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Semin Respir Crit Care Med 2015; 36(04): 630-638
DOI: 10.1055/s-0035-1556059
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Comprehensive Self-Management Strategies

J. Bourbeau
1   Montreal Chest Institute, McGill University Health Centre, Montréal, Quebec, Canada
2   Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre and McGill University, Montreal, Quebec, Canada
,
K. L. Lavoie
3   Department of Psychology, University of Quebec at Montreal. Montreal, Quebec, Canada
4   Montreal Behavioural Medicine Centre, Research Centre, Hopital du Sacré-Coeur de Montreal, Quebec, Canada
,
M. Sedeno
2   Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre and McGill University, Montreal, Quebec, Canada
› Author Affiliations
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Publication History

Publication Date:
03 August 2015 (online)

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Abstract

In this article, we provide a review of the literature on self-management interventions and we are giving some thought to how, when, and by whom they should be offered to patients. The present literature based on randomized clinical trials has demonstrated benefits (reduced hospital admissions and improved health status) for chronic obstructive pulmonary disease (COPD) patients undergoing self-management interventions, although there are still problems with the heterogeneity among interventions, study populations, follow-up time, and outcome measures that make generalization difficult in real life. Key to the success, self-management intervention has to target behavior change. Proper self-management support is a basic prerequisite, for example, techniques and skills used by health care providers “case manager” to instrument patients with the knowledge, confidence, and skills required to effectively self-manage their disease. To improve health behaviors and engagement in self-management, self-management interventions need to target enhancing intrinsic motivation to change. This will best be done using client-centered communication (motivational communication) that encourages patients to express what intrinsically motivates them (e.g., consistent with their values or life goals) to adopt certain health behavior, with the goal of helping them overcome their ambivalence about change. Finally, if we want to be able to design and implement self-management interventions that are integrated, coherent, and have a strong likelihood of success, we need to take a more careful look and give more attention at the case manager, the patient (patient evaluation), and the quality assurance.

Keywords

COPD - self-management - behavior change - case manager - quality assurance
 

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