Professor Colin P. Bradley University College Cork 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 9

Self Medication Market in Ireland 2007 10

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