How general practitioners and patients discuss type 2 diabetes mellitus and cardiovascular diseases concerns during consultations: Implications for digital health

Increasingly, patients are expected to take care of their health outside of medical settings (i.e. self-management).1 Self-management includes the actions taken by individuals to lead a healthy lifestyle, manage their long-term condition and prevent further illness, both individually and with support from healthcare professionals.2 It is widely promoted to empower patients, improve health outcomes, and reduce constraints on overstretched health systems.3 However, many individuals living with chronic conditions struggle to practise self-management effectively.46 Yet, few studies have focused on how self-management is discussed in general practitioner (GP)–patient consultations, specifically using a patient-centred analysis.
When self-management is poorly integrated, it can lead to treatment non-compliance, negatively impacting on health outcomes.7,8 GP consultations often present a major milestone for patients to stop and reflect on making changes that are actionable and sustainable for their health and wellbeing. However, GP consultations also present a missed opportunity to help patients in that regard. Limited studies have explored what ‘work’ is required from patients during and after the consultation regarding self-management.9,10 In some circumstances, self-management is discussed hastily due to time pressures in a consultation;11 and some self-management recommendations, whilst given with goodwill, may fail to acknowledge the specificities of the individual, such as daily routine, physical environment, social obligations, as well as beliefs and attitudes.1215 As a result, some patients leave the consultation feeling unsupported, not knowing what to do or how to start. Over time, a patient’s will and momentum to make changes diminish, and the patient returns to living in the status quo with no changes attempted, made or maintained to improve their health and wellbeing.

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