Owens John, Entwistle Vikki A, Cribb Alan, Skea Zoë C, Christmas Simon, Morgan Heather, Watt Ian S
Centre for Public Policy Research, King's College London, Waterloo Bridge Wing, Franklin-Wilkins Building, Waterloo Rd, London, UK, SE1 9NH.
Health Services Research Unit, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen, UK, AB25 2ZD.
BMC Fam Pract. 2017 Mar 20;18(1):39. doi: 10.1186/s12875-017-0611-7.
Support for self-management (SSM) is a prominent strand of health policy internationally, particularly for primary care. It is often discussed and evaluated in terms of patients' knowledge, skills and confidence, health-related behaviours, disease control or risk reduction, and service use and costs. However, these goals are limited, both as guides to professional practice and as indicators of its quality. In order to better understand what it means to support self-management well, we examined health professionals' views of success in their work with people with long-term conditions. This study formed part of a broader project to develop a conceptual account of SSM that can reflect and promote good practice.
Semi-structured individual interviews (n = 26) and subsequent group discussions (n = 5 groups, 30 participants) with diverse health professionals working with people with diabetes and/or Parkinson's disease in NHS services in London, northern England or Scotland. The interviews explored examples of more and less successful work, ways of defining success, and ideas about what facilitates success in practice. Subsequent group discussions considered the practical implications of different accounts of SSM. Interviews and group discussions were audio-recorded, transcribed and analysed thematically.
Participants identified a wide range of interlinked aspects or elements of success relating to: health, wellbeing and quality of life; how well people (can) manage; and professional-patient relationships. They also mentioned a number of considerations that have important implications for assessing the quality of their own performance. These considerations in part reflect variations in what matters and what is realistically achievable for particular people, in particular situations and at particular times, as well as the complexity of questions of attribution.
A nuanced assessment of the quality of support for self-management requires attention to the responsiveness of professional practice to a wide, complex range of personal and situational states, as well as actions and interactions over time. A narrow focus on particular indicators can lead to insensitive or even perverse judgements and perhaps counterproductive effects. More open, critical discussions about both success and the assessment of quality are needed to facilitate good professional practice and service improvement initiatives.
自我管理支持（SSM）是国际卫生政策的一个突出方面，在初级保健领域尤为如此。人们经常从患者的知识、技能和信心、健康相关行为、疾病控制或风险降低以及服务使用和成本等方面对其进行讨论和评估。然而，这些目标无论是作为专业实践的指南还是其质量指标都存在局限性。为了更好地理解良好的自我管理支持意味着什么，我们研究了卫生专业人员对其与慢性病患者合作中成功的看法。本研究是一个更广泛项目的一部分，该项目旨在构建一个能够反映并促进良好实践的自我管理支持概念框架。
对在伦敦、英格兰北部或苏格兰的国民医疗服务体系（NHS）中为糖尿病和/或帕金森病患者提供服务的不同卫生专业人员进行半结构化个人访谈（n = 26），随后进行小组讨论（n = 5组，30名参与者）。访谈探讨了较成功和较不成功工作的例子定义成功的方式以及关于在实践中促进成功的想法。随后的小组讨论考虑了自我管理支持不同描述的实际影响。访谈和小组讨论进行了录音、转录并进行主题分析。
参与者确定了与成功相关的广泛相互关联的方面或要素，包括：健康、幸福和生活质量；人们管理（或能够管理）的程度；以及专业人员与患者的关系。他们还提到了一些对评估自身表现质量具有重要意义的考虑因素。这些考虑因素部分反映了在特定人群、特定情况和特定时间什么是重要的以及实际可实现的方面的差异，以及归因问题的复杂性。
对自我管理支持质量进行细致入微的评估需要关注专业实践对广泛、复杂的个人和情境状态以及随着时间推移的行动和互动的响应能力。过于狭隘地关注特定指标可能导致不敏感甚至错误的判断，可能产生适得其反的效果。需要就成功和质量评估进行更开放、批判性的讨论，以促进良好的专业实践和服务改进举措。
