Paper short abstract:

This paper examines how patients, professionals and commissioners conceptualise self-management, using diabetes as a case study. It draws on patients’ and professionals’ views and approaches to self-management, elicited during a diabetes improvement project aimed at primary care services.

Paper long abstract:

Greater self-management of chronic health problems is an agreed priority for health service commissioners in times of rising population morbidity and shrinking resources. One UK decision-making body for commissioning health services suggested an approach to increase patient self-management that focused on a diabetes improvement project within primary care. The core of this project consisted of shared decision-making training for health professionals with the input of linked expert patients. The aim of this paper is to describe and understand current approaches to self-managing diabetes from the different stakeholders' perspectives'. The paper draws on emerging findings from observations of decision-making commissioner meetings over a one-year period during which the case for a diabetes improvement project was made and approved. It also draws on data collected from observations in clinical diabetic reviews, and interviews with general practitioners, nurses, practice managers and patients. The findings show that the commissioners' desire to shift the balance of responsibility for diabetes through patient shared decision-making contrasted with the existing approach to diabetes care by individual patients and health professionals. Health professionals focused their diabetes management on medication and expressed frustration at their seeming inability to influence the self-management of most of their patients. Patients' definition of self-management included keeping a careful diet, non-medical cures, and managing the bothersome symptoms of other comorbidities. Unpacking the current and sometimes conflicting UK clinical, patient and commissioning perspectives on diabetic care may help to support new approaches to self-management both in diabetes and other chronic conditions.