Evidence that it works

Collaborative self care has been used to guide efforts to improve the quality of chronic illness care in many different healthcare settings and for many different chronic conditions including diabetes, heart failure, geriatric care, depression, and asthma. This approach gives patients the confidence and skills for self care and for getting what they need from the healthcare system (that is, becoming active, informed patients). Such effective support of patients is more likely to occur when the providers of care themselves have the information, training, resources, and time to deliver effective interventions (that is, are a well prepared, proactive practice team).

There is now considerable evidence and practical experience that supports fundamental changes in the way we organise and deliver health care to better support patients who are living with a chronic condition. Consequently, we need to include psychological and behavioural expertise as essential supplements to basic medical treatment.

Patient centred care is more than a respectful attitude or a style of clinical interviewing. It means that healthcare systems are organised to maximise the effectiveness of patients to manage their chronic illness themselves.

Psychological medicine will make its full contribution only when an awareness of the importance of psychological and behavioural factors is fully integrated into general medical care.

Work on this article was supported by grants from the Robert Wood Johnson Foundation National Program for Improving Chronic Illness Care, NIMH grants MH51338 and MH41739, and NIH grant P01 DE08773.

The picture is reproduced with permission of CC Studio/SPL.

Making evidence based care time and cost effective Problems

• Time for patient care

• Time for assessing evidence

• Unrealistic patient expectations and demands

• Lack of patient understanding of behavioural basis of self care

• Lack of involvement of patients in clinical decisions

• Lack of professional skills

• Access to disparate community and medical services Solutions

• Treatment protocols

• Involvement of healthcare team

• Use of self help procedures

• Formalising links with local health, social, and voluntary agencies

• Liaison with specialist medical, psychiatric, and psychological services

• Continuing professional development

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