and increased hospitalization (DiMatteo, 2004). Conversely, good communication can obviate the need for extensive discussions about the medication regimen with every patient during every visit.

Methods for incorporating patient-centered communication about medications into day-to-day clinical practice can be drawn from the Chronic Care Model (as well as others employed to develop consumers’ self-management skills). The Chronic Illness Care Breakthrough Series Collaboratives established by the Institute for Healthcare Improvement and Associates in Process Improvement developed a five-component model of key steps to patient-centered self-management support (Glasgow et al., 2002) (see Figure 4-1). It is designed to organize evidence-based intervention components into an integrated and understandable iterative process appropriate for incorporation into busy primary care practices. The five components are as follows: (1) current self-management beliefs and behaviors are assessed, with feedback for both providers and patients; (2) the feedback prompts collaborative goal setting between patients and provider(s); (3) a personal action plan for self-management is developed; (4) initial self-management goals are refined and informed through the identification of anticipated barriers to and supports for the achievement

FIGURE 4-1 The Chronic Care Model: Key steps to patient-centered, self-management support.

SOURCE: Glasgow et al., 2002.



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