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Abstract
Patients with chronic conditions make day-to-day decisions about--self-manage--their
illnesses. This reality introduces a new chronic disease paradigm: the patient-professional
partnership, involving collaborative care and self-management education. Self-management
education complements traditional patient education in supporting patients to live
the best possible quality of life with their chronic condition. Whereas traditional
patient education offers information and technical skills, self-management education
teaches problem-solving skills. A central concept in self-management is self-efficacy--confidence
to carry out a behavior necessary to reach a desired goal. Self-efficacy is enhanced
when patients succeed in solving patient-identified problems. Evidence from controlled
clinical trials suggests that (1) programs teaching self-management skills are more
effective than information-only patient education in improving clinical outcomes;
(2) in some circumstances, self-management education improves outcomes and can reduce
costs for arthritis and probably for adult asthma patients; and (3) in initial studies,
a self-management education program bringing together patients with a variety of chronic
conditions may improve outcomes and reduce costs. Self-management education for chronic
illness may soon become an integral part of high-quality primary care.