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At the heart of general practice since 1960

Expert patients don't work, says study

By Emma Wilkinson

Self-management programmes such as the expert patients programme are unlikely to relieve pressure on GP time, a study suggests.

Patients who attend their GP surgery frequently do so because they have severe symptoms and not because they have needs that can be met by self-management, the qualitative research found.

The UK and Canadian research team concluded there was only ‘limited potential' for self-management programmes – including the high-profile Kaiser Permanente scheme – to reduce GP consultations.

Interviews with 23 Scottish patients in their 50s with four or more chronic conditions who were all ‘self-managing' found those patients who attended seven or more times in the past year were doing so because self-management was failing to control their condition.

Study leader Dr Anne Townsend, a post-doctoral fellow in medical sociology at the University of British Columbia in Vancouver, said: ‘It may be that self-management for particular groups, even when relatively effective, will not reduce GP utilisation, due to the course of the illness, nature of the symptoms and medication regimens.'

But she added that participants did find it helpful when they felt supported by health professionals in their self-management.

Dr Dermot Ryan, a GP in Loughborough with a special interest in asthma, agreed current models of self-management were too limited to deal with complex patients, but stressed it should still be possible to reduce GP use.

‘There is potential in these patients but it's attitude that needs to change. These are the heartsinks and the doctor takes their problem on board but then feels helpless.

‘The important thing is to give the problem back to them. You can equip patients to cope with it.'

The research is published online by Family Practice.

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