Self-care a path to better health outcomes

Matt Woodley

9/10/2020 4:03:40 PM

And GPs have a major role to play, according to a recently released policy blueprint.

Stock image representing healthcare pathways
Self-care has been identified as a pathway to better health outcomes.

The Self-care for health: a national policy blueprint, launched earlier this week by Federal Health Minister Greg Hunt and endorsed by more than 50 health experts from around the country, calls for new and inclusive policy reforms to support self-care and improve health.
It includes nine policy proposals designed to address healthcare disparities experienced in rural, socioeconomically disadvantaged and vulnerable communities.
‘While the term “self-care” implies a focus on the autonomy and actions of individuals, the underlying drivers and determinants of self-care capability are a range of environmental, economic and social factors that sit beyond the individual,’ the report states.
‘Governments and policymakers play a major role in creating environments that either inhibit or enable self-care, and are influential in the development of self-care capabilities at the population level.
‘Targeted support for self-care through health services and within [disadvantaged] communities through preventive health strategies and enhanced primary care capabilities would reduce health inequities and improve health outcomes.’
The nine proposals included in the blueprint are centred on improving health literacy for all; building self-care into healthcare practice; enabling consumers to be active partners in healthcare; assuring the quality and accessibility of digital health information; and developing measures for individual self-care and self-care support by health services.
To achieve these goals, it proposes structural policy reforms that include the implementation of funding and service models to support self-care; greater investment in preventive health and self-care; a national approach to enabling and supporting self-care; and support for individual and population health through all public policies.
Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care (REC–QC), contributed to the report and told newsGP while self-care refers to what people can do to look after themselves, it also relates to how they can best engage with the healthcare system and take an active part in shared decision making.
‘It’s not just care done independently of health systems … [but] how a person looks after themselves together with healthcare professionals,’ he said.
‘As GPs, we do this all the time. We know that if we can get somebody setting goals with us and proactively looking after their own long-term medical conditions, if we get people engaged in planning through GP management plans and in team care arrangements where they’re an active participant, then things go well.
‘People spend only a tiny fraction of their week in front of us and the vast majority of the time they are self-caring, and so we should be using every opportunity to build people’s capacity and to present information in a way that they can understand clearly, and is tailored to them and their needs.
‘Every healthcare encounter with every healthcare worker should have the maximisation of self-care as one of its aims.’
While GPs have a central role to play, report co-author Professor Rosemary Calder said self-care is ‘everyone’s business’.
‘COVID has shown how central self-care is to everyone’s good health,’ she said. ‘Now is the time for a systematic approach, led by a national agenda to enable shared responsibility between government organisations and healthcare professionals to tackle health inequity and support self-care for all Australians.
‘Right now, up to 60% of Australians lack the capacity to access, understand, appraise and use crucial information to make health-related decisions. Self-care by all, for all needs to become standard behaviour and practice in the community.
‘The same strong leadership from governments and health experts that has been so effective throughout the pandemic needs to be applied to improving the self-care of all Australians.’

Professor Mark Morgan says GPs are ‘uniquely placed’ to help people develop self-care skills.
Aside from promoting better health outcomes, the blueprint also offers a fiscal advantage in relation to the provision of healthcare.
According to the report, Australia spent $185.4 billion on health in 2017–18, equivalent to more than $7485 per person. While that figure is projected to rise, economic modelling reveals the cost-saving potential of self-care in Australia to be between $1300–$7515 per hospital patient, per year.
‘Australians make an estimated 232,507–922,012 unnecessary visits to emergency departments annually, at a cost of $124.5–$493.8 million, and 8.8–26.6 million avoidable general practitioner appointments at a cost of $397 million to $1.2 billion, for self-treatable health conditions and minor ailments,’ the report states.
‘The potential for health system savings has been emphasised by US analysis which shows that having just 5% of American adults living with one or more chronic conditions participate in an evidence-based, six-session self-management education program would deliver annual health system savings of US$3.3 billion [AU$4.6 b].’
Professor Morgan said the aim of self-care is not to save money, but to get more value from the money that is spent on healthcare.
‘It’s essential for getting better value out of the health system,’ he said, adding that GPs are ‘uniquely placed’ to help people develop self-care skills.
‘GPs are already generally good at involving people in self-care. But maybe there could be a focus on identifying how able a patient is to understand the messaging that they’re getting and to engage in self-care.
‘[In doing so] the advice that we give and the planning that we do with patients is tailored to their level of understanding, their capacity, and the context that the patients are in.’
Another way GPs can assist patients is to help them identify trusted sources of information when conducting their own health research.
‘The resources the RACGP hosts or endorses or accepts as guidance are a good starting point for that,’ Professor Morgan said.
‘I often advise my patients to use one extra word in their Google searches about things – if they put the word “evidence” in as an extra search term, it generally throws up more reliable sites than it would otherwise.’
Tailoring healthcare to individual needs is a vital aspect of primary healthcare, Professor Morgan says, as a ‘one size fits all’ fails to take into account a number factors that are known to negatively impact health outcomes.
‘It’s a task for practice nurses, for non-dispensing or community pharmacists, for allied health providers, for all of us to use these opportunities to tailor advice for individuals and support people to best look after their own care,’ he said.
‘The knowledge of the person – their family, the environment that they live in, and even an idea of their financial means and the breadth and depth of their physical and mental health conditions, how they’ve managed with previous illness – all of those things go into the melting pot, and is probably one of the reasons why the evidence shows that continuity of care is such a powerful factor in outcomes of healthcare.
‘GPs are uniquely placed to be able to do that in our health system … it really needs to be coordinated around a person’s central home for medical care, which is the GP practice, and the GP team.’
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