Promoting medical self-care: evaluation of a family intervention implemented in the primary health care by pharmacies.
(33/2838)
BACKGROUND: Medical self-care is the range of behaviours undertaken by people to promote or restore health when dealing with a medical problem. OBJECTIVES: The aim of the study was to evaluate medical self-care effects of a family intervention implemented in primary health care by pharmacies, in terms of non-professional and professional involvement. METHODS: The intervention was implemented in one of two primary health care areas during a 4-month period and involved consecutive families acting as an intervention (IG, n = 94) or a control (CG, n = 93) group. Eight telephone interviews were conducted with each family. The families were asked about complaints of illness, how long they prevailed and how they were treated. RESULTS: The results showed (P < 0.05-0.0001) that the IG had more medical problems (931 versus 621) compared with the CG, were less hospitalized (4 versus 10), stayed at home more to take care of sick children (84 versus 40), read more medical brochures (121 versus 31), tried more non-medical treatments (228 versus 116), and had fewer visits to the department of paediatrics but more visits to primary health care (69 and 98 versus 90 and 68). CONCLUSIONS: Due to the non-randomization procedure, some caution with regard to generalization of the results must be taken, but they are in concordance with established knowledge of the usefulness of medical self-care. The results indicate that a brief intervention for families can change the use of health authorities. It therefore seems meaningful to implement the intervention in a more comprehensive way in the primary health care setting, while at the same time trying to implement it as a large-scale randomized experimental study, comprising aspects such as the individual's need for care, the use of the right organization level and the assessment of economic costs and savings. (+info)
'Instilling the strength to fight the pain and get on with life': learning to become an arthritis self-manager through an adult education programme.
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The aim of this study was to determine whether the Arthritis Self-Management Programme (ASMP) is effective in promoting perceived control and self-management ability when delivered in an adult education setting. The study was a pre-test-post-test design based on a sample of 89 people attending an ASMP. Data were collected by self-administered questionnaires prior to the intervention and after the intervention, 4 months from baseline. The sample comprised 80% women, with a mean age of 57 years and a mean disease duration of 13 years. Most participants had either osteoarthritis or rheumatoid arthritis. After 4 months, participants demonstrated significant increases in arthritis self-efficacy (P < 0.0005), cognitive symptom management (P < 0.0005), communication with doctors (P = 0.018), exercise (P = 0.003) and relaxation (P < 0.00005). In addition, significant decreases were found in terms of pain (P = 0.034) and visits to other health professionals (P = 0.004). The first evaluation of the ASMP, delivered within the context of adult education, suggests that this form of community health education programme can offer substantial benefits for participants, particularly in terms of perceived ability to control various aspects of arthritis and in greater utilization of cognitive-behavioral techniques. (+info)
Impact of chronic pain on health care seeking, self care, and medication. Results from a population-based Swedish study.
(35/2838)
STUDY OBJECTIVE: To explore individual and social factors that could predict health care utilisation and medication among people with chronic pain in an unselected population. DESIGN: A mailed survey with questions about pain and mental symptoms, disability, self care action, visits to health care providers, and medication. SETTING: General populations in two Swedish primary health care (PHC) districts. Medical care was given in a state health system. PARTICIPANTS: A random sample (from the population register) of 15% of the population aged 25-74 (n = 1806). MAIN RESULTS: Among people reporting chronic pain 45.7% (compared with 29.8 of non-chronic pain persons, p < 0.05) consulted a physician and 7.2% (compared with 1.2%, p < 0.05) a physiotherapist during three months. Primary health care was the most frequent care provider. High pain intensity, aging, depression, ethnicity, and socioeconomic level had the greatest impact on physician consultations. Alternative care, used by 5.9%, was associated with high pain intensity and self care. Use of self care was influenced by high pain intensity, regular physical activity, and ethnicity. Alternative care and self care did not imply lower use of conventional health care. Women reporting chronic pain consumed more analgesics and sedatives than corresponding men. Besides female gender, high pain intensity, insomnia, physician consultation, social network, and self care action helped to explain medication with analgesics. Use of herbal remedies and ointments correlated to self care action, visit to an alternative therapist, high pain intensity, and socioeconomic level. CONCLUSIONS: The presence of chronic pain has an impressive impact on primary health care and medication. Various therapeutic actions are common and are partly overlapping. The use of health care among people with chronic pain depends above all on pain perception and intensity of pain but is also affected by ethnicity, age, socioeconomic level, and depressive symptoms. Among people with chronic pain use of analgesics is common in contrast with other types of pain relief (acupuncture, physiotherapy) suitable for treating chronic pain symptoms. (+info)
Common colds. Reported patterns of self-care and health care use.
(36/2838)
OBJECTIVE: To describe the self-reported prevalence and patterns of self-care and health care use for colds and flu. DESIGN: Using the expert panel method, a questionnaire was developed to explore self-care practices, attitudes, pharmaceutical use, and health care use for a range of cold and flu symptoms. SETTING: London and Windsor, Ont. PARTICIPANTS: Using a random-digit-dialing survey method, 210 residents were interviewed between November and December 1993. Of 1484 telephone numbers called, 1179 calls were ineligible. Two hundred ten questionnaires were completed for 305 eligible respondents. MAIN OUTCOME MEASURES: Demographic data, typical self-care practices, actual practice during respondents' last cold, opinions on appropriate practices, and knowledge of how to treat colds. RESULTS: Self-care was respondents' treatment of choice, and most respondents use over-the-counter drugs. Prescription drug use was low. Only 1% reported seeing a physician for their last cold. As the number of symptoms increased, however, reported use of over-the-counter drugs and calls or visits to doctors increased. CONCLUSIONS: Results are congruent with other studies showing that the health care practices of most respondents are consistent with low use of the health care system and high levels of self-care for colds and flu. (+info)
Asthma management: evidence based studies and their implications for cost-efficacy.
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This review attempts to infer a cost-effective strategy for the management of bronchial asthma based on evidence from randomized controlled trials. Acute severe asthma should be treated with short-acting inhaled beta-agonists followed by a short course of oral steroids. Decisions on hospital admission should be made within 1 to 2 hours and prolonged treatment in emergency departments avoided. A comprehensive educational and drug optimizing program will prevent chronic illness and relapse. Educational programs should be brief but intensive, supervised by asthma specialists and incorporate self monitoring of symptoms plus written action plans. Peak expiratory flow monitoring should not be mandated for all patients. Inhaled corticosteroids (ICS) are the most cost-effective drugs for the long term prevention of asthma. ICS should be started at low doses. If the symptoms of asthma are not well controlled by moderate doses of ICS, high dose ICS treatment should be avoided and add on medication prescribed instead. Oral bronchodilators are less expensive add on medication than long-acting inhaled beta-agonists. (+info)
Validation of self diagnosis of high blood pressure in a sample of the Spanish EPIC cohort: overall agreement and predictive values. EPIC Group of Spain.
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STUDY OBJECTIVE: High blood pressure is a variable related to several chronic conditions whose repeated measurement in large cohort studies is often not feasible having to rely on the self reporting of the subjects. The aim of the study is to validate such self diagnosis in a sample of members from the Spanish EPIC cohort study. DESIGN: Comparison of high blood pressure self diagnosis with the information provided by the personal medical record drawn from the primary health centre of reference for such population. SETTING: A small town near the EPIC-Murcia centre, one of five Spanish EPIC centres located in the south east, where inclusion in the cohort was offered to the general population. PARTICIPANTS: The agreement between self reported high blood pressure status and data from medical records was measured in a representative sample of men and women (n = 248) aged 30-69 years. Medical records were studied for a diagnosis of high blood pressure, an anti-hypertensive pharmacological treatment or subject's inclusion in a hypertension control programme run in the medical centre only for hypertensive people (definite high blood pressure cases). As well, in the absence of such a diagnosis, medical annotations of systolic or diastolic high blood pressure > or = 140/90 mm Hg (possible high blood pressure cases) were considered. Sensitivity, specificity, positive and negative predictive values and kappa scores were calculated for all, definite and possible high blood pressure cases. Variables associated with the probability of having a true positive or negative self report of high blood pressure were also tested. MAIN RESULTS: As expected, sensitivity was higher among definite cases (72.7%) than among possible cases (31.6%). Accordingly, the agreement between self report and medical record was higher for definite cases (kappa = 0.65) than for possible (kappa = 0.29 cases leading to a moderate overall agreement for all cases (kappa = 0.58; 95% CI: 0.47, 0.69). Having some level of education (OR: 0.31; 95% CI: 0.09, 1.05) was negatively associated to a true self report of high blood pressure while being female was positively associated (OR: 4.01; 95% CI 1.04, 16.8). No variable showed any association with having a true self report of being normotensive. CONCLUSIONS: High blood pressure self report shows a moderate agreement with medical information in this cohort allowing it to be used, with caution, as a surrogate variable of actual blood pressure status. However, because of its moderate sensitivity, it is not possible to rule out some underestimation when using self reported high blood pressure information for high blood pressure frequency measurements such as prevalence or incidence rates. This underestimation will be higher among men and educated people. (+info)
Home blood pressure monitoring: its effect on the management of hypertension in general practice.
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BACKGROUND: Ambulatory and home blood pressure monitoring have been shown to improve the management of hypertension. Either can be used to diagnose 'white coat hypertension' (WCH), which affects 10% to 20% of hypertensives and usually does not require drug treatment. Home monitoring has been used little in primary care. AIM: To investigate the use and acceptability of home monitoring, and to establish the incidence of WCH as diagnosed in a primary care setting. METHOD: Twenty practices were asked to monitor hypertensive patients, in particular those about to start drug treatment and those who were poorly controlled. RESULTS: A total of 660 patients were monitored. Sixty-four (27%) of the 236 untreated patients had WCH and no medication was started in 60 (94%) of this group. Forty-five (17%) of the 258 poorly-controlled patients had WCH and, of these, 34 (76%) continued with the same medication and 11 (24%) either reduced or stopped it. Compliance with recording was high. Questionnaires and focus groups with doctors and nurses showed that home monitoring represented a valuable enhancement of their management of hypertensive patients. Patients reported a high degree of interest and satisfaction with monitoring. CONCLUSIONS: Patients, doctors, and nurses found monitoring valuable, and found the instruments easy to use with few problems. The feasibility of screening for WCH with home blood pressure monitoring was demonstrated, and, for this specific purpose, it is recommended as the preferred alternative to ambulatory monitoring in primary care. (+info)
Non-compliance amongst adolescents with asthma: listening to what they tell us about self-management.
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BACKGROUND: Non-compliance with prescribed anti-asthma medication is considered to be a major problem. The reasons why adolescents may fail to comply with their regimen are poorly understood. OBJECTIVES: This study set out to understand better the reasons for non-compliance in adolescents with asthma. METHODS: In-depth interviews were conducted with a sample of 49 adolescents, aged 14-20 years, diagnosed as asthmatic more than a year previously and attending a hospital asthma clinic in Greater Glasgow. The interviews focused on young people's feelings about their illness and on their illness-related behaviour, including self-management. RESULTS: Most of the young people interviewed admitted that they had not always complied with their self-care regimens. Reasons given for non-compliance with prescribed medication in the past or at present were: forgetfulness, belief that the medication is ineffective, denial that one is asthmatic, difficulty using inhalers, inconvenience, fear of side effects, embarrassment and laziness. CONCLUSION: Most of those interviewed believed that compliance with prescribed medication was extremely important, with many having formed this belief following a negative experience which they attributed to their non-compliance. Nevertheless, barriers exist which mean that optimum self-care is not always achieved. It is suggested that future health care initiatives in this area be designed to provide practical information which aids the surmounting of these barriers and helps children and adolescents to be sufficiently aware of their own vulnerability at an early stage of their career as asthmatics. Peer education initiatives may meet these objectives, and more thought should be given to their development and optimum form. (+info)