Self Management support for chronic conditions

This framework provides an overview of the rationale for self-management support; and sets out how the HSE will implement self-management support for these four major chronic conditions.

Living Well with a Chronic Condition: Framework for self-management support .pdf (size 1.4 MB) - COPD, Asthma, Diabetes and Cardiovascular Disease.

Self-management means the tasks that individuals must undertake to live with one or more chronic (long-term) health conditions such as diabetes, heart failure, asthma or chronic obstructive pulmonary disease (COPD).

Self-management support is the provision of education and supportive interventions, to increase patients’ skills and confidence in managing their health problems. It includes regular assessment of progress and problems, goal setting, and problem-solving support.

It involves a fundamental transformation of the traditional patient-health professional relationship into a collaborative ongoing partnership.

Supporting and empowering people in managing their conditions as well as possible can improve quality of life and reduce the impact on health and the likelihood of complications, hospitalizations and deaths from these conditions.

Support for self-management includes a range of possible interventions, depending on the needs of the individual.  This support can be delivered in different formats such as:

• group based patient education e.g. for people with diabetes
• regular clinical review
• information, according to need and in a variety of formats
• action plans, for use when symptoms deteriorate e.g. asthma action plan
• exercise-based cardiac rehabilitation
• exercise-based pulmonary rehabilitation
• health behaviour change supports e.g. smoking cessation services
• support with dealing with the emotional and social aspects of chronic conditions
• peer support groups
• health coaching

Support for self-management is inseparable from high quality care for people with chronic conditions and is a priority for patients. Actions are required at the levels of the patient, the healthcare professional, the organisation, and partnerships with the wider health system in order to support self-management. Organisational and clinical leadership will be essential to support the culture change necessary in moving to more pro-active and person centred care, with the patient an active partner in their own healthcare.

Health Technology Assessment of Chronic Disease Self Management Support Interventions

HIQA published a Health Technology Assessment of Chronic Disease Self Management Support Interventions in December 2015 which is available at