Capital Health, Dalhousie University, Halifax, Nova Scotia, Canada.
Can J Diabetes. 2015 Aug;39(4):330-4. doi: 10.1016/j.jcjd.2015.01.002. Epub 2015 Mar 30.
Self-management and self-management support are concepts very familiar to those of us in diabetes care. These concepts require openness to understanding the behaviours of persons with diabetes broadly, not only behaviours restricted to the biomedical perspective. Understanding the importance of health behaviour change and working within the Expanded Chronic Care Model define the context within which self-management support should occur. The purpose of this perspective is to identify a potential limitation in existing self-management support initiatives. This potential limitation reflects provider issues, not patient issues; that is, true self-management support might require changes by healthcare providers. Specifically, although behavioural interventions within the context of academic research studies are evidence based, behaviour change interventions implemented in general practice settings might prove less effective unless healthcare providers are able to shift from a practice based on the biomedical model to a practice based on the self-management support model. The purpose of this article is to facilitate effective self-management support by encouraging providers to switch from a model of care based on the expert clinician encountering the uninformed help seeker (the biomedical model) to one guided by collaboration grounded in the principles of description, prediction and choice. Key to understanding the value of making this shift are patient-centered communication principles and the tenets of complexity theory.
自我管理和自我管理支持对于我们这些从事糖尿病护理的人来说是非常熟悉的概念。这些概念需要开放地理解糖尿病患者的行为，而不仅仅是局限于生物医学视角的行为。理解健康行为改变的重要性并在扩展的慢性护理模型内工作，定义了自我管理支持应该发生的背景。本观点的目的是确定现有自我管理支持计划的一个潜在局限性。这种潜在的局限性反映了提供者的问题，而不是患者的问题；也就是说，真正的自我管理支持可能需要医疗保健提供者做出改变。具体来说，尽管在学术研究背景下的行为干预是基于证据的，但在一般实践环境中实施的行为改变干预措施可能效果较差，除非医疗保健提供者能够从基于生物医学模型的实践转变为基于自我管理支持模型的实践。本文的目的是通过鼓励提供者从基于专家临床医生遇到不知情的寻求帮助者的护理模式（生物医学模型）转变为基于描述、预测和选择原则的协作模式，来促进有效的自我管理支持。理解进行这种转变的价值的关键是以患者为中心的沟通原则和复杂性理论的原则。
