The idea that patients are responsible for actively managing and maintaining their personal health and well-being - known in the medical community as self-management - is getting a boost through the internet. Employers already encourage their employees to take responsibility for their own health with wellness programs and incentives.
Today Internet users can monitor their diet and exercise online with the help of virtual networks and communities, but they can also access internet tools that catalog their personal health information to help them identify and manage their risk for depression, diabetes, or the flu. Self-management was first promoted by Thomas Creer in the 1960s during his work at the Children's Asthma Research Institute and Hospital.
Today self-management is gaining support in the medical community as a critical component in treating and managing chronic diseases like hypertension, congestive heart failure, depression and diabetes, which top the charts in the United States as being the most expensive and most widespread health problems in the country.
Patients with chronic conditions are challenging for health care providers to manage, especially with a health care system largely designed to treat acute illnesses. However, there is growing scientific evidence that patients who actively participate in their own health care decisions have improved health outcomes and higher functional status than those held in more passive roles.
Evidence also suggests that increased patient self-management is linked to increased patient satisfaction and reductions in hospital and emergency room costs. There is also strong evidence that stress management interventions that teach self-management of existing diseases are successful in the workplace. Most of these health self-help programs teach stress, pain and illness management, and include nutrition and exercise plans.
Large-scale studies of workplace stress programs show teaching self-management is effective in reducing business costs through decreased medical utilization and lowered absenteeism. Given the positive outcomes associated with self-management, it is not surprising that the most prevalent workplace wellness initiatives globally are Employee Assistance Programs (EAPs), which provide basic support for employees to manage common health concerns.
Ninety-five percent (95%) of employers surveyed in the recent report, "Working Well: A Global Survey of Health Promotion," reported offering EAPs to their employees, and seventy-six percent (76%) reported offering disease management programs. The trouble is in-house wellness counseling can be costly, especially for small and medium sized business, which have are much less likely to have self-management counseling programs.
Could the next trend be for patient self-management to digitize? New studies show that Web-based multimedia health promotion for the workplace, designed to improve dietary practices, reduce stress, and increase physical activity, can be more effective than seminar and print interventions.
Given the ubiquity of the internet and digital information in today's workplace, this could indicate a new trend in the way workplace wellness is delivered. Keas is one of the new players in the internet consumer health business. The company, led by the former head of the Google Health team, provides a platform for users to organize and manage their personal health data in a format that promotes self-management.
Users create a profile filled with personal health information, and are offered a range of interactive web tools designed to educate and provide community support for users as they keep track of their current or at-risk health concerns. Care plans cover preventative, chronic and acute health concerns, including plans helping users manage their low back pain, cholesterol or strep throat.
Keas is currently working with over seventy-five health groups, including expert cardiologists and health companies, to develop new care plans to help users manage their health at home. For the most part, internet health tools, known collectively as e-health, are focused primarily on the patient, helping the patient to manage his or her own care away from their doctor.
This represents a significant shift in how we approach medicine. "Our society defines care as something someone does to or for us," explains James S. Gordon, MD, Harvard-educated psychiatrist and Founder and Director of The Center for Mind-Body Medicine in Washington D.C.
"If we want to improve our nation's health we need our health system to give us the tools we need to prevent and treat chronic diseases. This means physicians and other health care providers need to see themselves as teachers of good health as well as treaters of poor health."
Founder and CEO of Keas, Adam Bosworth, agrees. "There is a serious lack of collaboration between patient and physician in the current health model," Bosworth explains. "Our intent with Keas is to open that communication gap by democratizing the online health management process."
Keas works actively with interested physicians and health care experts to create plans that act as a "dynamic syllabus" for each user. Because users add their own personal health data into their Keas profile, Keas is able to recommend specific plans and track what works and does not work for each individual in his or her efforts to manage their health from home.
"We are learning as we go - that's what we're about. It's not about choosing between the doctor's office or managing your health on your own, it's about adding on multiple sources for health advice and help," says Bosworth. So is all this online help actually helpful? Some studies have found that patients participating in online education and support groups have better health outcomes than control groups.
Online participants have also benefitted from greater satisfaction and confidence in managing their medical conditions. Despite initial optimism, research regarding e-health is still slim, although this may change as support for patient self-management continues to spread.
Continuing education courses for health care professionals intended to encourage patient self-management are offered at The Center for Mind-Body Medicine. "Self-management can be taught in small groups at worksites or online, as long as it creates social support," says Dr. Gordon. "These techniques not only have intrinsic benefits, you can do them for yourself, and therein lies real empowerment."
- Cook, Royer F , Billings, Douglas W, Hersch, Rebekah K, Back, Anita S, and Hendrickson, April: "A Field Test of a Web-Based Workplace Health Promotion Program to Improve Dietary Practices, Reduce Stress, and Increase Physical Activity: Randomized Controlled Trial." J Med Internet Res. 2007 Apr-Jun; 9(2): e17. Published online 2007 June 19. doi: 10.2196/jmir.9.2.e17.
- Evers Kerry E. eHealth promotion: the use of the Internet for health promotion. Am J Health Promot. 2006;20(4):suppl 1-7, iii.Jones, Deborah L, Tanigawa, Takeshi and Weiss, Steven M: "Stress Management and Workplace Disability in the US, Europe and Japan". J Occup Health Vol. 45, 1-7 (2003) .
- WORKING WELL: A Global Survey of Health Promotion and Workplace Wellness Strategies
About the Author
Rachel Permuth-Levine, PhD, MSPH, is a public health practitioner and an expert in worksite health promotion. As a health behavior theorist, she strives to use evidence-based programs that produce the best results for her employees.
Rachel is also a yoga and fitness instructor.Allison Lipps is a candidate for a Masters in Public Health at Tufts School of Medicine. She is currently the Workplace Health Promotion Intern at the NHLBI Center for Employee Wellness and Health Promotion and a Teaching Assistant at Tufts School of Medicine.