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Self-care doesn't cut GP workload

By Gareth Iacobucci

The validity of high-profile schemes such as the Expert Patient Programme has been brought into question after research showed self-management of arthritis did not reduce GP workload.

A study of 812 people with arthritis from 74 UK general practices showed a self-management programme that taught patients techniques for controlling their condition had no significant effect on pain, physical functioning, or contact with primary care at 12 months.

However, patients did have reduced anxiety and felt better equipped to manage their symptoms, the results published online in the BMJ show.

The researchers warned the Government had been promoting large-scale provision of the programme before a formal evaluation had been completed.

Study leader Dr Marta Bus-zewicz, senior lecturer in community-based teaching and research at Royal Free and Univ- ersity College medical school, London, said: 'Previous studies on arthritis self-management have been on volunteers, who may do better, but we looked at what would happen if you went out and routinely offered it to people with the condition attending primary care. I think that makes more of a difference than may have been thought.'

She added: 'The Government has implied that self-management should be offered to anyone with a chronic disease such as arthritis. We would say that one probably has to be more selective as to who might benefit.'

But Sir John Oldham, head of the NHS's Improvement Foundation, said the findings didn't necessarily contradict the Government's decision to promote expert patient programmes.

'I understand why self-management may not work for arthritis, but with conditions like COPD and diabetes, there has been evidence not only of improvement in outcomes for patients, but also reduced necessity of using the health services,' he said.

Dr Christian Mallen, research fellow in arthritis at Keele University and a GP in Newcastle-under-Lyme, Staffordshire, said the success of self-management was probably down to the patient.

'It's not a general fits-all model, I think it's a matter of getting the right patients for the right treatment.

'I think on the whole, getting patients involved in their care is going to have better outcomes because they feel more empowered by what they're doing.'

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