Published: 18/08/2005, Volume II5, No. 5969 Page 25

Self-management of chronic conditions such as inflammatory bowel disease has the potential to reduce health provision costs and benefit disease control, particularly for conditions with relapsing, remitting patterns.

This was the finding of a research team from the National Primary Care Research and Development Centre, York University's centre for health economics and Manchester University's epidemiology research unit.

They carried out a trial, funded by the NHS research and development health technology assessment programme, in outpatient clinics of hospitals in north-west England. It involved 700 patients with inflammatory bowel disease, who were followed for 12 months.

Self-completed questionnaires were carried out as well as face-to-face interviews with 28 patients and their 11 consultants to provide in-depth accounts.

The trial was designed to see whether an innovative approach to self-management could alter clinical outcome and affect health service use.

The approach provided patients with:

information through a guidebook developed with patients;

support and guidance from their consultant;

a jointly negotiated self-management plan;

open access to clinics, rather than relying on fixed appointments.

The results showed that self-managing patients made a third fewer hospital visits - without an increase in the number of primary care visits. Quality of life was maintained.

After the initial consultation, those who had undergone the selfmanagement intervention reported greater confidence in coping with their condition.

Interviews with patients and their consultants found the intervention clarified responsibilities and led to confidence in symptom management. Openaccess arrangements provided a better fit with patients' own selfmanagement of their condition and everyday routines, although some continued to prefer fixed appointments.

The research is important because this model for selfmanagement was built up from grass-roots involvement with patients and has been proven to engage consultants.

The model allows doctors to recognise and build on people's existing abilities.

However, outpatient organisational arrangements and personnel need to be responsive to patientinitiated requests for appointments to ensure the acceptability of this type of access arrangement.

Some people will continue to prefer the fixed appointment system, which should be retained if patient choice is to be respected.

Dr Anne Kennedy is research fellow at the National Primary Care Research and Development Centre.