What works for long term conditions (LTCs)

A large international evidence base encapsulated in the chronic care model (Wagner, EH, Austin BT, Von Korff, M. (1996) Organising Care for Patients with Chronic Illness. The Millbank Quarterly; 74(4)) suggests that better outcomes for people with long term conditions can be achieved when there is partnership working between an ‘engaged’, ‘empowered’ or ‘activated patient’[1] and an organised proactive health care system.

The most important element of this complex intervention is support for self management (SSM).

“Self care is one of the best examples of how partnerships between the public and health service can work… for every £100 spent on encouraging self care, around £150 worth of benefits can be achieved in return.”

SSM recognises that:

"People with LTCs are in charge of their own lives and self management of their condidtion, and are the primary decision makers about the actions they take in relation to the management of their condition" 

The desired outcome, i.e. someone who is an effective self manager, i.e. is a person ‘with the ‘knowledge, skills and confidence to manage their own health and healthcare.’  The focus moves from the clinician doing things ‘to’ the person, to one where enabling clinicians support people’s confidence and competence to manage the challenges of living with their condition.

There is an extensive evidence base for the effectiveness of interventions which support self management. 

Year of Care (via care planning and commissioning non traditional services to SSM) provides a systematic and practical approach to putting support for self management into routine practice.

[1] These different adjectives are used in different publications and are taken to mean someone who is actively and confidently involved in managing their own healthcare on a day to day basis.