This chapter addresses the issues associated with self-management in arthritis care. Alternative approaches to traditional medical care have gained popularity in the past decade. Some of the factors that have led to this are discussed in this chapter, including personal self-determination, the patient as consumer in a global economy, the backlash against medical technology, and fundamental questions about the medical model of care. Following this introduction, the goals of the Arthritis Self-Management and Bone-up on Arthritis Programs are outlined, along with the major theoretical underpinnings of both programmes. The impact of self-management programmes on the outcomes of disability, pain, depression and fatigue are reviewed, as are the potential implications for both the direct and indirect cost savings for a health system and society. The potential negative effects of self-management programmes are considered, and issues related to implementation, dissemination, quality control and long-term maintenance are reviewed. Finally, the value of self-management as a tool to be used effectively by the person with arthritis, in conjunction with his or her rheumatologist, is outlined. The relevance of well-established, valid and reliable self-management programmes is underscored by the growing number of people who seek help over the Internet. Without guidance, information can become harmful or distracting rather than helpful.
Copyright 2000 Harcourt Publishers Ltd.