Health and Disability

It is widely agreed that person centred services for people with long term conditions should be coordinated; support self management; engage people in decisions; provide effective prevention, early diagnosis, and intervention; and offer emotional, psychological, and practical support.6 More needs to be done to realise the untapped potential of patient led care through increasing tailored information, education, and training; access to new technologies; and peer and community support.12 13 Accumulating evidence and experience shows that people who are “activated”—that is, have the knowledge, skills, and confidence to manage their health effectively—are more likely to adopt healthy behaviours and have better health outcomes and care experiences.11 This may lead to better use of resources.11

Thus, health services need to provide a comprehensive and coordinated range of interventions for populations but organised to provide a tailored response for each person. This requires fundamentally new ways of thinking about service delivery and relationships, recognising that whole system approaches are needed with support for self management as the central component, as set out in the chronic care model.14 Recent comprehensive programmes of care, such as TEAMcare in the United States15 and the Flinders programme in Australia,16 show that system wide organisational change can be achieved and improve clinical and personal outcomes.