Self-management of chronic illness: practices and challenges of older patients’ involvement

Abstract

Self-management is the key response to chronic illness associated with positive outcomes such as improved health, maintained functional status and better quality of life. Self-management could be understood as a number of related actions performed by an ill person in order to overcome physical, social and psychological restrains of an illness. Medical management is an important part of self-management of chronic illness and it is common activity between ill person and general practitioners (GP). This article presents qualitative research results, the aim of which was to disclose GP’s self-management support practices and barriers that inhibit their attempts when medical services are provided to elderly people. Research was conducted in Kaunas city (Lithuania) in 2014. Data were collected and analyzed on the basis of grounded theory (Corbin, Strauss 1990). Seventeen semi-structured in-depth interviews with GP were conducted. The results reveal that self-management support is implemented in various ways. Some practices actualize it in interpersonal (GP-patient) level: information provision, education, motivation, and delegation of responsibilities. Some do it at institutional level (institution of primary health care) by organizing events and lectures. National prevention programs are also important part of self-management support. One of the biggest challenges which limits GP’s self-management support practices is a limited time for consultations. Fifteen minutes which is a common length of GP’s consultation in Lithuania is not enough when doctors face older adults with serious chronic illnesses. Other circumstances such as unmotivated patients, internalized stereotypes about old age, lack of resources, skills and knowledge needed for self-management, and unwillingness to take responsibility for treatment are also identified as barriers for self-management.