Disease Management:
 The Need for a Focus on Broader Self-Management Abilities and Quality of Life

Authors: Jane Murray Cramm, PhD, and Anna Petra Nieboer, PhD

Link: Find the article HERE

Chronic disease management is a complex, multi-faceted process that often includes the guidance and oversight of several medical professionals per individual. Due to the growing prevalence of CVD, COPD, diabetes, and comorbidities such as obesity and sedentariness, it is crucial that medical literature supports the implementation of efficacious programs aimed to manage the disease and behavior processes. Perhaps most of all, the literature should also reveal how to best improve quality of life. Cramm and Nieboer have published a great overview of 18 disease management programs conducted in the Netherlands, highlighting the effectiveness and limitations of several interventions designed to impact patient’s health behaviors, self-management abilities, and physical and mental quality of life.

Facts from the Article:

  • Participants of this study were enrolled in disease management programs that were based on the Chronic Care Model.
  • “The primary aim of the Chronic Care Model is to redesign and improve the quality of chronic care delivery through a focus on interactions between informed, activated patients and proactive health care teams”
  • The model includes 6 interrelated components of the quality of chronic care delivery: self-management support; delivery system design; decision support; clinical information systems; healthcare organization; community linkages
  • The results shared during interviews with many of the project leaders were consistent in their limitations:
    • “The most frequently mentioned interventions that could not be implemented or that were unsuccessful were ‘‘reflection interviews,’’ ‘‘e-consultation’’ (eg, via Internet, e-mail, or short message service), ‘‘individual care plans,’’ ‘‘informational meetings,’’ ‘‘involvement of patient groups and patient panels in care design,’’ and ‘‘periodic discussion sessions between care professionals and patients.”
  • No difference in physical quality of life, physical activity, smoking, educational level, or marital status was found
  • Patients’ mental quality of life scores decreased significantly over time, whereas their physical quality of life scores improved (both P < .001). Mean physical activity scores improved significantly and the percentage of current smokers declined (both P<.001)
  • Self-management abilities decreased over time, despite improvements in health behavior.


The authors do a very good job summarizing the results of their research: “Chronic Care Model and disease management programs based on it focus primarily on clinical and functional outcomes rather than overall quality of life and well-being.” If healthcare is to truly make long lasting effects on the patients’ well being, self-management abilities, and mental quality of life, then interventions should address these factors, rather than solely on illness or impairment. The limitations of this review are clearly defined: it is worth noting that without a control group it is difficult to generalize improvements in health behaviors or physical quality of life. The future of disease management may well contain components of the Chronic Care Model, but as we try to right the ship of public health we must not lose focus on addressing broader self-management abilities and quality of life.



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