Back to contents
Previous
Next
Download printable version (pdf)
Chapter 2
What we know about the practice
and impact of self care
This chapter describes the scope of self care in theUKand considers whatwe know from recent work in the field about its impact.
Self care is the basic level of health care in any society.1 In the UK, self care comprises
an estimated 80% of all care episodes. Figure 2.1 shows the relationship of self care
to professional care, and demonstrates how professionals and the public are coproducers
of care.
Self care is a continuum, starting from the individual responsibility people take in
making daily choices about their lifestyle, and risk taking. This may be in their work,
travel and hobbies, and other aspects of their everyday lives. Next along the continuum,
Figure 2.2 shows the self care of ailments without and with assistance from
health professionals such as pharmacists, GPs or practice nurses. Shared care follows –
by health professionals together with their patients, as individuals cope with long term
health conditions and acute health problems. Ultimately on the right hand of the
continuum there is 100% professional care with little or no opportunity for self care in
the immediate episode, e.g. complex co-morbidities, compulsory psychiatric care or
major trauma or illness – until the start of recovery when self care can emerge again.
Figure 2.3 maps the various approaches to self care, from the achievement and
maintenance of good health and a healthy lifestyle to the prevention of ill health and
minimising symptoms from minor illness. The figure also introduces the interrelationship
between the promotion of health in the community through social
care, outside the primary care setting.
Components of self care
The aims of promoting self care among your patients or the local population are to
encourage individual people to:
P: Prevent the condition developing
A: Await resolution of the symptoms
R: use self care skills for Relief of symptoms
T: learn to Tolerate symptoms that do not resolve or cannot be reasonably
alleviated.
The size of each PART quadrant in Figure 2.4 will depend on the specific level and
range of self care skills for a particular condition.
Enhance the level of self care skills of individuals and self care support provided by the NHS by considering each component. Push the boundaries of self care to the maximum that is safe for your patients or the general public, and affordable in terms of resources such as time and capacity of primary health care professionals. Some self care support approaches will focus on one of the quadrants. Others may have more than one component in the total intervention. The case study in Box 2.1 combines Prevention of worsening asthma using preventive therapy more effectively and by smoking cessation, with Relief through better use of medication.
| Box 2.1: Case study: proactive self care support for people with asthma Fifty practices in 25 PCTs are articipating in ‘Asthma Care’, a proactive telephone outreach service to support self care. A nurse contacts individual patients in a series of regular calls to discuss their asthma and related issues. Smoking cessation advice is also given, as is explanation of the importance of preventer therapy, and where reliever therapy fits in. Overall, around one-third of patients did not have an action plan for their asthma. Patients were referred to their asthma nurse or GP where needed. An evaluation was conducted with 150 patients who had completed the programme and reported: better understanding of their asthma (86%); improvement in their asthma (69%); better compliance with preventer medicine (39%); reduced amount of reliever medicine taken (40%). Patients felt they had time to discuss their questions and had confidence they could raise other issues. |
The case study reported in Box 2.2 describes Tolerance and Awaiting resolution as well as Relief of children’s minor ailments. Involving the family and carers is important in promoting self care. Families have a strong influence on someone’s use of health services and health seeking behaviour.
| Box 2.2: Case study: education and advice on children’s minor ailments Sure Start and four local pharmacies on an estate in Hull are collaborating to make greater use of pharmacies as health advice centres. The aim is to increase parent education on health issues in under-three year olds in an under-doctored area. Parents register with a local pharmacy for advice on children’s minor health problems that they would otherwise have consulted the GP about. Simple information leaflets are distributed on the six ailments covered by the scheme: temperature/aches/pains; stuffy nose; colic; nappy rash; diarrhoea/sickness; teething; dry skin. Pharmacists can supply medicines free of charge for five of the six ailments. So far, no medicine has been supplied in 10–15% of cases. In roughly half of these, the pharmacist’s view is that advice is sufficient and for the rest they think that referral for medical advice is necessary. |
Some conditions lend themselves to self care more than others. Problems such as back pain or sore throat are likely to get better anyway without any medical management or treatment. At the same time, people need information about the occasional serious aspect of their illness that requires medical attention. The ‘red flags’ in back pain, which if undetected and treated as an emergency can lead to permanent paralysis, or the very occasional sore throat that turns out to be a quinsy, require a safety net. Chapters 10 to 13 contain in-depth illustrative patient pathways covering back pain, asthma, cough and sore throat, and demonstrate how the four components of self care – prevention, await resolution, relieve symptoms and tolerance – apply to each condition. Look at Box 2.3 to think more about selecting appropriate types of self care support intervention.
| Box 2.3: Gaining maximum impact from self care support intervention A review of qualitative research on self care concluded that: a number of factors need to be considered when devising health care interventions for managing demand better. These include an assessment of the meaning of the disease to the person so that self care information can be designed in a way that fits people’s prior beliefs and lifestyles. Timing and the stage in a person’s illness career are also important factors to consider when designing effective self care support interventions. Social interaction and the impact of significant others may affect whether or not a self care regime is followed, and autonomy and control are also relevant to designing acceptable self care strategies. |
There are many innovative practical examples of self care support across all health settings. In a recent review no examples of a whole systems approach to self care across a health economy were found.