Self-Management Support and Education
Self-management involves focusing on an individual’s role in managing chronic disease. This term is often associated with self-care and includes an array of activities needed to effectively manage one or more chronic conditions.1
Self-management support and education is defined as assistance provided by clinicians and public health practitioners to enhance an individual’s self-efficacy in managing one or more chronic conditions. This Domain 3 strategy can include activities such as patient education, support for lifestyle modifications, and support to help individuals develop the skills needed for effective chronic disease management.1,2
The evidence base for implementing self-management support and education for people with chronic disease, including those with hypertension, in health care systems and practices is very strong. Studies demonstrate internal and external validity, and there has been independent replication with positive results. Several studies have been conducted and show the positive effect of self-management support and education in improving blood pressure control. However, limited implementation guidance is available to help health care systems and practices adopt this strategy.
Self-management support and education has been linked specifically to positive cardiovascular outcomes, including lowered blood pressure, increased hypertension-related knowledge, and enhanced competence in hypertension self-management behaviors.1–4 Research has also shown that self-management support and education can improve medication adherence, self-efficacy, self-rated health, cognitive symptom management, frequency of aerobic exercise, and depression.5
Health Disparity Impact
Self-management programs have been effective among both white and African American participants, but studies note the need to further test programs among other racial and ethnic populations. Certain components of self-management support and education may be more important in rural and low-income settings, where health care resources may be limited, but this issue has not been looked at in-depth and deserves further exploration.6
The costs of chronic disease self-management programs vary depending on the strategy and program components used. Hypertension self-management education programs that use strategies beyond SMBP can be cost-effective.7 Chronic disease self-management programs can potentially be cost-saving. For example, one self-management education program was estimated to save health systems $394 per participant per year, and it has been estimated that health systems could save $3.9 billion nationally if 5% of adults with one or more chronic conditions were reached.8 More research that uses actual cost data rather than modeled estimates is needed to confirm these findings.
Self-management support and education has been implemented in several community and clinical settings, including YMCAs, Federally Qualified Health Centers (FQHCs), and managed care health systems.
- Policy and Law-Related Considerations
The Bundled Payments for Care Improvement Advanced (BPCI Advanced) Modelexternal icon is a new iteration of the Centers for Medicare & Medicaid Services (CMS) and the Center for Medicare and Medicaid Innovation (Innovation Center) continuing efforts in implementing voluntary episode payment models. The Model aims to support healthcare providers who invest in practice innovation and care redesign to better coordinate care and reduce expenditures, while improving the quality of care for Medicare beneficiaries. BPCI Advanced qualifies as an Advanced Alternative Payment Model (APM) under the Quality Payment Program. Agency for Healthcare Research and Quality’s TAKEHeart Initiativeexternal icon to Increase Use of Cardiac Rehabilitation.
Increasing Access to Quality Cardiac Rehabilitation Care Actexternal icon.
- Implementation Guidance
Health departments can link patients to self-management programs in their communities. One tool developed to help patients find self-management educational programs in their communities is a CDC resource called Learn More. Feel Better.9
Self-management support and education for chronic disease is widely supported by federal and nonfederal initiatives, including CDC’s Million Hearts Initiative.external icon10
Self-Management Education at ThedaCare
ThedaCare health care system serves 100,357 adult patients in northeast Wisconsin. ThedaCare is a 2013 Million Hearts® Hypertension Control Champion that has successfully implemented a self-management program to help adults with hypertension learn self-management skills. Patients in the ThedaCare Physicians program are given educational materials on nutrition, exercise, hypertension medication, health problems associated with hypertension, and smoking cessation. When they complete the program, patients receive a free home blood pressure monitor. After implementing the program, ThedaCare reported steady improvement among patients with uncomplicated hypertension. From 2012 to 2013, the blood pressure control rate among ThedaCare patients increased by 1.4% (81.6% to 83.0%), which equates to 23,136 of ThedaCare’s 27,879 patients with high blood pressure having this condition under control. ThedaCare’s success is attributed to having strong leadership support and a provider champion for the program.
For more information:
Website: www.thedacare.orgexternal icon
- Galdas P, Fell J, Bower P, et al. The effectiveness of self-management support interventions for men with long-term conditions: a systematic review and meta-analysis. BMJ Open. 2015;5(3):e006620.
- Dye CJ, Williams JE, Evatt JH. Activating patients for sustained chronic disease self-management. J Prim Care Community Health. 2016;7(2):107–112.
- Taylor SJC, Pinnock H, Epiphaniou E, et al. A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS—Practical systematic Review of Self-Management Support for long-term conditions. Health Serv Deliv Res. 2014;2(53).
- Thomas VG, Gaston MH, Porter GK, Anderson A. Prime Time Sister Circles®II: evaluating a culturally relevant intervention to decrease psychological and physical risk factors for chronic disease in mid-life African American women. J Natl Med Assoc. 2016;108(1):6–18.
- Franek J. Self-management support interventions for persons with chronic disease: an evidence-based analysis. Ont Health Technol Assess Ser. 2013;13(9):1–60.
- Whittle J, Schapira MM, Fletcher KE, et al. A randomized trial of peer-delivered self-management support for hypertension. Am J Hypertens. 2014;27(11):1416–1423.
- Trogdon JG, Larsen B, Larsen D, Salas W, Snell M. Cost-effectiveness evaluation of a collaborative patient education hypertension intervention in Utah. J Clin Hypertens (Greenwich). 2012;14(11):760–766.
- Ahn S, Basu R, Smith ML, et al. The impact of chronic disease self-management programs: healthcare savings through a community-based intervention. BMC Public Health. 2013;13(1):1–6.
- Centers for Disease Control and Prevention. Self-Management Education: Learn More. Feel Better. https://www.cdc.gov/learnmorefeelbetter. Accessed February 14, 2017.
- Million Hearts. Tools and Protocols. https://millionhearts.hhs.gov/tools-protocols/index.htmlexternal icon. Accessed February 1, 2017.
Note: The web version has been updated in an effort to keep the linked resources current, and for this reason some of the content may differ with the PDF version.