Disease Management: Maximising Treatment Adherence and Self-Management

The effective management of chronic illness has historically been plagued by patient non-adherence to treatment regimens. While disease management initiatives have recently proliferated in an attempt to more effectively manage these chronic illnesses, many of these new programmes have lacked effective behaviour change interventions. It is expected that this void will hopefully be corrected as more sophisticated second generation disease management programmes are developed. This article explores the major issues and forces driving patient non-adherence and recommends a number of strategies to be used to enhance patient adherence and to improve patient self-management. Specifically, the authors propose 6 guiding principles for improving patient adherence and self-management. These principles include: 1. (i) taking a comprehensive, holistic, patient-centred approach to disease management; 2. (ii) being aware of the many different forms of nonadherence; 3. (iii) facilitation of patient motivation and readiness to change; 4. (iv) collaboratively supporting self-management behaviour; 5. (v) focusing less on problems and more on solutions; and 6. (vi) establishing and maintaining good communications with the patient. The success of disease management will require, in many cases, a major re-engineering of how we deliver and coordinate healthcare. Importantly, the development of systematic behaviour change interventions and adoption of a true patient-centred approach to disease management will be essential if meaningful, long term clinical and economic outcomes are to be achieved. Case managers and specialty disease management organisations that focus on the development of new, implementable behaviour change interventions will play a major role in insuring that our second generation of disease management programmes incorporate these new patient empowerment interventions.