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Chapter 7 - part 3
Seeing self care from the
patient’s perspective
Understand physical constraints and personal circumstances
Some stroke patients, for example, have physical or cognitive impairments that make self care difficult. Other patients may have caring responsibilities (i.e. children or other dependants), that restrict their ability to undertake self care for themselves.
Improve health at work
The work place is a setting for health promotion and self care.29 Work is important to maintain a person’s health and wellbeing, as well as earning an income.30 The national strategy aims to help people avoid work-related problems as well as take care of minor health problems at work with access to appropriate treatment – such as for sprains and muscular strains.
The Chartered Society of Physiotherapy offers advice and treatment for a range of health problems that might impinge on people’s fitness for work. They advise people to undertake certain exercises every hour or so to reduce their risk of developing workrelated aches and pains, to avoid sitting for too long, and to get up and stretch every 20 minutes or so.31
Research by the Developing Patient Partnerships (DPP) organisation has found that if employees had more information from their employer about taking care of common ailments they would be less likely to take time off work.32 Resources include campaign materials, health bulletins, patient education of all sorts and health toolkits - for PCTs and practices too. DPP provide a health at work service comprising regular campaigns (e.g. beating back pain), health bulletins and health toolkits with personal health folders for employees, and advice and support for employers in promoting occupational health and managing sickness absence.33
Other community initiatives to get people back to work, as in Box 7.12, can further boost health and self care opportunities.
Box 7.12: Examples of projects helping unemployed people back to work Learning and Employment Action Package (LEAP)The LEAP project is headed by Connexions Staffordshire. It helps people gain employment through a programme of in-depth, continuous support and job mentoring. The programme is free and confidential and supports people in the early stages of their employment. LEAP is for anyone who is unemployed, between 16 and 65 years of age and who is not claiming Job Seeker’s Allowance. It specifically targets lone parents, ex-offenders, the long term unemployed, people with disabilities and those from minority ethnic groups. A team of job mentors meets with clients as often as they require and at convenient locations for them. Next MovesNext Moves offers a range of specialist services and activities to motivate and support individuals as soon as they become unemployed. Connexions adult advisers work with adults when they register with Jobcentre Plus. Participants can sign up for up to 16 hours per week for a maximum of 13 weeks. Participants have free access to newspapers, postage, telephone and the internet to search for jobs. Sixty per cent of those entering the programme are expected to move quickly into employment. |
Understand more about complementary health care
Many people buy complementary and alternative medicine (CAM) therapies – around 10% of the population visit a CAM practitioner in any year. So any self care approach should take into account the thinking and practice of complementary health care. Health professionals need to know that people are taking or using complementary therapies that might interact with prescribed medicines or cause adverse effects.
About half of all general practices in England offer patients access to complementary therapies.34 The extent to which these can be integrated into conventional primary care provision is a balancing act between patients’ expectations and needs, and accepted standards of medical and scientific principles of practice.35
Who provides complementary therapies?
Some complementary practitioners are practising health professionals such as doctors, physiotherapists or nurses who are state registered with their own professional organisations. Others such as osteopaths and chiropractors are registered with their own statutory bodies. Most complementary practitioners have completed further education in their discipline. Their knowledge and skills mainly come from training based on what has been passed down by tradition rather than proven by scientific evidence.
Many conventional health professionals practise in the typically holistic manner of complementary therapists too (see Figure 5.1, p. 54). Scientific, artistic and spiritual insights need to be applied together to restore health. Holistic practitioners believe that illness provides opportunities for positive change as you reflect on your circumstances, and create a better balance to your life. People opt for complementary therapies because they are ‘low tech’, or because their symptoms are persisting, or as a result of real or perceived adverse effects from conventional treatments.36
The evidence for complementary therapies
There is not much research evidence on how many of the alternative therapies are effective for exactly what conditions. The Cochrane Collaboration has completed 145 reviews of randomised controlled trials of complementary and alternative therapies: one-third showed a positive or possibly positive effect, and in over half there was insufficient evidence to make a judgement.37 Just because acupuncture is proven to be effective for low back pain, does not necessarily mean that it is effective for headaches. For many people it is the placebo effect, the fact that they are taking a treatment, that makes them think the treatment is working. If someone listens to them with interest and uses their hands to massage or treat them, they are likely to leave that consultation feeling better.
Some publications and sources of reference promote complementary healthcare to people as part of a general self care approach, so that they are informed about what a treatment entails, likely benefits or possible risks and costs.38 The cost effectiveness of complementary treatments to the NHS is still uncertain. A systematic review of cost effectiveness included five research studies; complementary treatments represented an additional cost to usual care in four of the five studies.39
References
1 Critchlow M. Enabling Self Care. Report on focus groups of patients with long term conditions,
and healthcare professionals in Southwark and Lambeth PCTs. London: Health First; 2005.
2 Rogers A, Entwistle V and Pencheon D. A patient led NHS: managing demand at the
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3 www.staffordbc.gov.uk/la21
4 www.csp.org.uk
5 www.drfoster.co.uk
6 www.arc.org.uk
7 www.reducetherisk.org.uk
8 www.mind.org.uk/index.htm
9 www.chic.org.uk
10 www.diabetes.org.uk
11 www.dpp.org.uk
12 www.familydoctor.co.uk
13 Long-term Medical Conditions Alliance (LMCA). Supporting Expert Patients. How to develop
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14 Department of Health. Expert Patients Programme Update. Issue 13. August 2005.
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16 Griffiths C, Motlih J, AzadAet al. Randomised controlled trial of a lay-led self-management
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19 Sadler M. NHS Direct – let the force for patients be with you. BMJ Careers. 2005; 10
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22 www.askaboutmedicines.org
23 www.healthwise.org
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25 Cardol M, Schellevis FG, Spreeuwenberg P et al. Changes in patients’ attitudes towards the management of minor ailments. British Journal of General Practice. 2005; 55: 516–21.
26 McRobbie H and McEwen A. Helping Smokers to Stop: advice for pharmacists in England.
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27 National Pharmaceutical Association (NPA). Pharmacy Contract Service Specification 4 – promotion of healthy lifestyles (public health). St Albans: NPA; 2005. www.npa.co.uk
28 McLean J and Pietroni P. Self care – who does best? Social Science and Medicine. 1990; 30: 591–6.
29 Department of Health. Choosing a Better Diet: a food and health action plan. London: Department of Health; 2005.
30 Department of Health. Health, Work and Well-being – caring for our future: a strategy for the health and well-being of working age people. London: Department of Health; 2005.
31 Chartered Society of Physiotherapy. Fit to Work. London: Chartered Society of Physiotherapy; 2005. www.csp.org.uk
32 Developing Patient Partnerships. Health at Work: workplace health education. London: DPP; 2005.
34 Thomas KJ, Coleman P and Nicholl JP. Trends in access to complementary or alternative medicines via primary care in England: 1995–2001. Results from a national survey. Family Practice. 2003; 20: 575–7.
35 Frenkel MA and Borkan JM. An approach for integrating complementary–alternative medicine into primary care. Family Practice. 2003; 20: 324–32.
36 Thompson T and Feder G. Complementary therapies and the NHS. British Medical Journal. 2005; 331: 856–7.
37 Manheimer E, Berman B, Dubnick H et al. Cochrane Reviews of Complementary and Alternative Therapy: evaluating the strength of the evidence. 2004. www.cochrane.org/ colloquia/abstracts/ottawa/P-094.htm
38 Pinder M, Pedro L, Theodorou G et al. Complementary Healthcare: a guide for patients. London: The Prince of Wales’s Foundation for Integrated Health; 2005. www.fihealth.org.uk
39 Canter P, Thompson Coon J and Ernst E. Cost effectiveness of complementary treatments in the United Kingdom: systematic review. British Medical Journal. 2005; 331: 880–1.