چکیده (انگلیسی):

Background:Self-management support to facilitate people with type 2 diabetes to effectively manage their
condition is complex to implement. Organisational and system elements operating in relation to providing optimal
self-management support in primary care are poorly understood. We have applied operational research techniques
to model pathways in primary care to explore and illuminate the processes and points where people struggle to
find self-management support.
Methods:Primary care clinicians and support staff in 21 NHS general practices created maps to represent their
experience of patients’ progress through the system following diagnosis. These were collated into a combined pathway.
Following consideration of how patients reduce dependency on the system to become enhanced self-managers, a
modelwascreatedtoshowthe influences on patients’ pathways to self-management.
Results:Following establishment of diagnosis and treatment, appointment frequency decreases and patient
self-management is expected to increase. However,capacity to consistently assess self-management
capabilities; provide self-management support; or enhance patient-led self-care activities is missing from the
pathways. Appointment frequencies are orientated to bio-medical monitoring rather than increasing the ability
to mobilise resources or undertake self-management activities.
Conclusions:The model provides a clear visual picture of the complexities implicated in achieving optimal
self-management support. Self-management is quickly hidden from view in a system orientated to treatment delivery
rather than to enhancing patient self-management. The model created highlights the limited self-management
support currently provided and illuminates points where service change might impact on providing support for
self-management. Ensuring professionals are aware of locally available support and people’sexistingnetworksupport
has potential to provide appropriate and timely direction to community facilities and the mobilisation of resources.