Open Access Highly Accessed Research article

Is Europe putting theory into practice? A qualitative study of the level of self-management support in chronic care management approaches

Arianne Elissen1*, Ellen Nolte2, Cécile Knai3, Matthias Brunn4, Karine Chevreul45, Annalijn Conklin26, Isabelle Durand-Zaleski45, Antje Erler7, Maria Flamm8, Anne Frølich9, Birgit Fullerton7, Ramune Jacobsen10, Zuleika Saz-Parkinson11, Antonio Sarria-Santamera11, Andreas Sönnichsen12 and Hubertus Vrijhoef13

Author affiliations

1 Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Duboisdomein 30, PO Box 616, , Maastricht, 6200 MD, the Netherlands

2 Health and Healthcare Research programme, RAND Europe, Cambridge, UK

3 Faculty of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK

4 URC Eco Ile-de-France, Université Paris Est Créteil, Paris, France

5 AP-HP Recherche Clinique Santé Publique, Hôpital Henri Mondor, Créteil, France

6 MRC Epidemiology Unit, University of Cambridge, Cambridge, UK

7 Institute of General Practice, Johann Wolfgang Goethe-University, Frankfurt, Germany

8 Department for Evidence-based Medicine and Clinical Epidemiology, Danube University Krems, Krems, Austria

9 Department of Health Services Research, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark

10 Institute of Preventive Medicine, Frederiksberg Hospital, Frederiksberg, Denmark

11 Instituto de Salud Carlos III, Agencia de Evaluación de Tecnologías Sanitarias, Madrid, Spain

12 Institute of General and Family Medicine, Witten/Herdecke University, Witten, Germany

13 TRANZO Scientific Centre for Care and Welfare, Tilburg University, Tilburg, the Netherlands

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Citation and License

BMC Health Services Research 2013, 13:117  doi:10.1186/1472-6963-13-117

Published: 26 March 2013



Self-management support is a key component of effective chronic care management, yet in practice appears to be the least implemented and most challenging. This study explores whether and how self-management support is integrated into chronic care approaches in 13 European countries. In addition, it investigates the level of and barriers to implementation of support strategies in health care practice.


We conducted a review among the 13 participating countries, based on a common data template informed by the Chronic Care Model. Key informants presented a sample of representative chronic care approaches and related self-management support strategies. The cross-country review was complemented by a Dutch case study of health professionals’ views on the implementation of self-management support in practice.


Self-management support for chronically ill patients remains relatively underdeveloped in Europe. Similarities between countries exist mostly in involved providers (nurses) and settings (primary care). Differences prevail in mode and format of support, and materials used. Support activities focus primarily on patients’ medical and behavioral management, and less on emotional management. According to Dutch providers, self-management support is not (yet) an integral part of daily practice; implementation is hampered by barriers related to, among others, funding, IT and medical culture.


Although collaborative care for chronic conditions is becoming more important in European health systems, adequate self-management support for patients with chronic disease is far from accomplished in most countries. There is a need for better understanding of how we can encourage both patients and health care providers to engage in productive interactions in daily chronic care practice, which can improve health and social outcomes.

Chronic illness; Disease management; Self-management support; Comparative study; Qualitative research