Self-management is becoming increasingly important in COPD health care although it remains difficult to embed self-management into routine clinical care. The implementation of self-management is understood as a complex interaction at the level of patient, health care provider (HCP), and health system. Nonetheless there is still a poor understanding of the barriers and effective facilitators. Comprehension of these determinants can have significant implications in optimizing self-management implementation and give further directions for the development of self-management interventions. Data were collected among COPD patients (N=46) and their HCPs (N=11) in three general practices and their collaborating affiliated hospitals. Mixed methods exploration of the data was conducted and collected by interviews, video-recorded consultations (N=50), and questionnaires on consultation skills. Influencing determinants were monitored by 1) interaction and communication between the patient and HCP, 2) visible and invisible competencies of both the patient and the HCP, and 3) degree of embedding self-management into the health care system. Video observations showed little emphasis on effective behavioral change and follow-up of given lifestyle advice during consultation. A strong presence of COPD assessment and monitoring negatively affects the patient-centered communication. Both patients and HCPs experience difficulties in defining personalized goals. The satisfaction of both patients and HCPs concerning patient centeredness during consultation was measured by the patient feedback questionnaire on consultation skills. The patients scored high (84.3% maximum score) and differed from the HCPs (26.5% maximum score). Although the patient-centered approach accentuating self-management is one of the dominant paradigms in modern medicine, our observations show several influencing determinants causing difficulties in daily practice implementation. This research is a first step unravelling the determinants of self-management leading to a better understanding.

Purpose: The purpose is to get insight in the demand for and prevalence of care of defined populations. Theory:To reach the Triple Aim of simultaneously improving population health, improving the patient experience of care, and reducing per capita cost, a population denominator is required. Also, the demand for care in the future will to a large extent be determined by the increase of chronic diseases and ageing. Methods:In the 'Wijk-en Praktijkscan' (Neighbourhood and Practice scan) demographic data and data about the demand for care has been combined with patient data at the lowest possible geographical level. The Wijk-en Praktijkscan has been implemented in various Health Centres and Care Groups in the Netherlands. Findings:The scan provides among others insight in differences between the expected and actual demand for care and the prevalence and geographical distribution of patients with one or more (chronic) diseases.Discussion: Insight in the demand for care of a specific population is a key element to organise the supply of care in neighbourhoods in a more integrated way. It is also necessary to get insight in the potential possibilities for substitution of care that will probably reduce costs and lead to better health.

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