The Importance of Self-Management in the Context of Personalized Care in COPD

Abstract

Ana Cravo,1 Darush Attar,2 Daryl Freeman,3 Steve Holmes,4 Lindsay Ip,5 Sally J Singh6,7 1Medical Affairs, Boehringer Ingelheim Ltd, Bracknell, UK; 2North Central London Clinical Commissioning Group (CCG), London, UK; 3Norfolk Community Health & Care, Norwich, UK; 4The Park Medical Practice, Shepton Mallet, UK; 5King’s Health Partners and Ealing Community Partners, London, UK; 6Faculty of Health and Life Sciences, Coventry University, Coventry, UK; 7Department of Respiratory Sciences, University of Leicester, Leicester, UKCorrespondence: Steve HolmesThe Park Medical Practice, Cannard’s Grave Road, Shepton Mallet, Somerset, BA4 5RT, UKTel [phone]Email [email protected]: Despite current guidelines and decades of evidence on the benefits of a self-management approach, self-management of COPD remains relatively under-utilized in clinical care compared with other chronic diseases. However, self-management interventions can play a valuable role in supporting people with COPD to respond to changing symptoms, and thereby make appropriate decisions regarding the management of their own chronic condition. In this review, we discuss the history and evolution of the concept of self-management, assess current multidisciplinary support programs and clinical interactions designed to optimize self-management, and reflect on how effective these are in terms of clinical and humanistic outcomes. We also evaluate the mechanisms for encouraging change from protocol-based care towards a more personalized care approach, and discuss the role of digital self-management interventions and the importance of addressing health inequalities in COPD treatment, which have been accelerated by the COVID-19 pandemic. Reflecting on the importance of self-management in the context of symptom monitoring and provision of educational support, including information from patient organizations and charities, we discuss the ideal components of a self-management plan for COPD and provide six key recommendations for its implementation: 1) better education for healthcare professionals on disease management and consultation skills; 2) new targets and priorities for patient-focused outcomes; 3) skills gap audits to identify barriers to self-management; 4) best practice sharing within primary care networks and ongoing professional development; 5) enhanced initial consultations to establish optimal self-management from the outset; and 6) negotiation and sharing of self-management plans at the point of diagnosis.Keywords: chronic obstructive pulmonary disease, COPD, self-management, personalized care

Keywords

• chronic obstructive pulmonary disease
• copd
• self-management
• personalized care