Patient self-management of chronic disease in primary care
Patient self-management of chronic disease in primary care
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DOI：
10.1001/jama.288.19.2469
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发表时间：
2002-11-20
影响因子：
120.7
通讯作者：
Grumbach, K
中科院分区：
文献类型：
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作者：
Bodenheimer, T;Lorig, K;Grumbach, K
患有慢性病的患者每天都会做出自我管理疾病的决定。这一现实引入了一种新的慢性病模式：患者-专业伙伴关系，涉及协作护理和自我管理教育。自我管理教育是对传统患者教育的补充，支持患者在慢性病的情况下尽可能地过上最好的生活质量。传统的患者教育提供信息和技术技能，而自我管理教育则教授解决问题的技能。自我管理的一个核心概念是自我效能感，即自信地执行必要的行为，以达到预期的目标。当患者成功地解决了患者确定的问题时，自我效能感就会增强。来自对照临床试验的证据表明：(1)教授自我管理技能的计划在改善临床结果方面比仅提供信息的患者教育更有效；(2)在某些情况下，自我管理教育可以改善结果，并可以降低关节炎、甚至可能是成人哮喘患者的成本；以及(3)在初步研究中，将各种慢性病患者聚集在一起的自我管理教育计划可能会改善结果并降低成本。慢性病自我管理教育可能很快就会成为高质量初级保健不可或缺的一部分。
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.