Promoting effective self-management programmes to improve COPD

Abstract

The recent priority focus on integrated chronic care is not surprising given the burden of chronic disease. This focus has led to the development of integrated care programmes for chronically ill patients. Despite important heterogeneity in these programmes, there is a commonality of objectives i.e. to reduce fragmentation of care, and to increase continuity and coordination of care 1. Self-management interventions are an important component of integrated chronic care and the most commonly mentioned 2. An increasing number of healthcare professionals agree that patients with chronic disease should receive support to help them self-manage their disease as effectively as possible. Current evidence in chronic diseases suggests that patients with effective self-management skills make better use of healthcare professionals’ time and have enhanced self-care 3, 4. Through their daily decisions about medication, self-measurements and exercise, people with chronic diseases play a central role in determining the course of their disease. Unfortunately, what is already common practice in other chronic diseases is not yet applied in chronic obstructive pulmonary disease (COPD). We now urgently need to tackle COPD and ensure that effective self-management interventions, as an important part of integrated chronic care, are implemented when present. We now have sufficient scientific evidence to recommend self-management interventions for patients with COPD. Two recent systematic reviews have shown positive outcomes for patients with COPD 5, 6. In the most recent update of the Cochrane Database of Systematic Reviews , it was demonstrated that self-management programmes reduce the probability of COPD-related hospital admissions 6. Another systematic review demonstrated a significant reduction in healthcare utilisation (unscheduled/emergency centre visits, number of hospitalisations and length of hospital stay) in trials that implemented self-management with other components of the chronic care model compared to trials with self-management alone 5. Self-management also …