tional patient education programs by requiring teaching, supporting, and working closely with patients. Also, as cited earlier in this chapter, expert designers and researchers on these programs caution that many programs calling themselves self-management programs do not teach all the core skills involved and fail to address the necessary scope of issues (Lorig and Holman, 2003). Self-management support is defined as the “systematic provision of education and supportive interventions to increase patients’ skills and confidence in managing their health problems, including regular assessment of progress and problems, goal setting, and problem-solving support” (IOM, 2003:52 [emphasis added]). Whereas traditional patient education offers technical information and skills training (typically in areas defined by the clinician), self-management education supports patients in identifying their problems and provides techniques to help them make decisions, take appropriate actions, and modify these plans as circumstances or the course of their illness changes. Patient self-management thus requires that a clinician utilize a collaborative model of practice in which the patient and clinician are equal partners, with equal expertise (Bodenheimer et al., 2002a). Whereas the clinician brings expertise in the illness and therapeutics, patients are experts in their own lives and in what concerns them and motivates and enables them to make changes in their lives. This model is the basis for a collaborative process between the health care provider and patient in which attainable, short-term goals are identified by the patient, discussed jointly, and agreed upon.

Several approaches have been developed in recent years to support individuals’ self-management. One example, the Wellness Recovery Action Plan (WRAP), is a structured approach designed to help individuals with mental illnesses identify internal and external resources for facilitating recovery, and then use these tools to create a plan for successful living (Copeland, 2002). Creating a WRAP plan generally begins with development of a personal Wellness Toolbox, consisting of simple, safe, and (usually) free self-management strategies such as a healthy diet, exercise, good sleep patterns, and pursuit of adult life roles. The person then uses this toolbox to create an individualized plan for using each strategy to attain and/or maintain recovery. The plan also includes identification of early warning signs of symptom exacerbations or crisis, and ways in which the toolbox can help people manage and feel better. In addition, WRAP encourages development of a crisis plan, which states how the person would like to be treated in times of crisis (similar to an advance directive), as well as a postcrisis plan for getting back on the road to recovery.

Patient self-management of chronic illness also has become one of the pillars of the Chronic Care Model, reflecting recognition of the fact that for chronic illnesses, patients themselves are their principal caregivers—



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