Self-management fails to cut GP consultations

Patient self-care programmes fail to reduce rates of GP consultations, UK research has shown.  

The finding casts doubt on the value of the DoH Expert Patients Programme, which is expected to receive a three-fold increase in funding by 2012, raising capacity from 12,000 to 100,000.  

Of 812 patients with osteoarthritis of the knee, hip or both, rates of GP consultation were similar in those assigned to six sessions of a self-management programme plus an education booklet as in those given the booklet alone.  

Patients on the self-management programme experienced a significant decrease in depression at four months and anxiety at 12 months compared with the control group. But intervention failed to substantially improve physical functioning, stiffness or pain levels at either follow-up.  

This suggests active recruitment of patients to self- management programmes is, as yet, inappropriate, said lead researcher Dr Marta Buszewicz, from the department of primary care and population sciences at the Royal Free and University College Medical School, London.  

‘We need to think about which particular patients will do well with it,’ she said.  

‘It may be particularly useful for those who have anxiety or depression, but it would take further research to establish this.’  

Darlington GP Dr Ahmet Fuat, a member of the Primary Care Rheumatology Society, said: ‘People with arthritis do keep coming back and I don’t think a short programme like this will stop them coming back.’  

Self-management programmes are ‘hugely expensive and hugely cumbersome’, he added, and suggested that giving these patients information leaflets and discounted gym membership was a better strategy. 

‘I think that would be a  lot more valuable than sitting down and talking to people about osteoarthritis,’ he said.  

But Professor Mike Kirby, a Hertfordshire GP with an interest in arthritis, called for further research into how self-management could improve outcomes for appropriate patients.  

‘In almost any condition you can name, empowering a patient about how they can benefit themselves can help,’ he said.  

Professor Anne Rogers, from the National Primary Care Research and Development Centre in Manchester who is involved in the national evaluation of expert patient programmes, said the range of self- management strategies caused confusion for GPs. 

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