Health professionals might even devalue the importance of
social support that people draw on to self manage their conditions.33
In this study the attending doctors had attended
a seminar on patient self management so they could emphasise
the importance of referral for self management for better
control. One study has revealed that high ratings of general
practitioner (GP) communication enhanced self monitoring of
blood glucose when patient self efficacy was high, but impeded
self monitoring when self efficacy was low.34 A study conducted
on a large healthcare system of enhanced primary care showed
a lower degree of improvement in diabetes care (HbA1c reduced
from 7.86% to 7.41%).35 A paradigm shift towards partnership
care consisting of two main componentsdcollaborative care and
self management education, that are conceptually similar but
clinically separabledwould facilitate better clinical outcomes.36
GPs should therefore be more sensitive to patients with low self
efficacy and encourage them to attend self management
programmes aimed at raising their self efficacy, rather than
stepping in to take over the entire process.