UK researchers have raised doubts over a flagship self-management programme for chronic diseases, questioning its overall impact on health and ability to produce cost savings.
The government-backed expert patients programme uses lay tutors to help patients learn skills to manage their conditions better. It has received £18 million funding from the Department of Health so far and is due to be rolled out to 100,000 patients by 2012. But researchers at Queen Mary's school of medicine and dentistry in London, writing in the British Medical Journal, say evidence to date, from four UK trials, shows that while lay-led programmes may increase patients' confidence to manage their disease, they make little impact on either hospital admissions or the use of other healthcare resources in the NHS. The EPP consists of six group sessions fostering self-care skills such as improved confidence, and ability to manage stress, achieve goals and work in partnership with healthcare professionals. The BMJ article notes such programmes can increase patients' confidence to change behaviour, which can lead to improved psychological health. But these outcomes are modest compared with certain professionally-led rehabilitation schemes, which combine self-management advice with structured exercise programmes and have yielded 'clinically important' results. The authors call for more research into EPPs to see if they could be made more effective, for example by adding slots for clinicians to teach clinical disease management skills. Physiotherapist Tanya Desfontaines, who underwent an EPP course to deal with her own chronic asthma and later became a trained tutor, said she did not expect the courses to replace other forms of therapy. She suggested it was unrealistic to expect patients, particularly those with multiple conditions, suddenly to make less use of health services, although they might use them more effectively. Her colleague Vivienne Thorpe, learning and development clinical lead for Devon primary care trust, agreed: 'These programmes are not a catch-all, and I firmly believe they should be part of a range of options based around self-care and self-management.'
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