CDSM: International &National Perspectives
The UK Expert Patients Programme: results and implication from a national evaluation

Professor Anne Rogers
National Primary Care Research & Development Centre
University of Manchester

In England, service delivery for long-term conditions is based around three tiers. Case
management is for patients with multiple, complex conditions, involving intensive care to avoid
complications and admissions. Disease management is for patients at some risk, and involves
supporting patients with long-term conditions through guideline-based programmes in primary care,
facilitated by financial incentives. The final tier involves self care support for low risk patients
(estimated as 70-80% of those with long-term conditions). In England, self care support has been
developed through the 'Expert Patients Programme', which is providing lay led generic courses to
improve the self care skills of patients. The results and interpretation of the national evaluation
programme of the EPP will be presented.

This includes:

1) a pragmatic randomised controlled trialundertaken with patients with a wide range of long-term conditions who were randomised to immediate access to a self care support group, or to a waiting list control group. The course was group-based and involved six weekly sessions. Primary outcomes (measured at 6 months) were self efficacy, reported energy and routine health services utilisation. A full cost-effectiveness analysis was also conducted.

2) A process evaluation exploring the way in which organizations in our health system professionals and patients responded to this government initiative

3) A longitudinal qualitative study of patient experience of attending the EPP and its impact on existing
self care strategies. It will be argued that there are both positive and negative lessons to be learned
from attempts to embed a national policy of this nature into the UK health system which is likely to
have implications for other health care systems and patient centred initiatives more generally.


Why is high quality self-management for chronic conditions imperative for
Australian health care

Dr Richard Osborne
Centre for Rheumatic Diseases
University of Melbourne

It is now apparent that the nature, extent and future growth of chronic disease burden will cripple
health care systems if decisive action is not taken. The four conditions; mental health, type 2
diabetes, serious injury, cardiovascular disease, cancer, and musculoskeletal disease, account for
about 70% of the burden amongst working age people alone. Self-management has the potential
to mitigate the personal burden borne by individuals with long term chronic conditions through
improving capacity to self-care, empowering individuals to participate in life and by assisting them
to reduce risk factors for disease progression.

The operationalisation of self-management support in Australia has been undertaken with the
support of several systematic Australian and State Government policy initiatives, an enthusiastic
non-government health sector, numerous community-base organisations and a growing research
community. The generation and uptake of self-management support has been tremendously
successful in some settings. However wider and more effective application has been stymied by
the ‘short term’ nature of project funding, provision of a limited range of self-management
interventions and limited integration across the healthcare and disease continuum. In Australia, the
body of knowledge and grounded expertise regarding how to deliver self-management support to
individuals with chronic conditions is enormous, however dissemination and exchange of this
knowledge has remained largely untapped.

It is imperative that major advances in our approach to primary prevention and the care of people
with chronic and complex conditions be made. The Way Forward includes consideration of an
individual’s interest in self-care, multi-disciplinary care, access to high quality self-management
support and a healthcare system that streamlines and facilitates patient access to and engagement
in self-care across the care continuum. With these fundamentals in place, individuals with chronic
conditions will be better supported to participate in society and optimise their quality of life.
This conference, The Way Forward Conference for Chronic Disease Self-management, will expose
why self-management support is an imperative for both the Australian healthcare sector and for
individuals suffering from chronic conditions.