Demand for patient self-management tools--technologies used by consumers to manage their health issues outside formal medical institutions--is gaining momentum. This surge of interest springs from a variety of converging influences: new ideas about clinical care, universal concern about costs, political interest in stimulating competition among providers, shifting consumer habits, and an explosion of technological innovation. Some analyses of this market sort self-management tools into an overwhelming number of micro-segments. Others categorize the market by user group without differentiating much among the technologies themselves. This report attempts to create a typology that distinguishes tools primarily by patient role and secondarily by variations in the complexity of technology. The various tools may be described as follows: (1) Technologies that support subordinate patient roles provide modest patient discretion within a strong supervisory context. The approach is similar to the one adopted by the automobile industry, in which the expanding role of devices has reduced the possibility for human error. (2) Tools for structured roles involve more active but limited patient participation. In these cases, technologists have proceeded cautiously because of physician wariness about sharing control. (3) Tools for collaborative roles involve patients using their own knowledge and making decisions jointly with clinicians. Such tools engage physicians and patients in the shared decision-making envisioned by disease management advocates and clinical care theorists. (4) Tools that facilitate autonomous roles help patients take health matters in hand without major participation by clinicians. While each of these self-management roles has kindled a growing market for new technology, not all have inspired corresponding changes in clinical care delivery. As patients continue to adopt self-management tools, clinicians will need to better understand these tools and how best to apply them in caring for their patients.
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