Potential effect of self-care algorithms on the number of physician visits

Self-Care among U.S. Elderly

The self-care movement is discussed, with emphasis on programs for senior citizens. Self-care is defined and several conceptual classifications of self-care activities are reviewed. Among the aspects of the contemporary self-care movement reviewed are commercialism, professional dominance, potential of self-care groups as political interest groups, and program impact evaluation issues. From an inventory containing over 2000 programs and being constructed as part of a national study of self-care activities, 25 programs with a major focus on self-care training or self-help activities for the elderly were identified. From preliminary information available on these programs, a description is provided of the range within which self-care programs for the elderly vary with respect to five characteristics: (1) program sponsorship and setting, (2) target groups, (3) methods of program implementation, (4) type and size of staff, and (5) program goals and activities. Future directions for program development and research on self-care for the elderly are suggested.

Cold/flu knowledge, attitudes and health care practices: results of a two-city telephone survey

The purpose of this paper is to describe knowledge, attitudes and practices of cold and flu self-care and health care utilization, and to identify the predictors of health care utilization for the cold and flu among residents of London and Windsor. Using a random digit dialing survey method, 417 residents were interviewed between November-December, 1993 and February-March, 1994. This survey revealed good knowledge about colds and flu and understanding of appropriate physician visits. Only seven percent reported a doctor visit for their last cold. Socio-demographic, health status, attitude and knowledge level variables were subjected to a logistic regression analysis to identify which variables predicted self-reported physician visits. Only attitudes and health status showed statistically significant log odds (3.6 and 1.5, respectively). In summary, consistent with other studies, attitude and health status, not knowledge, appear to be significant predictors of physician visits for colds/flu.

Consumer attitudes towards computer-assisted self-care of the common cold

Knowledge of colds and flu and attitudes towards use of computers for self-care are compared for 260 young adult users and 194 young adult non-users of computer-assisted self-care for colds and flu. Participants completed a knowledge questionnaire on colds and flu, used a computer program designed to enhance self-care for colds and flu, and then completed a questionnaire on their attitudes towards using a computer for self-care for colds and flu, and then completed a questionnaire on their attitudes towards using a computer for self-care for colds and flu, perceived importance of physician interactions, physician expertise, and patient-physician communication. Compared with users, non-users preferred personal contact with their physicians and felt that computerized health assessments would be limited in vocabulary and range of current medical information. Non-users were also more likely to agree that people could not be trusted to do an accurate computerized health assessment and that the average person was too computer illiterate to use computers for self-care.

Effects of systematic patient education about cough on the consulting behaviour of a general practice population

In four general practices the effects of systematic patient education on cough were compared with four control practices. Intended and unintended contacts for cough were defined. In two successive autumn-winter periods, in 62% of 5890 contacts for cough the intervention could be applied. In spite of the better baseline situation in the experimental practices, the percentage of intended contacts with the GP increased from 47 to 65% (control group: 28 and 30%, respectively, P < 0.01). There was a considerable interpractice variance. For methodological reasons a leaflet was sent to all the patients in the experimental practices. This possibly also led to a shift in the consulting pattern.

Self-care and the elderly: review and implications

Self-care is the most predominant and basic form of primary care, yet research in the area, particularly with respect to the elderly, has been minimal. As a result, despite the breadth of the self-care movement, very little is precisely known and understood about it. Diminished functional health status is the major cause of loss of independence. Self-care is conceptualized as an important strategy in maintaining functional health.

A preliminary study on the timeliness of ambulatory care utilization following medical self-care interventions

A sub-sample, from a large prospective study examining the effects on utilization from the introduction of medical self-care materials, was followed to determine the timeliness of that utilization. Judgments on early, on time, or late visits, by patients, providers, and algorithms showed agreement for experimentals (n = 203) but not controls (n = 56). Comparisons on the rates of judged early, on time, and late visits differed between groups (by the physician and algorithm comparison), and further differed when comparing late only visits (by the algorithm comparison). The experimentals demonstrated a trend to delay care seeking though no adverse effect on health was identified when comparing subsequent illness days and hospitalizations. Medical self-care can reduce utilization and improve patients' ability to judge visit timeliness. Apparent trends to increase late visits may be an artifact of conservative judgments rendered by medical opinion.

Sense of control: potentials for intervention

A substantial amount of research has demonstrated that the sense of control is associated with numerous positive outcomes, including good health. Many aspects of the personal and social conditions of old age influence the control-health relationship. Environmental events associated with old age often place limits on the range of outcomes that are attainable by older people. Moreover, the association between control and indicators of health status may be altered by old age. Finally, old age may influence the relationship between control and various health maintenance behaviors. Aspects of the sense of control can be altered with small interventions that can enhance health specifically and the quality of aging in general. Given the relationship between control and health in old age, several possible factors may help explain or mediate this relationship including mechanisms of behavioral and cognitive change, and physiological adaptations. Despite the largely positive outcomes associated with increased sense of control, negative outcomes are also possible, especially when control is not desired or entails too much responsibility or other demands.

Self-care in Israel: physicians' views and perspectives

This paper examines physicians' perceptions about potential effects of lay self-care. The research was designed to explore these perceptions regarding three types of effects with particular reference to their general distribution and their inter-relationships. The findings showed that physicians distinguished clearly among the effects of self-care but that their opinions differ considerably regarding the effects on utilization, costs and hospitalization rates. The implications of these findings are discussed.

The activated patient: dogma, dream, or desideratum?

In this paper we critically review the active patient concept and place it in a broader social and historical context. We argue that as a reflection of core, Western European values, the active patient concept has not been adequately scrutinized. Very little research has been done that explicitly tests the claims that have been advanced on behalf of this ideal model of the clinician-patient relationship. The research that is available is far from definitive and does not support many of the assertions made by advocates of this approach to patienthood. We urge investigators to substitute theory driven research programs for those motivated by advocacy of a particular ideological stance.

Aging and health: effects of the sense of control

The relation between health and a sense of control may grow stronger in old age. This could occur through three types of processes: experiences particularly relevant to control may increase markedly in old age; the association between control and some aspect of health may be altered by age; and age may influence the association between control and health-related behaviors or the seeking of medical care. Studies show that there are detrimental effects on the health of older people when their control of their activities is restricted; in contrast, interventions that enhance options for control by nursing home patients promote health. With increasing age, however, variability in preferred amounts of control also increases, and sometimes greater control over activities, circumstances, or health has negative consequences including stress, worry, and self-blame. Mechanisms mediating the control-health relation include feelings of stress, symptom labeling, changes in the neuroendocrine and immune systems, and behavior relevant to health maintenance.

Consensual norms regarding patient involvement

A stratified sample of 72 nurses, physicians and members of the general public met together in small tripartite dialogue groups each month for 20 months, in order to mutually identify health care behaviors that effectively involve patients in their own health care. Content analysis of 200 hours of verbatim transcripts from the dialogue sessions yielded 1245 patient involvement behaviors. These behaviors were rated by all subjects for their degree of importance within the normative health care relationship through use of a Likert-type inventory. Analysis of the 656 behaviors from the inventory which were classified as essential for effective patient involvement produced 44 clusters, with inter-item correlations ranging from 0.80 to 0.95. Further reduction of the 44 clusters indicated six core clusters, suggesting key norms that existed regarding effective involvement of patients in their own care. Salient norms centered on overt contracts in health relationships, egalitarian communication between patient and professional, patient access to broad-based information, tailoring of treatment programs, self-care and lifestyle modification. The lack of congruence between these norms and the realities of health care is discussed.

What makes persons "patients" and patients "well?

The transitions from person to patient and back represent social decision points rather than boundaries determined by shifting biological equilibria, as doctors so often suppose. Moreover, host resistance to pathogenic agents is weakened by social stress and strengthened by social support. Thus, the efficiency and effectivenss of medical care will be improved if the clinician, in assessing patient problems, systematically inquires into the social determinants of the decision to seek help. The probability of resolving the patient's difficulties will be enhanced by targeting treatment measures at the social components of the illness experience as well as at the pathophysiology of the disease process.

Effective algorithm-based triage and self-care protocols: quality medicine at lower costs

The triage phase of an algorithm-based medical care system was analyzed in three military patient environments. Combat medics triaged 4,799 patients using a physician-prepared triage manual which specified levels of initial health care based on the patient's presenting complaints and a brief history. Evaluation indicated that 36% of those reporting for sick call were eligible for treatment by medically appropriate self-care protocols. Of the remaining 64%, all but 4% could receive initial evaluation by non-physician health care extenders. The study demonstrates that personnel receiving basic medical training and orientation to an algorithm-directed triage system can direct military patients to appropriate levels of health care.