This work was supported by the Australian Research Council via a Future Fellowship awarded to Dr Linda Bennett to conduct research into compromised fertility in Indonesia. “
“The burden of noncommunicable diseases (NCDs), which are also known as long-term conditions (LTCs), is rapidly increasing worldwide [1] and it is predicted that by 2020 LTCs will account for almost three-quarters of all deaths worldwide [2]. By 2025 the number of people in England with at least one LTC find protocol will rise by 3 million to 18 million [3]. Government policy places emphasis on self-management as a means of improving the management of LTCs, and supporting patient participation

in healthcare is seen as a key mechanism to improve self-management [4] and [5]. National Health Service quality improvement programs position patient centeredness and patient involvement, as well as self-management support for LTCs, at the heart of government initiatives [6]. Many patients with a LTC want to participate more in their health care and would feel more confident with the support and encouragement from their health care provider. However, the majority of patients feel this support and encouragement is currently lacking [7]. Nearly two-thirds of patients also believe that their confidence

to self-care would increase with the provision of support from others who had similar health concerns [7]. The push towards greater involvement of people in their own care reflects the pressure on the NHS from the rising number of people with LTCs. In the UK, self-management programs (SMPs) p38 MAP Kinase pathway delivered by patients (lay-led), such as the Expert Patient Program (EPP), have emerged. A systematic review and meta-analysis involving nearly 7500 LTC patients who attended lay-led and lay and health professional

co-delivered SMPs reported small improvements in self-efficacy, depression, pain, disability, fatigue, self-rated health, aerobic exercise and cognitive symptom management [8]. The largest UK randomized controlled trial of the EPP showed improvements in energy, self-efficacy and other psychosocial outcomes and that it was cost-effective [9]. Despite these benefits, primary and secondary care services were reluctant to engage with the EPP [10]. Evidence suggests patients in the EPP feel that the inclusion of health care practitioners to provide condition specific Sorafenib cell line information would be a useful addition to the valuable social modelling provided by lay tutors [11]. The Health Foundation, which is an independent charity working to continuously improve the quality of healthcare in the UK, sought to develop a national quality improvement demonstration program. The approach, called Co-Creating Health (CCH), was influenced by the policy context around self-management in the UK and on reviews of research and practice, and emerging quality improvement programs, especially those using some or all of Wagner’s chronic care model (CCM) [12].