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This Week in Managed Care: December 30, 2016
December 30, 2016

Barriers to Self-Management of COPD

AJMC Staff
As the prevalence of chronic obstructive pulmonary disease increases, self-management will become increasingly important. However, a new study has highlighted the difficulties of embedding self-management into routine care.
As the population ages, it is expected that the number of people with chronic obstructive pulmonary disease (COPD) will increase by 38% between 2005 and 2025. As such, self-management will become increasingly important in COPD care. However, a new study published in the International Journal of COPD highlighted the difficulties of embedding self-management into routine clinical care.

Researchers in the Netherlands collected data from 46 patients with COPD and their healthcare providers through interviews, video-recorded consultations, and questionnaires on consultation skills.

“Although the patient-centered approach accentuating self-management is one of the dominant paradigms in modern medicine, our observations show several influencing determinants causing difficulties in daily practice implementation,” the authors wrote.

They determined that while patients had heard of e-health applications for self-management, few actually use them for a variety of reasons. The components of self-management that were given most attention during consultations were “information provision,” “training skills,” and “self-monitoring.” The components of self-management that were raised less frequently during consultations were “maintaining behavior change,” “social support,” and “managing emotions.”

The researchers determined that connecting to patients’ goals and expectations is a barrier. In half of the consultations, the providers asked about patient-centered goals and questions patients had. However, the majority (88.5%) of patients mentioned no questions or goals.

Similarly, the providers “expressed difficulties in estimating what motivated patients” when it came to self-management. And yet, both the providers and patients saw the importance of communication. Patients identified several reasons they were hesitant to take on self-management:
  1. Low level of experienced burden of the disease
  2. Not wanting to be confronted with their disease
  3. Dealing with external social problems

“We conclude that during consultation, a traditional healthcare approach is still commonly used in which [healthcare providers] take the leading role,” the authors wrote.

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