INNOVATIONS IN PRIMARY CARE Patient Self-management of Chronic Disease in Primary Care

Patient Self-management of Chronic Disease in Primary Care The nation’s 65-year-and-older population will swell from 35 million in 2000 to 53 million in 2020 as the babyboomer generation reaches the age of increasedchronicdiseaseprevalence.Many baby boomers bring to the health care system a high level of sophistication. In the view of one analyst, baby boomers “will accelerate the movement and awareness of self-care and wellness and will irreversibly alter the traditional doctor-patient relationship.” What is the “irreversibly altered doctor-patient relationship”—a consumerist fad or a genuine transformation of health care? Will primary care physicians—who care for most people with chronic illness—be ready for this new relationship? In this fourth article of the series “Innovations in Primary Care,” we resume the discussion of chronic illness management initiated in the article “Improving Primary Care for Patients with Chronic Illness: The Chronic Care Model.” According to the Chronic Care Model, optimal chronic care is achieved when a prepared, proactive practice team interacts with an informed, activated patient. The new patient-physician relationship for chronic disease features informed, activated patients in partnership with their physicians. This article begins by discussing 2 versions of the patient-physician relationship in chronic disease, the traditional relationship and the patientprofessional partnership. These are, in fact, poles of a spectrum rather than wholly distinct concepts. The contrasting paradigms are described in relation to 2 aspects of chronic illness management: clinical care and patient education. This first section of the article ends with a description of selfmanagement education in chronic disease. The second section of the article explores whether self-management education can improve clinical outcomes or reduce health care costs.