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Chapter 2
- part 3
What we know about the practice
and impact of self care
Self care support provided by pharmacists
Chapter 6 contains many examples of self care support by pharmacists and their
teams. Relatively simple interventions can make a big difference. A one-hour educational
and medicines management visit by a community pharmacist which
emphasised self care, medications and screening processes for complications, resulted
in improved diabetic control in a study involving 80 patients. Teamwork between the
pharmacist and health professionals in the general practice team was key.59
Some PCTs have tried out Pharmacy First (www.erewash-pct.nhs.uk). Box 2.2
described the collaboration between Sure Start and four pharmacies in Hull in making
greater use of pharmacies as health advice centres.
Can we afford to promote self care?
Some examples included here have demonstrated that supporting self care can result in tangible benefits to people’s health and thus cost savings to the NHS and society in general, as healthier people can work harder and more effectively, for longer. While specific and reliable information about the cost effectiveness of the various types of self care is limited, the promotion of self care has been recognised as an important aspect of managing demand.60 However, for any significant effect on demand in primary care, multifaceted approaches are required at all points, from avoidance of first contact with health services to possible referral to secondary care. The various components of an integrated self care support resource and the entire range of self care interventions must be considered when advising and supporting patients.61
The Wanless review suggested that in general for every £100 spent on encouraging
self care, £150 worth of benefits can be expected in return.62 In a systematic review of
self help treatments for anxiety and depression in primary care, none of the eight
studies included had data on long term clinical benefits or cost effectiveness.63 A
systematic review of the clinical and cost effectiveness of patient education models for
adults with types 1 and 2 diabetes, for instance, found 24 studies of such education;
but only two of these reported on the cost effectiveness of their educational intervention.
64 The trial of self-monitoring in hypertension found that self-monitoring did
not cost significantly more than usual care.47 A trial of a guidebook offering self help
information plus a self help group meeting resulted in a 60% reduction in primary care
consultations, and costs were reduced by £73 per year.65 For the present, self care
support may be developed and promoted in the hope that it will result in affordable
benefits and be cost effective. Evidence suggests that
intervening at the community level is potentially more powerful or at least more cost effective than interventions at individual level66
unless the interventions are targeted at high risk individuals.
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