Effective treatment of chronic illness requires patients to manage their own condition. Fortunately, one of the beauties of self-management is that it can be used by anyone with a chronic illness regardless of their ethnicity and socioeconomic levels. This point has been amply demonstrated in a number of self-management programs, such as that shown in the inner-city projects established for childhood asthma in the United States. Whether all patients with a chronic illness have equal opportunities to learn and perform self-management is another matter. A study by Greene and Yedidia looked at the influence of provider support for self-management on patients' performance of these activities, a widely presumed but understudied relationship, particularly among underserved populations. The authors surveyed an ethnically diverse, primarily low-income sample of 956 patients (or parents of pediatric patients) with diabetes or asthma in 17 outpatient-teaching settings across the country. Analysis of the data found that patients with strongly positive assessments of their providers were much more confident in self-care. Furthermore, among patients with diabetes, high assessments of provider support, in comparison with low, were significantly associated with performance of self-management tasks, amounting to approximately one more day per week. These relationships were significant for patients with either illness and from varied socioeconomic backgrounds.

COMMENTS: The conclusion by Greene and Yedidia was that their findings validate their measure of provider support, its relevance to underserved populations, and its usefulness for evaluating quality of care. It likely did. At the moment, poor patients receive less than optimal medical treatment in the U.S. Despite Medicaid, there are few safety nets that they can count on to provide health care assistance when needed. Reducing their burden through teaching them to perform self-management skills would be of great help. Thus, any method we can use to better identify these patients, as well as to tailor programs more closely to their needs, is welcomed.

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J. Greene & M.J. Yedidia. Provider behaviors contributing to patient self-management of chronic illness among underserved populations. Journal of Health Care in the Poor and Underserved, 2005 ;16:808-824.