Transcript The development of self-care and its implications for GPs

The development of self-care
and its implications for
General Practitioners
Professor Colin P. Bradley
University College Cork
Self Care - Definition
Self-care includes healthy living
behaviours such as avoiding health
risks, adequate physical exercise,
proper nutrition, maintenance of mental
well-being, and taking medicines
(prescription and over-the counter)
responsibly and appropriately.
Self care in relation to illnesses
• Acute illness
– Accurate appraisal of symptoms
– Appropriate self medication (for symptom
relief)
• Chronic illness
– Adherence to lifestyle advice
– Self monitoring of condition
– Appropriate adjustment of medication(s)
The illness ice-berg (After Hannay, 1979)
MAJOR ILLNESS
Hospital/Secondary care
GP/Primary care
MINOR ILLNESS
SELF-CARE
PRE-SYMPTOMATIC DISEASE
HEALTH
The illness ice-berg is shifting
MAJOR ILLNESS
Hospital/ secondary care
GP/ primary care
MINOR ILLNESS
SELF-CARE
PRE-SYMPTOMATIC DISEASE
HEALTH
Drivers of self care
• Patient education/ information
– General media
– Internet
• Barriers to accessing doctors
– Cost
– Manpower shortage(s)
– Doctors busy with ‘serious’ illnesses
• Positive experience of self care
• Negative experience of healthcare
• Desire for autonomy
Self care support in the UK (DoH, 2007)
Summary of research on self help
support from UK
“Overall the evidence suggests that self
care support can result in beneficial
health outcomes for people and more
appropriate use of health and social
care services.”
UK Department of Health, 2007
OTC Medicines as a % of the Total
Pharmaceutical Market 2007
Self Medication Market in Ireland 2007
Benefits of self care
• Patient empowerment and
responsibility for own health
• Ease of access
• More effective/ appropriate use of
health services
• Reduced costs of medicines and health
services
Risks of self care
• Late diagnosis
• Misdiagnosis
• Inappropriate use of medicines
–
–
–
–
–
Avoidable adverse effects
Interactions
Excessive dosage or duration
Sub-optimal treatment
Over reliance on medication (medicalisation)
• Lost opportunities for health promotion
Implications for GPs – acute illness
• Reduced workload of ‘minor illness’
• Patients will come with more
information/ misinformation and self
diagnosis
• Patients presenting will have tried self
care and self medication
• Patients will expect more active
investigation and management (from
the ‘off’)
Implications for GPs – chronic illness
• Higher level of patient education
required
– Disease process
– Mode of action, dosing etc of medications
– Targets and action lines for intervention
• More actively engaged patient
– More questioning/ demanding?
– More compliant?
– Partnership rather than paternalism