Kuala Lumpur
Management of a disease by the patient is central to control of its effects. A wide range of influences in the person's social and physical environments enhance or impede management efforts. Interventions to improve management by patients can produce positive outcomes including better monitoring of a condition, fewer symptoms, enhanced physical and psychosocial functioning, and reduced health care use. Successful programs have been theory based. Self-regulation is a promising framework for the development of interventions. Nonetheless, serious gaps in understanding and improving disease management by patients remain because of an emphasis on clinical settings for program delivery, neglect of the factors beyond patient behavior that enable or deter effective management, limitations of study designs in much work to date, reliance on short-term rather than long-term assessments, and failure to evaluate the independent contribution of various program components.
Control of chronic disease continues to dominate the agenda of health care systems; this is because primary prevention and cure are not available for many diseases, and because the population worldwide is living longer with accompanying chronic conditions. Just as it is difficult to put what we know about primary prevention fully into practice (e.g., change behavioral patterns related to diet, physical activity levels, smoking, etc.), so too is it difficult to put into practice what is known about secondary prevention, that is, preventing and managing effects of disease. This chapter explores the factors that enable people with chronic disease to keep their conditions under control. Optimum disease management by the patient for purposes of this discussion is defined as the means to achieve the highest degree of functioning and lowest level of symptoms given the severity of a condition.