Feature Story

Self-management programs found to improve health and reduce use of health care by people with chronic diseases

Chronic disease is a major cause of disability and use of health care services, accounting for about 70 percent of all health care expenditures. In a recent study, patients with chronic diseases who participated in a brief chronic disease self-management program improved their health or had less deterioration and used fewer health care services over a 2-year period, compared with their status when they began the program.

The study, which was supported in part by the Agency for Healthcare Research and Quality (HS06680), was conducted by researchers at Stanford University, the University of California, San Francisco, and Kaiser Permanente. It involved the 7-week (2.5 hours weekly) community-based, peer-led Chronic Disease Self-Management Program and was based on the principles of an arthritis self-management program, according to the researchers.

Designed to help patients with chronic disease develop self-management skills, the program's content included adoption of exercise programs; use of cognitive symptom management techniques, such as guided relaxation and distraction; nutritional change; fatigue and sleep management; use of medications and community resources; management of emotions; health-related problem solving; and other skills. Compared with their status prior to the program (baseline), participants showed significant reductions in health distress and increases in perceived self-efficacy, and they made fewer visits to physicians and emergency rooms at each followup period during the 2-year study.

Program participants, who had a mean of 2.2 chronic conditions and increased disability, did not show deterioration in any other health variables, which would otherwise be expected during a 2-year period. Neither did they have significant increases in number of hospitalizations or days in the hospital. Even in the face of increasing disability, their activity and role functions did not decline. The 2-year savings due to reduced hospital days and outpatient visits was about $590 per participant. The program is now being implemented by many health care organizations in the United States as well as abroad.

More details are in "Chronic disease self-management program: 2-year health status and health care utilization outcomes," by Kate R. Lorig, Dr.P.H., Philip Ritter, Ph.D., Anita L. Stewart, Ph.D., and others, in Medical Care 39(11), pp. 1217-1223.

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