UK self-care support initiatives for older patients with long-term conditions: a review

Abstract

Objectives: Supporting self-care for people with long-term conditions is an aim of UK health policy. As many with long-term conditions are older it is of interest to explore which self-care support interventions have positive impacts for this group. This review explores what types of intervention have been reported in the UK and their impact upon older people.

Methods: Studies were identified using existing reviews, electronic databases and through hand searching journals. After inclusion and exclusion criteria were applied data were extracted from 18 studies. These were summarized in a narrative synthesis supported by summary tables.

Results: All studies described interventions to support self-care, many targeted at people with arthritis. All used patient education, usually delivered to groups by a range of professionals. The majority of studies reported some significant positive outcomes, most frequently changes in physical functioning, illness knowledge and increased self-efficacy. The average age of participants was 60.

Discussion: This review shows that self-care interventions have had positive effects for older participants but it remains unknown how best to support self-care in participants over 75, a group of people with long-term conditions who may have different needs.

Keywords

Interventions Long-term conditions Older people Self-care

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References

Department of Health. Ten things you need to know about long term conditions. Available at http://www.dh.gov.uk/en/Healthcare/Longtermconditions/DH_084294 (accessed September, 2008).

British Household Panel Survey. British Household Panel Survey 2001, London: HMSO , 2001.

Department of Health. Saving lives: our healthier nation, London: Department of Health , 1999.

Department of Health. The NHS and Social Care long term conditions model, London: Department of Health, 2005.

Dost A. Towards a self care support strategy, London: Department of Health, 1998.

Deakin T. , McShane CE , Cade JE , Williams Rdrr. Group based training for self-management strategies in people with type 2 diabetes mellitus. Art. No.: CD003417. DOI: 10.1002/14651858. CD003417.pub2, 2005.

Forster A. , Smith J. , Young J. , Knapp P. , House A. , Wright J. Information provision for stroke patients and their caregivers. Art. No.: CD001919. DOI: 10.1002/14651858.CD001919, 2001.

Gibson PG , Powell H. , Coughlan J. , et al. Self-management education and regular practitioner review for adults with asthma. Art. No.: CD001117. DOI: 10.1002/14651858.CD001117, 2002.

Lewin SA , Dick J. , Pond P. , et al. Lay health workers in primary and community health care. Art. No.: CD004015. DOI: 10.1002/14651858.CD004015. pub2, 2004.

10.

Effing T. , Monninkhof EM , van der Valk Pdlpm , et al. Self-management education for chronic obstructive pulmonary disease. Art. No.: CD002990. DOI: 10.1002/14651858.CD002990, 2002.

11.

Powell H. , Gibson PG Options for self-management education for adults with asthma. Art. No.: CD004107. DOI: 10.1002/14651858.CD004107, 2002.

12.

Riemsma RP , Kirwan JR , Taal E. , Rasker JJ Patient education for adults with rheumatoid arthritis. Art. No.: CD003688. DOI: 10.1002/14651858. CD003688, 2003.

13.

Shaw EJ , Stokes T. , Camosso-Stefinovic J. , Baker R. , Baker GA , Jacoby A. Self-management education for adults with epilepsy. Art. No.: CD004723. DOI: 10.1002/14651858.CD004723.pub2, 2007.

14.

Toelle BG , Ram FSF. Written individualised management plans for asthma in children and adults . Art. No.: CD002171. DOI: 10.1002/146 51858.CD002171.pub2, 2003.

15.

Turnock AC , Walters EH , Walters JAE , Wood-Baker R. Action plans for chronic obstructive pulmonary disease. Art. No.: CD005074. DOI: 10.1002/14651858.CD005074.pub2, 2005.

16.

Wetzels R. , Harmsen M. , Van Weel C. , Grol R. , Wensing M. Interventions for improving older patients' involvement in primary care episodes . Art. No.: CD004273. DOI: 10.1002/14651858. CD004273.pub2, 2006.

17.

Bosch-Capblanch X. , Abba K. , Prictor M. , Garner P. Contracts between patients and healthcare practitioners for improving patients' adherence to treatment, prevention and health promotion activities . Art. No.: CD004808. DOI: 10.1002/14651858. CD004808.pub3, 2007.

18.

Haynes RB , Yao X. , Degani A. , Kripalani S. , Garg A. , McDonald HP Interventions for enhancing medication adherence. Art. No.: CD000011. DOI: 10.1002/14651858.CD000011.pub2, 2005.

19.

Heneghan CJ , Glasziou P. , Perera R. Reminder packaging for improving adherence to self-administered long-term medications. Art. No.: CD005025. DOI: 10.1002/14651858.CD005025. pub2, 2005.

20.

Vermeire E. , Wens J. , Van Royen P. , Biot Y. , Hearnshaw H. , Lindenmeyer A. Interventions for improving adherence to treatment recommendations in people with type 2 diabetes mellitus. Art. No.: CD003638. DOI: 10.1002/14651858.CD 003638.pub2, 2005.

21.

McKinstry B. , Ashcroft RE , Car J. , Freeman GK , Sheikh A. Interventions for improving patients' trust in doctors and groups of doctors . Art. No.: CD004134. DOI: 10.1002/14651858.CD 004134.pub2, 2006.

22.

Jolliffe JA , Rees K. , Taylor RS , Thompson D. , Oldridge N. , Ebrahim S. Exercise-based rehabilitation for coronary heart disease. Art. No.: CD001800. DOI: 10.1002/14651858.CD001800, 2000.

23.

Lacasse Y. , Goldstein R. , Lasserson TJ , Martin S. Pulmonary rehabilitation for chronic obstructive pulmonary disease . Art. No.: CD003793. DOI: 10.1002/14651858.CD003793.pub2, 2006.

24.

Moore H. , Summerbell C. , Hooper L. , et al. Dietary advice for treatment of type 2 diabetes mellitus in adults. Art. No.: CD004097. DOI: 10.1002/ 14651858.CD004097.pub3, 2004.

25.

Thomas DE , Elliott EJ , Naughton GA Exercise for type 2 diabetes mellitus. Art. No.: CD002968. DOI: 10.1002/14651858. CD002968.pub2, 2006.

26.

Gillespie LD , Gillespie WJ , Robertson MC , Lamb SE , Cumming RG , Rowe BH Interventions for preventing falls in elderly people. Art. No.: CD000340. DOI: 10.1002/14651858.CD000340, 2003.

27.

Murray E. , Burns J. , See Tai S. , Lai R. , Nazareth I. Interactive Health Communication Applications for people with chronic disease . Art. No.: CD004274. DOI: 10.1002/14651858.CD004274. pub4, 2005.

28.

Currell R. , Urquhart C. , Wainwright P. , Lewis R. Telemedicine versus face to face patient care: effects on professional practice and health care outcomes. Art. No.: CD002098. DOI: 10.1002/ 14651858.CD002098, 2000.

29.

Welschen LMC , Bloemendal E. , Nijpels G. , et al. Self-monitoring of blood glucose in patients with type 2 diabetes mellitus who are not using insulin. Art. No.: CD005060. DOI: 10.1002/14651858. CD005060.pub2, 2005.

30.

Mistiaen P. , Poot E. Telephone follow-up, initiated by a hospital-based health professional, for post discharge problems in patients discharged from hospital to home. Art. No.: CD004510. DOI: 10.1002/14651858. CD004510.pub3, 2006.

31.

Ramaratnam S. , Baker GA , Goldstein LH Psychological treatments for epilepsy. Art. No.: CD002029. DOI: 10.1002/14651858.CD002029. pub2, 2005.

32.

Yorke J. , Fleming SL , Shuldham CM Psychological interventions for adults with asthma. Art. No.: CD002982. DOI: 10.1002/14651858.CD002982. pub3, 2005.

33.

Rees K. , Taylor RS , Singh S. , Coats AJS , Ebrahim S. Exercise based rehabilitation for heart failure. Art. No.: CD003331. DOI: 10.1002/14651858.CD00 3331.pub2, 2004.

34.

Griffin S. , Kinmonth AL Systems for routine surveillance for people with diabetes mellitus . Art. No.: CD000541. DOI: 10.1002/14651858.CD 000541, 1997 .

35.

Renders CM , Valk GD , Griffin S. , Wagner EH , van Eijk JTM , Assendelft WJJ. Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings. Art. No.: CD001481. DOI: 10.1002/14651858. CD001481, 2000.

36.

Barlow J. , Wright C. , Sheasby J. , Turner A. , Hainsworth J. Self-management approaches for people with chronic conditions: a review . Patient Educ Couns 2002; 48: 177-87.

37.

Chodosh J. , Morton SC , Mojica W. , et al. Meta analysis: Chronic disease self-management programs for older adults. Ann Intern Med 2005; 143: 427-38.

38.

Newman S. , Steed L. , Mulligan K. Self-management interventions for chronic illness. Lancet 2004; 364: 1523-37.

39.

Warsi A. , Wang PS , LaValley MP , Avorn J. , Solomon DH Self-management education programs in chronic disease: A systematic review and methodological critique of the literature. Arch Intern Med 2004; 164: 1641-9.

40.

Weingarten SR , Henning JM , Badamgarav E. , Knight K. , Hasselblad V. , Gano A. Interventions used in disease management programmes for patients with chronic illness-which ones work? Meta-analysis of published reports. BMJ 2002; 325: 925.

41.

Zaza S. , Wright-DeAguero LK , Briss PA , et al. Data collection instrument and procedure for systematic reviews in the guide to community preventive services. Am J Prev Med 2000; 18: 44-74.

42.

Barlow JH , Turner AP , Wright CC Long-term outcomes of an arthritis self-management programme. Rheumatology 1998b; 37: 1315-19.

43.

Barlow JH , Williams B. , Wright CC Instilling the strength to fight the pain and get on with life: learning to become an arthritis self manager through an adult education programme. Health Educ Res 1999; 14: 533-44.

44.

Barlow JH , Turner AP , Wright CC A randomized controlled study of the Arthritis Self-management Programme in the UK. Health Educ Res 2000; 15: 665-80.

45.

Buszewicz M. , Rait G. , Griffin M. , et al. Self management of arthritis in primary care: randomised controlled trial. BMJ 2006 ; 333: 879.

46.

Finnerty JP , Keeping I. , Bullough I. , Jones J. The effectiveness of outpatient pulmonary rehab in chronic lung disease: a randomized controlled trial. Chest 2001; 119: 1705-10.

47.

Hammond A. A cross over trial evaluating an educational behavioural joint protection programme for people with rheumatoid arthritis. Patient Educ Couns 1999; 37: 19-32.

48.

Hammond A. , Freeman K. One year outcomes of a randomized controlled trial of an educational behavioural joint protection programme for people with rheumatoid arthritis . Rheumatology 2001; 40: 1044-51.

49.

Helliwell PS , O'Hara M. , Holdsworth J. , Hesselden A. , King T. , Evans P. A 12-month randomized controlled trial of patient education on radiographic changes and quality of life in early rheumatoid arthritis. Rheumatology 1999; 38: 303-8.

50.

Hill J. , Bird H. , Johnson S. Effect of patient education on adherence to drug treatment for rheumatoid arthritis: a randomised controlled trial. Ann Rheum Dis 2001; 60: 869-75.

51.

Lord J. , Victor C. , Littlejohns P. , Ross FM , Axford JS Economic evaluation of a primary care-based education programme for patients with osteoarthritis of the knee. Health Technol Assess 1999; 3: 23.

52.

Victor CR , Triggs E. , Ross F. , Lord J. , Axford J. Lack of benefit of a primary care-based nurse-led education programme for people with osteoarthritis of the knee. Clin Rheumatol 2003; 24: 358-64.

53.

Skinner TC , Carey ME , Cradock S. , et al. Diabetes education and self management for ongoing and newly diagnosed: process modelling of pilot study. Patient Educa Couns 2006; 64: 369-77.

54.

Steed L. , Lankaster J. , Narnard M. , Hurel S. , Newman S. Evaluation of the UCL diabetes self management programme: a randomized controlled trial. J Health Psychol 2005; 10: 261-76.

55.

Griffiths T. , Burr M. , Campbell I. , et al. Results at 1 year of outpatient multidisciplinary pulmonary rehabilitation: a randomised controlled trial . Lancet 2000; 355: 362-8.

56.

Rogers H. , Atkinson C. , Bond S. , Suddes M. , Dobson R. , Curless R. Randomized controlled trial of a comprehensive stroke education program for patients and caregivers. Stroke 1999; 30: 2585-91.

57.

Kennedy A. , Reeves D. , Bower P. , et al. The effectiveness and cost effectiveness of a national lay-led self care support programme for patients with long-term conditions: a pragmatic randomised controlled trial. J Epidemiol Community Health 2006; 61: 254-61.

58.

Freeman K. , Hammond A. , Lincoln NB Use of cognitive-behavioural arthritis education programmes in newly diagnosed rheumatoid arthritis. Clin Rehabil 2002; 16: 828.

59.

Sharpe L. , Sensky T. , Timberlake N. , Ryan B. , Brewin CR , Allard S. A blind, randomized, controlled trial of cognitive-behavioural intervention for patients with recent onset rheumatoid arthritis: preventing psychological and physical morbidity. Pain 2001; 89: 279-83.

60.

Barlow JH , Turner AP , Wright CC Sharing caring and learning to take control: Self management training for people with arthritis. Psychol Health Med 1998a; 3: 387-93.

61.

Krichbaum K. , Aarestad V. , Buethe M. Exploring the connection between self-efficacy and effective diabetes self-management. Diabetes Education 2003; 29: 653-62.

62.

Bandura A. Self-efficacy in changing societies, Cambridge : Cambridge University Press, 1995 .

63.

Lorig K. , Chastain RL , Ung E. , Shoor S. , Holman H. Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis Rheumatology 1989; 30, 1: 37-44.

64.

Talbot F. , Nouwen A. , Gingras J. , Gosselin M. , Audet J. The assessment of diabetes-related cognitive and social factors: the multidimensional diabetes questionnaire. J Behav Med 1997; 20: 291-312.

65.

Office of National Statistics. Focus on health 2006 edition, Hampshire: Palgrave Macmillan, 2006.

66.

Department of Health. Carers at the heart of 21st-century families and communities, London: Department of Health, 2008 .

67.

Department of Health. Self care support: baseline study of activity and development in self care support in PCTs and local areas, London: Department of Health, 2005.