Self-management of chronic conditions: implications for rural physicians of a demonstration project Down Under.

OBJECTIVES This paper describes the outcomes achieved for clients of a demonstration project in self-management in one of Australia's most rural and remote states. METHODS Client survey data obtained over a maximum of 18 months from 264 clients in 3 sites across Tasmania were analyzed using standard descriptive techniques. These data provided demographic information as well as client self-assessments of health and well-being, and health-related behaviours. Tests of significance were conducted on differences in client health data over a maximum of 4 data collection times. RESULTS In relation to demographic factors, these data show low education, employment and income levels in an aged population. There were gender differences in project participation (many more females than males), and relatively low levels of completion of the self-management course by those who were not married and who were living with their families. Statistically significant improvements in health dimensions were obtained for those clients attending the self-management course (where p values <.0.05): in the areas of distress, symptoms and depression. Data also show significant declines over time in client ratings of exercise behaviours and cognitive self-management strategies. CONCLUSIONS The effects of barriers to self-management of chronic conditions (lack of formal education, age-related physical frailty, and poverty) are likely to be multiplied in areas showing a paucity of health professionals and related health infrastructure. The data for gender and living arrangements suggest the importance of tailoring self-management programs to meet the needs of specific community sub-groups. Declining ratings are one of the least explored areas of self-management research, yet they point to the importance of sustaining interventions in rural communities. Rural physicians apprised of the issues in implementing successful self-management programs in rural contexts can be an important resource for more isolated communities wanting to achieve workable programs with sustainable gains.