Factors affecting uptake, such as being referred by a known clinician, who also co-delivered the SMP may have contributed buy Z-VAD-FMK to the high completion rates achieved. We have reported elsewhere that the co-delivery model was well received by patients . Generally,
more men, ethnic minorities, people who lived alone, who had no educational qualifications and did not own their own homes, attended the SMP when compared to other UK self-management programs . This suggests that the SMP was relatively successful at recruiting patients who traditionally do not attend self-management programs. Irrespective of condition, patients who completed the SMP were more activated. The 8.0 point mean improvement in the PAM score compares to a 4.7 mean improvement reported by patients attending a similar self-management program in the United States 5-Fluoracil solubility dmso . Over half (53.9%) of patients reported a meaningful (≥4 point) improvement in activation. Improved activation
on the PAM is important because other research has shown that activated patients are more likely to participate in collaborative decision-making with their clinicians, report improved health-related behaviors and clinical outcomes and adhere to physical therapy  and . Patients with depression and patients with musculoskeletal pain enjoyed better health status after attending the SMP. Only patients with depression enjoyed a significantly improved health related quality of life as measured by the generic EQ VAS. Two other self-management studies  and  similarly found no improvement using the EQ VAS among patients with arthritis and patients with COPD respectively. A recent meta-analysis of Stanford University’s arthritis self-management programs (ASMP) and generic chronic O-methylated flavonoid disease self-management course (CDSMC) suggested that improvements in quality of life might take longer (i.e. >12 months) to emerge compared to other outcomes such as self-efficacy . Further,
it has been suggested that some generic measures may not be sensitive enough to adequately capture quality of life improvements after attending self-management programs . Patients with depression and patients with musculoskeletal pain, who were more anxious and depressed at baseline compared to patients with COPD and patients with diabetes, reported significant reductions in these outcomes at follow-up. More patients, approximately 10%, were no longer clinically anxious or depressed. NICE recommends a collaborative care approach for LTC patients with co-morbid mental health problems in primary care which includes patient education and self-management support . The finding that patients across all 4 conditions were significantly more often using self-management skills and techniques, as measured by the heiQ subscale skills and technique acquisition, is important given that the primary aim of the SMP is to enhance patients’ ability and capacity to self-manage their condition.