The Dutch approach to structured disease management for chronic conditions and, in particular, the self-management support activities included in that approach can be summarized as follows.
Implementation processes and experiences varied considerably among the practices implementing CHW and MA team-based approaches, resulting in differences in the organization of health coaching and self-management support activities.
Template completion in the 13 countries was complemented by a case study of the Dutch DISMEVAL partner, which aimed to assess health professionals' perspectives of the level of and barriers to implementation of self-management support activities in daily practice.
The German disease management programmes, which were introduced between 2003 and 2006 for six conditions (breast cancer, type 1 and 2 diabetes, coronary heart disease, asthma and chronic obstructive pulmonary disease), offer self-management support activities for each disease.
For each approach, respondents described whether and how self-management support activities were implemented, according to the CCM-related Assessment of Chronic Illness Care (ACIC) survey [ 34]; that is, patient education, collaborative care planning, provision of self-management tools, and structured follow-up.
The overall impression is that nurses enact their work in three spatial domains: clinical interactions and activity primarily within patient-centred spaces; administrative work in an 'office' setting, and equipment, stock management and support activities conducted within the 'backstage' areas of a practice.
Dr. Janet Nelson is a Director of Business Development for URS Corporation, currently supporting program growth at the National Energy Technology Laboratory (NETL) and providing project management support for several activities.
Two key issues emerged in the focus groups: (a) patient education to support self-management and (b) support activities for informal caregivers in order to enable them to keep on caregiving in adequate conditions.
Self-management support (SMS) activities were re-assigned to the midwives and BHW.
Scenario planning is a widely accepted management process for decision support activities.
