Plevinsky Jill M, Greenley Rachel N, Fishman Laurie N
Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL.
Department of Gastroenterology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Clin Exp Gastroenterol. 2016 Aug 23;9:259-67. doi: 10.2147/CEG.S106302. eCollection 2016.
Self-management, including medication adherence, is associated with improved health and outcomes for patients with inflammatory bowel disease. The concept of self-management is complex, but can be divided into those aspects that involve the individual patient, those that involve the provider-patient relationship, and those that encompass the social environment. At the individual level, enhancing problem-solving skills and self-efficacy have both been shown to improve self-management tasks, particularly adherence to treatment. However, it is critical to consider these domains from a lifespan perspective because these processes by which self-management can be improved are distinct for children, adolescents, young adults, and adults. A particular emphasis is placed on strategies to improve self-management of older adolescents and young adults as they transition from pediatric to adult providers. The review concludes with recommendations for providers, including rationale and techniques for assessing and promoting patient self-efficacy, encouraging the development of problem-solving skills, improving the patient-provider relationship, and enhancing social support. Providers are encouraged to utilize elements of problem-solving skills training, engage in collaborative relationships with their patients, and offer their patients recommendations for how to increase the quality of their social support networks as ways of increasing overall self-management.
自我管理，包括药物依从性，与炎症性肠病患者的健康改善及预后相关。自我管理的概念很复杂，但可分为涉及个体患者的方面、涉及医患关系的方面以及涵盖社会环境的方面。在个体层面，提高解决问题的能力和自我效能都已被证明能改善自我管理任务，尤其是治疗依从性。然而，从生命周期的角度考虑这些领域至关重要，因为改善自我管理的这些过程在儿童、青少年、青年和成年人中是不同的。特别强调改善年长青少年和青年自我管理的策略，因为他们正从儿科医疗服务过渡到成人医疗服务。该综述最后为医疗服务提供者提出了建议，包括评估和提高患者自我效能的基本原理和技巧、鼓励解决问题能力的发展、改善医患关系以及增强社会支持。鼓励医疗服务提供者利用解决问题技能培训的要素，与患者建立合作关系，并为患者提供如何提高其社会支持网络质量的建议，以此作为提高整体自我管理的方法。
