Defining self-care
Self-care involves much more than buying over-the-counter medicines.
It starts with preventing ill health, including the actions taken
to maintain both physical and mental health. It also includes
caring for minor ailments, managing long-term conditions and maintaining
health after an acute illness. |
Further information
To support the drive to encourage self-care, the DoH
has set up a new website.
In the coming months it will include examples of good practice in
self-care. |
Self-care is frequently mentioned in Government policy. And last week
it
hit the headlines again when the Department of Health in England published
a document setting out why self-care is important and how it should be
supported.
“It’s all about empowering patients and the public to take
more control over their lives. Everybody is used to brushing their teeth
regularly
to keep the dentist at bay. We are looking to get more people to adopt
this proactive approach towards their general health care,” says
Health Secretary John Reid.
“Self care — a real choice”, is aimed at NHS managers
and health care practitioners. The document deals in general terms with
what
the NHS and practitioners can do, and this article will draw out which
of these roles can be taken on by, or involve, pharmacists.
Importance of self-care
Self-care is important because the health service could not cope without
it. The document gives the example of a patient with
diabetes: on average he or she has three hours of contact with health
professionals per year, during the remaining 8,757 hours a year he
or she is dependent on self-care.
But the importance of self-care goes far beyond saving time for the
NHS. Patient satisfaction is higher among those who care for themselves.
And
evidence suggests that supporting self-care leads to improved health
and quality of life for patients, with reduced use of both primary
care and hospital resources.
Nearly every aspect of health, from the most basic intervention to
prevent an accident right through to managing a serious chronic condition,
can
involve self-care. Roles for pharmacists exist at many levels and include
the provision of:
· Public health and lifestyle advice
· Self-diagnosis tools
· Advice and information about diseases
· Medicines for minor ailments
· Advice and information about medicines for minor and chronic conditions
· Advice on managing long-term conditions, such as responding to an exacerbation
· Personalised care plans for people with long-term conditions
The Proprietary Association of Great Britain is a long-term advocate
of self-care. Gopa Mitra, director of health policy and public affairs
at the PAGB, comments: “Our member companies have promoted the
message of self-care in their marketing activities for many years. It
is satisfying to see now that the NHS is being encouraged to support
health professionals to help people self care.” She adds: “This
is clearly good news for the profession of pharmacy in raising pharmacists’ profile
in supporting people’s self-care as stated in the pharmacy contract.”
Treating minor ailments
One of the most obvious areas in which community pharmacists could — and
already do — contribute much to promoting self-care is in the area
of minor ailments. The DoH document points out that 40 per cent of GP
time is spent dealing with patients with minor, self-treatable illnesses.
In Northumberland, Tyne and Wear Strategic Health Authority, a pharmacy-led
scheme has attempted to tackle this. Ian Spencer, director of clinical
governance at the SHA, explains that the minor ailments scheme was launched
in December 2000. It now involves 57 GP practices and 80 community pharmacies
and is offered to 343,100 people, some 25 per cent of the SHA population.
The scheme covers upper respiratory tract infections, gastrointestinal
conditions, hay fever, cystitis and thrush, and head lice. “We
provide a leaflet for each condition explaining what the symptoms are,
what people can do themselves and where to go for further help. We are
looking for sustainable change,” says Dr Spencer. Patients obtain
the leaflets from surgeries and they contain tokens for a free supply
of medicine from a pharmacy (for exempt patients). “The scheme
reduces demand at the surgery, speeds up the transaction for the patient
and offers the
patient another choice. It has also been low cost: less than £5
per transaction including a £3 fee for the pharmacist,” he
adds.
Of course, minor ailments schemes are now well established in a number
of locations. In England and Wales, a minor ailments service will be
an enhanced service — to be commissioned locally — under
the new pharmacy contract but in Scotland it will be one of the four
core services.
Self-care will also be supported in a number of other ways through the
new pharmacy contracts. In England and Wales, one of the essential services
is “Support for self care” through which pharmacists will
provide
advice on the treatment of minor illnesses and chronic conditions, and
make interventions to promote healthy lifestyles.
Alastair Buxton, head of NHS services at the Pharmaceutical Services
Negotiating Committee, says: “Pharmacists are the ultimate self-care
supporting professionals. Self-care has always been important to pharmacy
but now it has moved up the political agenda and this is something that
pharmacists need to understand. It is why self-care is being recognised
within the new contract.”
Other aspects of the new contract through which self-care will be supported
are provision of information in the dispensing service, promotion of
healthy lifestyles in the public health service, and signposting to other
health professionals and organisations. Medication reviews could lead
to patients having a better understanding about their medicines thereby
enhancing self-care.
Supporting self-care is not limited to community pharmacy. Hospital pharmacists
have roles, too, particularly in developing
patients’ understanding about medicines and management of long-term
conditions after discharge from hospital. The same applies to primary
care pharmacists, many of whom conduct medication reviews.
It is clear that pharmacists can offer a great deal of support to promote
self-care. But the most important people in self-care are the
patients themselves. Patients have to choose what help they need and
whom they want to provide it. This is why it is important for pharmacists
to be included in the package of options that the NHS offers. Also central
is the Expert
Patient Programme through which patients are involved in
the management of chronic disease (PJ, 31 May 2003, p743).
Furthermore, when offering a service, it is important to help the patient
get the most from it. For example, a patient guide to medication review
published by the Medicines Partnership helps patients to prepare for
their review. Further information about the guide, called “Focus
on your medicines”, is available.
Self-care is part of everyday life. It features frequently in recent
Government policy. Two particular current priorities are care of long-term
conditions and patient choice: self-care is central to both so pharmacists
will have a key role in delivering them. |
The
Pharmaceutical Journal