Diabetes self-management arrangements in Europe: a realist review to facilitate a project implemented in six countries

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• 作者：Antonis A Kousoulis (28)
  Evridiki Patelarou (28) (29)
  Sue Shea (28)
  Christina Foss (30)
  Ingrid A Ruud Knutsen (30)
  Elka Todorova (31)
  Poli Roukova (32)
  Mari Carmen Portillo (33)
  Mar铆a J Pumar-M茅ndez (33)
  Agurtzane Mujika (33)
  Anne Rogers (34)
  Ivaylo Vassilev (35)
  Manuel Serrano-Gil (35)
  Christos Lionis (28)
  
  28. Clinic of Social and Family Medicine ; Faculty of Medicine ; University of Crete ; Voutes ; P.O. Box 2208 ; Heraklion ; 71003 ; Greece
  29. Florence Nightingale School of Nursing and Midwifery ; King鈥檚 College London ; London ; UK
  30. Institute of Health and Society ; University of Oslo ; Oslo ; Norway
  31. Department of Economic Sociology ; University of National and World Economy ; Sofia ; Bulgaria
  32. NIGGG ; Bulgarian Academy of Sciences ; Sofia ; Bulgaria
  33. School of Nursing ; University of Navarra ; Pamplona ; Spain
  34. NIHR CLAHRC Wessex ; Health Sciences ; University of Southampton ; Hampshire ; UK
  35. Fundaci贸n Educaci贸n Salud y Sociedad ; Murcia ; Spain
  
• 关键词：Chronic disease ; Diabetes mellitus ; Europe ; Government ; Delivery of health care ; Health policy ; Health personnel ; Self ; care ; Social welfare
• 刊名：BMC Health Services Research
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：14
• 期：1
• 全文大小：546 KB
• 参考文献：Noncommunicable Diseases Country Profiles 2011: WHO Global Report. World Health Organization, Geneva
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  109. The pre-publication history for this paper can be accessed here: 53/prepub" class="a-plus-plus">http://www.biomedcentral.com/1472-6963/14/453/prepub
  
• 刊物主题：Public Health; Health Administration; Health Informatics; Nursing Management/Nursing Research;
• 出版者：BioMed Central
• ISSN：1472-6963

文摘

Background Self-management of long term conditions can promote quality of life whilst delivering benefits to the financing of health care systems. However, rarely are the meso-level influences, likely to be of direct relevance to these desired outcomes, systematically explored. No specific international guidelines exist suggesting the features of the most appropriate structure and organisation of health care systems within which to situate self-management approaches and practices. This review aimed to identify the quantitative literature with regard to diabetes self-management arrangements currently in place within the health care systems of six countries (The United Kingdom, The Netherlands, Norway, Spain, Bulgaria, and Greece) and explore how these are integrated into the broader health care and welfare systems in each country. Methods The methodology for a realist review was followed. Publications of interest dating from 2000 to 2013 were identified through appropriate MeSH terms by a systematic search in six bibliographic databases. A search diary was maintained and the studies were assessed for their quality and risk of bias. Results Following the multi-step search strategy, 56 studies were included in the final review (the majority from the UK) reporting design methods and findings on 21 interventions and programmes for diabetes and chronic disease self-management. Most (11/21, 52%) of the interventions were designed to fit within the context of primary care. The majority (11/21, 52%) highlighted behavioural change as an important goal. Finally, some (5/21, 24%) referred explicitly to Internet-based tools. Conclusions This review is based on results which are derived from a total of at least 5,500 individuals residing in the six participating countries. It indicates a policy shift towards patient-centred self-management of diabetes in a primary care context. The professional role of diabetes specialist nurses, the need for multidisciplinary approaches and a focus on patient education emerge as fundamental principles in the design of relevant programmes. Socio-economic circumstances are relevant to the capacity to self-manage and suggest that any gains and progress will be hard to maintain during economic austerity. This realist review should be interpreted within the wider context of a whole systems approach regarding self-care support and chronic illness management.