living in the community with physical chronic illness: the effectiveness and meaningfulness of the patient-practitioner encounter.

Abstract

Review Objectives: The overall objective of the review is to determine the best available evidence regarding the promotion and support of self-care management for adults living in the community with chronic illness during the patient-practitioner encounter. Review Questions: What is the effectiveness of the patient-practitioner encounter in promoting and supporting self-care management of people with chronic illness? What are the individual and organisational factors which help or hinder recognition, promotion and support of chronic disease self-care management strategies? What are the similarities and differences between how ‘effectiveness’ is defined in this context by patients and different practitioners? Inclusion Criteria for the Review: Types of interventions: The intervention of interest to this review is a patient-practitioner encounter where the aim is self-care management. A `patient’ is taken to refer to an adult with a physical chronic illness and a `practitioner’ may be one of a variety of health professionals since the care of a patient with chronic illness may be monitored by a number of practitioners from different professions such as doctors, nurses, specialists, pharmacists and social workers (Wagner, 2000). Since patients meet various professionals in a variety of community settings regarding their care, the term ‘encounter’ will be used in this review to encompass all types of appointments where patients meet practitioners, and where collaboration may take place. As patients with physical chronic illness may be routinely seen for follow up of self-care management at a hospital, outpatient departments will be included as a community setting for the purpose of this review as well as other settings more commonly associated with community settings such as General Practitioner surgeries and clinics at health centres. Types of outcome: The outcome of this review is effective self-care management. Effectiveness might be measured by objective measures of increased self-care management behaviours e.g. engaging in health promotion activities, and adherence to treatment protocols, and appropriate decision making on the results of self-monitoring. However self-care management may also be measured by subjective means e.g. perceptions of control in self-care management, or personal values and attitudes towards important roles and relationships when the effects of illness are managed in social contexts.