Why is this topic important?

Over the last decade, a dramatic rise in the prevalence of chronic conditions has emerged, altering the way in which care is delivered and received. Presently, one in every three individuals will at some time in their life be living with a chronic condition (1, 2). Coupled with aging populations and rising health care costs, these chronic conditions will create a financial burden that is expected to overwhelm the finite medical and personnel resources of any given country. The reality of this global situation will mean that clinicians will be present for only a fraction of a patient’s life and these people will be living for a long period of time and mostly outside the formal health care system. Importantly, such people have an integral role in managing because the pace of disease progression and nearly all health outcomes are mediated through their own behavior (3).

One promising approach to improving outcomes and reducing health care costs associated with chronic conditions is self-management, whereby individuals, in collaboration with health care professionals, assume greater responsibility for health care decisions. In the past, almost all health care and teaching was provided by health care professionals, but there is acknowledgement that many of the clinical functions (e.g., monitoring HbA1c, blood pressure and weight) and teaching activities can be effectively carried out by patients. An inherent philosophical re-orientation is taking place whereby health professionals are seeing their relationship with patients as partners and coaches.

The growing emergence of self-management support programs not only involves changes at the clinician-patient level but also requires change at multiple levels: office environment, health system, policy and environmental supports (4). The bottom line is that self-management is good medicine, and health care without a strong selfmanagement component does not meet quality standards.