Self-management support has potential but is difficult to deliver in routine primary care

The increasing prevalence of chronic conditions worldwide is putting huge pressure on health systems to look for effective ways of doing things differently. One appealing option from both the point of view of potential effectiveness and reduced cost is the idea of people with chronic conditions becoming active partners in the care of their own conditions. As demonstrated by the pioneering work of health educators such as Lorig et al,1 self-management (SM) support interventions that are delivered directly to the patient can be effective, but are often plagued by problems of limited reach or appeal only to those with greater motivation or health literacy.2-4 One way of addressing these issues is to embed SM support into existing health services used by people with chronic conditions. Primary care services are the obvious choice given their accessibility, low cost and potential for addressing equity