Research

Personalized care planning for diabetes: policy lessons from systematic reviews of consultation and self-management interventions

Jonathan Graffy^a1, Simon Eaton^a2, Jackie Sturt^a3 and Paul Chadwick^a4

^a1 General Practice and Primary Care Research Unit, University of Cambridge, Cambridge, UK

^a2 Northumbria Healthcare NHS Trust, North Tyneside General Hospital, North Shields, UK

^a3 Warwick Medical School, University of Warwick, Coventry, UK

^a4 Podiatry and Foot Health, Hope Hospital, Salford, UK

Abstract

Aim To determine whether a process of care planning for people with diabetes, combining a patient-centred approach by practitioners with measures to promote self-management by patients, improve health outcomes.

Background Health policy, in many countries, seeks to engage people with long-term conditions in protecting their health. This review was conducted by members of a working group established by the Department of Health and Diabetes, UK to consider the potential for personalized care planning in UK diabetes services.

Methods Review of systematic reviews. The Cochrane Library and Database of Reviews of Effectiveness were searched to identify reviews concerned with components of care planning. Reviews conducted before 1990, and those involving education outside the consultation were excluded. Abstracts were reviewed and data extraction undertaken by reviewers working independently in pairs.

Results In all, 86 reviews were identified as potentially relevant and 22 included. Patient-focused interventions, such as pre-consultation prompts, enhanced the role patients played in consultations. Personalized approaches using tailored information influenced health behaviour more than uniform approaches. Decision aids and computerized knowledge management improved the process of decision-making. Although effective communication was important, focusing solely on changing practitioner behaviour appeared inadequate. Taken together, there was good evidence that the processes involved in personalized care planning would engage patients more effectively in managing their care, but little robust research on the impact on health outcomes of doing so.

Conclusions The present review identifies effective interventions that are available for clinicians to use in diabetes consultations, but engaging patients requires more than this. Mechanisms to share information and decision-making need further development and evaluation to assess their impact on health outcomes. Narrowly targeted interventions focused on practitioner behaviour appear less effective than whole-system approaches. Personalized care planning offers a mechanism to integrate patient-centred medicine and support for self-management to improve diabetes care.

(Received September 24 2008)

(Accepted March 26 2009)

Key words

• care planning;
• diabetes;
• patient-centred medicine;
• self-management;
• shared decision-making;
• systematic review

Correspondence:

^c1 Correspondence to: Dr Jonathan Graffy, Senior Clinical Research Associate, General Practice and Primary Care Research Unit, Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK. Email: jonathan.graffy@phpc.cam.ac.uk