Newman Stanton, Steed Liz, Mulligan Kathleen
Unit of Health Psychology, Centre for Behavioural and Social Sciences in Medicine, University College London, London, UK.
Lancet. 2004;364(9444):1523-37. doi: 10.1016/S0140-6736(04)17277-2.
An increasing number of interventions have been developed for patients to better manage their chronic illnesses. They are characterised by substantial responsibility taken by patients, and are commonly referred to as self-management interventions. We examine the background, content, and efficacy of such interventions for type 2 diabetes, arthritis, and asthma. Although the content and intensity of the programmes were affected by the objectives of management of the illness, the interventions differed substantially even within the three illnesses. When comparing across conditions, it is important to recognise the different objectives of the interventions and the complexity of the issues that they are attempting to tackle. For both diabetes and asthma, the objectives are concerned with the underlying control of the condition with clear strategies to achieve the desired outcome. By contrast, strategies to deal with symptoms of pain and the consequences of disability in arthritis can be more complex. The interventions that were efficacious provide some guidance as to the components needed in future programmes to achieve the best results. But to ensure that these results endure over time remains an important issue for self-management interventions.
为了让患者更好地管理自身慢性病，已开发出越来越多的干预措施。这些措施的特点是患者承担大量责任，通常被称为自我管理干预措施。我们研究了针对2型糖尿病、关节炎和哮喘的此类干预措施的背景、内容和效果。尽管这些项目的内容和强度受疾病管理目标的影响，但即使在这三种疾病中，干预措施也存在很大差异。在不同疾病情况之间进行比较时，重要的是要认识到干预措施的不同目标以及它们试图解决的问题的复杂性。对于糖尿病和哮喘，目标都涉及病情的根本控制，并采用明确的策略来实现预期结果。相比之下，应对关节炎疼痛症状和残疾后果的策略可能更为复杂。有效的干预措施为未来项目实现最佳效果所需的组成部分提供了一些指导。但要确保这些结果长期持续，仍然是自我管理干预措施的一个重要问题。
