Provide information in a manner appropriate for the person

General practices are increasingly adapting to people’s needs and commitments by offering alternative modes of communication such as email, the Internet and text messaging. Email could provide a convenient way for patients to reschedule appointments or request repeat prescriptions, and has been suggested as a low-cost alternative to postal or phone reminders.^15,16

The Internet is a major source of information, yet most health professionals have given little consideration to how patients access information and the strengths of those information sources to patients. In many cases, the Internet may provide better information than a doctor or health educator.

Mobile phone text messaging has been reported to be an effective and welcome mode of reminding teenagers to take their asthma medication and providing tips on inhaler use and asthma self-care.⁸

Because people often can’t retain all the information if it is given at once, education may need to be tailored over several consultations, particularly where behaviour change is the goal.³ Chronic disease self-management programs are increasingly being adopted as a structured approach to meeting people’s information needs.

Tailor management through shared decision-making

Key features of effective doctor–patient interaction to manage long-term conditions are shared goal setting, written management plans and regular follow-up.³

Health professionals can help ensure their recommendations are suited to the patients’ needs by asking them how confident they are about managing their condition, their expectations for management, what they understand about the condition, and what factors that will affect their ability and willingness to carry out aspects of self-management such as readiness to monitor glucose in diabetes, barriers to losing weight or increasing physical activity, or problems adhering to preventer asthma medication.

Routine attention to the following aspects of the person’s situation has been suggested as a way of ensuring that the visit results in shared decision-making and individualised management plans:³

• Explore people’s social supports and physical environment, which may influence their health (e.g. smokers in the person’s household, access to healthy food choices and physical activity, family attitudes to the behaviour changes needed to stay well).

• Negotiate an agreed individualised written disease management plan, including specific strategies for dealing with acute symptomatic episodes.

• Find common ground for planning ongoing management so that you and the patient can agree on what should be done.

• Find out whether and to what extent the person wants to participate in decision-making. This might depend on age, cultural background and education.

Patients with moderate-to-severe asthma benefit from a combination of self-management education, GP review and an individualised written asthma action plan.^7,17 Participation in self-management education programs that include preparation of a written asthma action plan helps people understand their condition and take responsibility for day-to- day monitoring and medication adjustment, and has been shown to reduce hospitalisation rates, emergency department visits, other unplanned urgent asthma care, days missed from work or school, night-time symptoms and effects on quality of life.¹⁷ There is also strong evidence for benefits of self-management approaches in diabetes and hypertension, and some evidence for arthritis and chronic obstructive pulmonary disease.18 (See Offer referral to self-management programs.)