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Annexure C (ii)(b)(sn)

Summary notes:
National Chronic Disease Strategy - Australian Health Ministers’ Conference 2005

Action area: Self-management

Self-management is about people being actively involved in their own health care. All people with chronic disease self manage to some extent at all times, although the ability and resources to do this vary across the lifespan and at different stages of illness. Self-management principles aim to optimise people’s capacity to self manage throughout the continuum of chronic disease prevention and care.

Self-management requires the person, their family and carers, service providers and the health system working together to achieve better health outcomes. Self-management is underpinned by the person being at the centre of their own health care, and involves the skills and resources that a person needs to negotiate the health system and maximise their quality of life across the continuum of prevention and care.

Embedding the principles of self-management in the health system means that a person is supported by the system to:

•   understand the nature of their illness including risk factors and co-morbidities

•   have knowledge of their treatment options and be able to make informed choices regarding treatments

•   actively participate in decision making with health professionals, family and carers, and other supports in terms of continuing care

•   follow a treatment or care plan that has been negotiated and agreed with their health care providers, family and carers, and other supports

•   monitor signs and symptoms of change in their health condition and have an action plan to respond to identified changes

•   manage the impact of the disease on their physical, emotional and social life and have better mental health and wellbeing as a result

•   adopt a lifestyle that reduces risks and promotes health through prevention and early intervention

•   have confidence in their ability to use support services and make decisions regarding their health and quality of life.

Self-management involves all the levels of the health system—individuals, their families and carers, service providers, health organisations, the wider health system and the community. Self-management principles must be firmly embedded throughout the continuum of chronic disease prevention and care, and this requires a major cultural shift in work practices and service delivery.

Future directions for self-management

Reorienting the health system to support self-management

Incorporating self-management within the health system requires a significant change in focus. Currently, funding for self-management approaches is set against an acute care system that, by virtue of its crisis response, tends to receive budgetary priority. In contrast, the longer term, collaborative and multidisciplinary planning that supports self-management encounters many systemic barriers.

Self-management should be routinely encouraged through all health care encounters. There are many opportunities in the development and progression of chronic disease to engage the person in learning and behaviour change. Health professionals need to be oriented toward this engagement and skilled at identifying and taking advantage of these opportunities.

The ability of individuals to self manage is likely to be enhanced the earlier it is started. So, support for self-management should commence at the earliest possible opportunity, and include people at risk of disease and in the early stages of chronic disease.

Improving the capacity of the peer, disability and carer support sectors

Self-management encompasses a range of daily behaviours, such as taking medicines, having an adequate diet, physical activity, hygiene, stress reduction and social support.  Many of these behaviours relate to a broader set of attitudes, behaviours and skills that can include significant lifestyle changes related to risk factors. Self-management also includes coping with changes to life roles and aspirations, and accommodating long term engagement with the health system.

Health professionals have an important role in helping people to identify and achieve appropriate behavioural and lifestyle changes. However, such significant life change requires a wider system of support, beyond that provided by the health system.

Of particular importance are the peer, disability, carer and aged care support sectors. These sectors often take the lead role in developing self-management resources, yet they tend to be poorly resourced and not well integrated with other parts of the health system.

These sectors are also essential in providing psychosocial support and rehabilitation services for people with chronic disease, as well as providing support and respite for their families and carers, and these are essential elements of self-management.

Importantly, the health system cannot work in isolation from other sectors, services and industries. Many of the risk and protective factors for the development, progress and complications of chronic disease occur in the settings of everyday life. It is essential that environments for work, education, recreation and community living, along with all health services, support healthy lifestyle choices and reduce the risks for chronic disease.

While the health sector needs to take leadership, advocating, engaging and partnering with other sectors is essential. The significant and sustainable change that is required to achieve the objectives of the NCDS necessitates whole-of-government and whole-of-community approaches.