The Pharmaceutical Journal
Vol 273 No 7325 p715
13 November 2004

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Self-care goes under the microscope

A pilot project about to start at Erewash Primary Care Trust will examine the impact of self-care on the local population. Harriet Adcock reports

Agenda series

Self-care is a theme that runs through many Government initiatives and strategy documents: the NHS Improvement Plan; the programme for managing long-term conditions; the expert patient programme; the new pharmacy contract. The list goes on.

However, despite being a feature of these initiatives the self-care elements are not linked together. In June this year, Government backing was announced for a pilot project designed to address this and to show how valuable self-care can be within a local population.

The project — “Joining up self-care in the NHS” — will build on existing programmes supporting self-care within Erewash Primary Care Trust. It will also test the impact of three self-care modules within the trust: the prevention of coronary heart disease; an education programme for parents and carers of children with asthma; and the treatment of minor ailments aimed at mothers and their families (see Panel 1).
The project, initiated by the Proprietary Association of Great Britain, is being funded through the Government’s Working in Partnership Programme (see Panel 2) and is set to go live in January 2005.

Paula Clarke, chief executive of Erewash PCT, explains that the PCT’s strategic direction has been informed by US models of health care, which actively promote self-care as a way to manage long-term conditions better. “The health service spends a lot of money at the top of the health care pyramid. If we spend time at the bottom, we can get a huge health gain for our population,” she says.

With this in mind, the project aims to get everyone thinking about self-care and so encourage uptake of available resources. Part of this will include developing “self-care aware” consultations — asking health professionals to be open to the concept of self-care behaviour. Gopa Mitra, director of health policy and public affairs at the PAGB, says: “It is important for health care professionals to espouse self-care and to share this thinking with patients.”

Ms Mitra explains that pharmacists will have input into each of the three self-care modules being tested.

The coronary heart disease programme is a community-based intervention involving a self-assessment risk calculator. It will be available through public houses, clubs and workplaces, as well as more traditional outlets, such as pharmacies. “We are trying to show how a PCT can work with its community in the wider sense,” says Ms Mitra.
After completing the self-assessment, people will be guided towards an appropriate source of advice, such as their pharmacist. “It will not be about sending people back to general practice,” she adds.

Like the coronary heart disease programme, the minor ailments schemes and expert parent programme will make use of a variety of outlets to promote the self-care message, including schools and mother-and-baby groups. “The NHS has tended to think if it is going to deliver a health message it must be delivered from an NHS establishment. This takes a different angle,” says Ms Mitra.

Again, people will be encouraged to make use of health care resources other than their local general practice, such as community pharmacy and NHS Direct.
Alison Blenkinsopp, professor of practice of pharmacy at Keele University’s department of medicines management, is on the project’s steering group. She explains that the aim of the expert parent programme is to build parents’ confidence and to help them manage their child’s asthma successfully. “This is the first time that a programme like this has been run for a group of parents whose children all have the same condition,” she adds.

Evaluation
Evaluation of the project will involve baseline research, intervention questionnaires, post intervention questionnaires, focus groups and interviews with patients and health professionals.

Professor Blenkinsopp says that evaluation of the minor ailments scheme and expert parents programme will focus on groups of mothers or carers who have participated in the interventions. Comparisons will be made, respectively, with mothers not registered with a minor ailments scheme and with parents and carers who have not participated in the expert parents programme. GP and pharmacy records will also be examined to establish whether the interventions used in the project changed people’s health-care-seeking behaviour.

The project’s final report is expected in 2006, but those involved hope that the interventions will be ongoing. “This is not intended to be a short-term programme,” says Ms Mitra. “Out of all of this, we hope to have documentation to show how the self-care approach can be implemented in any PCT.”