It is of paramount importance to call stakeholders to action at macro-, meso-, and micro-levels to promote and support self-management as a base strategy in health planning for coping with COVID-19 during and after the lockdown periods.
The COVID-19 pandemic has forced many countries to impose mandatory confinement measures and mobility restrictions. Although a necessary decision to contain the spread of COVID-19, it has proven hard for citizens, and it is not without risks in other areas of health.
We are taking advantage of this month’s issue to reflect on the need to support the population, especially those suffering from chronic diseases, to actively implement self-management practices.
Supporting healthy lifestyles and self-management of diseases as a priority
In the context of the COVID-19 pandemic, we need to advocate and support healthcare professionals to continue promoting mental health care and healthy lifestyles. Governments that have not yet done so, are encouraged to promote physical exercise, daily walks, and access to family-friendly community spaces, while maintaining social distancing measures. The promotion of healthy eating is to be emphasized, considering the reduction in energy expenditure and physical activity that has occurred due to confinement. At the same time, warning the population not to overdo physical activity is also essential. As for the management of chronic diseases, we must urgently ensure that patient contact is not lost. This can be achieved by promoting the use of remote consultations and seeking additional strategies to accompany patients in their care, such as family involvement.
Epidemiological data has shown that older patients with chronic conditions are at high risk of severe and critical illness from COVID-19, resulting in high mortality (Yang, Jing, 2020). Therefore, it is even more important to highlight the need for effective communication with patients while providing adequate self-management support, including advice on self-monitoring and early detection of worsening symptoms, as well as establishing point of contact for any health need. These measures could contribute to reducing exacerbations, avoidable hospitalizations, and associated healthcare costs. This will be also important during post-confinement periods to avoid symptoms of post-traumatic stress and the progression of the severity of chronic diseases (WHO, 2020).
Dr Carola Orrego Villagrán
Carola, Deputy Director of the Avedis Donabedian University Institute (FAD), has extensive experience in the design, management, and coordination of research and development projects in the field of quality improvement and patient safety. She has participated in several European and Spanish research projects focused on patient empowerment and self-management.
Implementing self-management support in the context of COVID-19
The COMPAR-EU project, currently in the analysis stage, is examining the comparative effectiveness and cost-effectiveness of self-management interventions and we do not yet know which self-management strategies are most effective and cost-effective to provide good guidance to stakeholders. However, we know that there is substantial evidence from hundreds of systematic reviews supporting the effectiveness of different types of remote interventions for several types of outcomes. Many of these describe positive results in short-term interventions that can be of value in the context of COVID-19 (PROSTEP, 2015).
Regarding the scope of implementation, most of these interventions can be carried out by a range of healthcare professionals, specially from primary care, including doctors, nurses, physiotherapists, dietitians, psychologists, and others. The wide scope of healthcare professionals who can implement these interventions can improve the distribution of the burden of care in the current context of scarce resources. Intervention outcomes, within the context of COVID-19, should prioritize patient activation and self-efficacy, psychological wellbeing, maintaining healthy lifestyles, self-monitoring and early detection of worsening symptoms, ensuring adherence to treatments, and reducing avoidable hospitalizations. When implementing non-face-to-face interventions, it is essential to ensure a variety of security measures including informed consent, confidentiality, and accurate patient identification (Ghosh, Gupta & Misra, 2020). Published recommendations regarding the use of telehealth in the context of a global emergency should also be taken into account (e.g. Smith et al., 2020). Finally, we need to consider that the type of support provided is aligned with the patients’ needs and tailored to their health literacy level, considering several means of remote delivery and avoiding digital inequities, particularly with older people.
Self-management support is even more important today, and we need to ensure continuity of care for our patients. Do not hesitate to contact the COMPAR-EU team for any assistance or further information related to self-management support.