How do people choose between self-care, supported self-care and GP consultation in minor illness?

Lead Research Organisation: University of Aberdeen
Department Name: Biomedical Sciences

Abstract

As demand for health services continues to increase, the ways in which services are provided may need to change to meet that demand. Traditionally in the UK the GP is the focus for health service provision but, increasingly, people are being encouraged to practise more self-care. Health professionals, such as community pharmacists and practice nurses, are offering services that support patients in the self-management of both minor and chronic illnesses. The success of such services will partly depend on the extent to which the public is willing to accept them as alternatives to GP consultations. It is therefore important to understand how people decide between self-care, supported self-care and GP consultation.

My PhD work showed that the choice between self-care and professional advice is influenced by many factors, inter-related in a complex way. Future research will aim to further explore these relationships. Results so far suggest that when designing ways to increase and improve self-care, flexible services that meet individuals‘ needs should be provided. Specifically, by enhancing the way pharmacy services are organised, it is hoped that patients undertaking self-care will experience improved access to support, delivered in a way that meets their needs and preferences and optimises outcomes.

Technical Summary

Increasing demand for health services in the UK means that traditional methods of supplying health care may no longer be appropriate. Government policies place increasing emphasis on self-care by individuals. It is, therefore, important to understand how people choose between self-care and consulting a health professional. This thesis aimed to investigate decision-making in the management of minor illness, in the context of symptoms associated with analgesic use.
A cross-sectional survey was mailed to a random sample of the Scottish population (n=3000) asking about their use of medicines, particularly over-the-counter (OTC) analgesics. Qualitative interviews with 24 respondents to the survey asked about how and why people manage symptoms of minor illness associated with analgesic use in particular ways. Another survey containing a discrete choice experiment (DCE) was mailed to a further 652 respondents to the original survey, to establish preferences for self-care and different services that might be used to manage minor illness.
The survey showed that analgesics were the most commonly used OTC medicines and community pharmacies were most people‘s usual source of analgesics. Up to 8% of the population were judged to be potentially at risk from inappropriate use of OTC analgesics.
Interviewees responded to symptoms associated with analgesic use by consulting health care professionals, practising self-care or doing nothing. Reasons for practising self-care included convenience, influence of others, avoidance of medical interventions, supplementation of medical treatments, and perceived appropriateness. Factors influencing how people managed symptoms mapped well onto Andersen‘s Behavioral Model of Health Services Use, suggesting that this theoretical model may be useful in explaining self-care behaviour.
The DCE found that people preferred to manage flu-like symptoms using unsupported self-care, and were willing to pay almost £23 to do so. When professionalce was required, people preferred pharmacy advice, followed by GP consultation. Other types of advice (practice nurse consultation, complementary therapist and NHS 24 advice) were less preferred. People preferred paying less money and waiting less time to manage symptoms.
All three studies showed that most people liked to use self-care to manage symptoms of minor illness associated with analgesic use. The relationship between self-care behaviour and factors influencing it is complex. Interventions that aim to improve self-care should focus on providing flexible support for those who need it.
In this fellowship, I aim to further disseminate my PhD findings, gain new research skills and develop project proposals to enable further investigation and explanation of self-care behaviour.

Publications

10 25 50
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Ayorinde AA (2013) Screening for major diseases in community pharmacies: a systematic review. in The International journal of pharmacy practice

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Matheson C (2010) Management of drug misuse: an 8-year follow-up survey of Scottish GPs. in The British journal of general practice : the journal of the Royal College of General Practitioners

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Paudyal V (2013) Are pharmacy-based minor ailment schemes a substitute for other service providers? A systematic review. in The British journal of general practice : the journal of the Royal College of General Practitioners

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Rennie L (2012) Preferences for managing symptoms of differing severity: a discrete choice experiment. in Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research

 
Description Help for Hay Fever Pilot RCT
Amount £165,738 (GBP)
Funding ID CZH/4/746 
Organisation Chief Scientist Office 
Sector Public
Country United Kingdom
Start 04/2012 
End 03/2013
 
Description PPRT Project Grant
Amount £287,970 (GBP)
Organisation Pharmacy Research UK 
Sector Charity/Non Profit
Country United Kingdom
Start 04/2011 
End 03/2013
 
Description Sir Hugh Linstead Fellowship Award
Amount £30,500 (GBP)
Organisation Pharmacy Research UK 
Sector Charity/Non Profit
Country United Kingdom
Start 10/2012 
End 09/2013
 
Description Sir Hugh Linstead Fellowship Award
Amount £27,547 (GBP)
Organisation Pharmacy Research UK 
Sector Charity/Non Profit
Country United Kingdom
Start 10/2011 
End 09/2012
 
Description Aberdeen Health Psychology Group 
Organisation University of Aberdeen
Department School of Medicine & Dentistry Aberdeen
Country United Kingdom 
Sector Academic/University 
PI Contribution 1) Provision of peer support 2) Facilitating shared learning opportunities e.g. organisation of a workshop for non-psychologists: 'Behaviour in Health: An Introduction to Theories in Health Psychology' Continuing Professional Development for Health Researchers." 3) Collaboration on funding application (£193k): "Can a goal-focussed intervention delivered in Scottish community pharmacies improve outcomes for people with intermittent allergic rhinitis? A pilot randomised controlled trial.
Collaborator Contribution The group has provided peer support for the health psychology-related aspects of my fellowship/ research programme and peer learning opportunites for me, the fellow. One of my fellowship supervisors is a senior member of the Aberdeen Health Psychology Group with whom I have collaborated on funding applications
Impact 1) Publication: 19733461 2) Conference oral presentation: "General beliefs about medicines remain stable after 44 months despite changes in health status". UK Society of Behavioural Medicine Conference, Southampton, December 2009
Start Year 2008
 
Description CSO Hay Fever Study 
Organisation Chief Scientist Office
Country United Kingdom 
Sector Public 
PI Contribution Myself and Professor Amanda Lee (University of Aberdeen) are co-chief investigators for this study ("Can a goal-focussed intervention delivered in Scottish community pharmacies improve outcomes for people with intermittent allergic rhinitis? A pilot randomised controlled trial"). I was responsible for drafting and submitting the funding application as well as the application to the NHS research ethics comittee. I am responsible for ongoing day to day management of the study researcher.
Collaborator Contribution Collaborators from the named institutons contributed to the development of the application and study protocol. They jointly form the research team and contribute to monthly research meetings, used for the purpose of ongoing development of study materials and methods. The research was funded by CSO
Impact This collaboration resulted in the award of funding from the Health Services Research Committee of the Chief Scientist Office (Scottish Government) - "Can a goal-focussed intervention delivered in Scottish community pharmacies improve outcomes for people with intermittent allergic rhinitis? A pilot randomised controlled trial." See Further funding
Start Year 2012
 
Description CSO Hay Fever Study 
Organisation NHS Greater Glasgow and Clyde (NHSGGC)
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution Myself and Professor Amanda Lee (University of Aberdeen) are co-chief investigators for this study ("Can a goal-focussed intervention delivered in Scottish community pharmacies improve outcomes for people with intermittent allergic rhinitis? A pilot randomised controlled trial"). I was responsible for drafting and submitting the funding application as well as the application to the NHS research ethics comittee. I am responsible for ongoing day to day management of the study researcher.
Collaborator Contribution Collaborators from the named institutons contributed to the development of the application and study protocol. They jointly form the research team and contribute to monthly research meetings, used for the purpose of ongoing development of study materials and methods. The research was funded by CSO
Impact This collaboration resulted in the award of funding from the Health Services Research Committee of the Chief Scientist Office (Scottish Government) - "Can a goal-focussed intervention delivered in Scottish community pharmacies improve outcomes for people with intermittent allergic rhinitis? A pilot randomised controlled trial." See Further funding
Start Year 2012
 
Description CSO Hay Fever Study 
Organisation University of Edinburgh
Country United Kingdom 
Sector Academic/University 
PI Contribution Myself and Professor Amanda Lee (University of Aberdeen) are co-chief investigators for this study ("Can a goal-focussed intervention delivered in Scottish community pharmacies improve outcomes for people with intermittent allergic rhinitis? A pilot randomised controlled trial"). I was responsible for drafting and submitting the funding application as well as the application to the NHS research ethics comittee. I am responsible for ongoing day to day management of the study researcher.
Collaborator Contribution Collaborators from the named institutons contributed to the development of the application and study protocol. They jointly form the research team and contribute to monthly research meetings, used for the purpose of ongoing development of study materials and methods. The research was funded by CSO
Impact This collaboration resulted in the award of funding from the Health Services Research Committee of the Chief Scientist Office (Scottish Government) - "Can a goal-focussed intervention delivered in Scottish community pharmacies improve outcomes for people with intermittent allergic rhinitis? A pilot randomised controlled trial." See Further funding
Start Year 2012
 
Description CSO Hay Fever Study 
Organisation University of Glasgow
Country United Kingdom 
Sector Academic/University 
PI Contribution Myself and Professor Amanda Lee (University of Aberdeen) are co-chief investigators for this study ("Can a goal-focussed intervention delivered in Scottish community pharmacies improve outcomes for people with intermittent allergic rhinitis? A pilot randomised controlled trial"). I was responsible for drafting and submitting the funding application as well as the application to the NHS research ethics comittee. I am responsible for ongoing day to day management of the study researcher.
Collaborator Contribution Collaborators from the named institutons contributed to the development of the application and study protocol. They jointly form the research team and contribute to monthly research meetings, used for the purpose of ongoing development of study materials and methods. The research was funded by CSO
Impact This collaboration resulted in the award of funding from the Health Services Research Committee of the Chief Scientist Office (Scottish Government) - "Can a goal-focussed intervention delivered in Scottish community pharmacies improve outcomes for people with intermittent allergic rhinitis? A pilot randomised controlled trial." See Further funding
Start Year 2012
 
Description CSO Hay Fever Study 
Organisation University of Southampton
Country United Kingdom 
Sector Academic/University 
PI Contribution Myself and Professor Amanda Lee (University of Aberdeen) are co-chief investigators for this study ("Can a goal-focussed intervention delivered in Scottish community pharmacies improve outcomes for people with intermittent allergic rhinitis? A pilot randomised controlled trial"). I was responsible for drafting and submitting the funding application as well as the application to the NHS research ethics comittee. I am responsible for ongoing day to day management of the study researcher.
Collaborator Contribution Collaborators from the named institutons contributed to the development of the application and study protocol. They jointly form the research team and contribute to monthly research meetings, used for the purpose of ongoing development of study materials and methods. The research was funded by CSO
Impact This collaboration resulted in the award of funding from the Health Services Research Committee of the Chief Scientist Office (Scottish Government) - "Can a goal-focussed intervention delivered in Scottish community pharmacies improve outcomes for people with intermittent allergic rhinitis? A pilot randomised controlled trial." See Further funding
Start Year 2012
 
Description CSO Hay Fever Study 
Organisation University of Sydney
Country Australia 
Sector Academic/University 
PI Contribution Myself and Professor Amanda Lee (University of Aberdeen) are co-chief investigators for this study ("Can a goal-focussed intervention delivered in Scottish community pharmacies improve outcomes for people with intermittent allergic rhinitis? A pilot randomised controlled trial"). I was responsible for drafting and submitting the funding application as well as the application to the NHS research ethics comittee. I am responsible for ongoing day to day management of the study researcher.
Collaborator Contribution Collaborators from the named institutons contributed to the development of the application and study protocol. They jointly form the research team and contribute to monthly research meetings, used for the purpose of ongoing development of study materials and methods. The research was funded by CSO
Impact This collaboration resulted in the award of funding from the Health Services Research Committee of the Chief Scientist Office (Scottish Government) - "Can a goal-focussed intervention delivered in Scottish community pharmacies improve outcomes for people with intermittent allergic rhinitis? A pilot randomised controlled trial." See Further funding
Start Year 2012
 
Description Minor ailments study 
Organisation NHS Grampian
Country United Kingdom 
Sector Public 
PI Contribution I am a co-applicant on the application for funding, and co-investigator in the conduct of a study spanning Grampian in Scotland and East Anglia in England.
Collaborator Contribution This is a collaboration on a research study. Members of the multi-disciplinary research team based in East Anglia contribute to the study through participant recruitment, data collection, input to team meetings (continuous development of study procedures) and input to publications, reports and other study documentation. The research was funded by PRUK
Impact Project grant (see next section - PPRT funding for Minor Ailments Study) I am a member of this multi-disciplinary research team which involves pharmacists, medics, a psychologist and a health economist Papers from this study have been referenced in http://www.gov.scot/Publications/2015/11/9014 (Main Report of the National Review of Primary Care Out of Hours Services, Monday, November 30, 2015)
Start Year 2010
 
Description Minor ailments study 
Organisation Pharmacy Research UK
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution I am a co-applicant on the application for funding, and co-investigator in the conduct of a study spanning Grampian in Scotland and East Anglia in England.
Collaborator Contribution This is a collaboration on a research study. Members of the multi-disciplinary research team based in East Anglia contribute to the study through participant recruitment, data collection, input to team meetings (continuous development of study procedures) and input to publications, reports and other study documentation. The research was funded by PRUK
Impact Project grant (see next section - PPRT funding for Minor Ailments Study) I am a member of this multi-disciplinary research team which involves pharmacists, medics, a psychologist and a health economist Papers from this study have been referenced in http://www.gov.scot/Publications/2015/11/9014 (Main Report of the National Review of Primary Care Out of Hours Services, Monday, November 30, 2015)
Start Year 2010
 
Description Minor ailments study 
Organisation University of East Anglia
Department School of Medicine UEA
Country United Kingdom 
Sector Academic/University 
PI Contribution I am a co-applicant on the application for funding, and co-investigator in the conduct of a study spanning Grampian in Scotland and East Anglia in England.
Collaborator Contribution This is a collaboration on a research study. Members of the multi-disciplinary research team based in East Anglia contribute to the study through participant recruitment, data collection, input to team meetings (continuous development of study procedures) and input to publications, reports and other study documentation. The research was funded by PRUK
Impact Project grant (see next section - PPRT funding for Minor Ailments Study) I am a member of this multi-disciplinary research team which involves pharmacists, medics, a psychologist and a health economist Papers from this study have been referenced in http://www.gov.scot/Publications/2015/11/9014 (Main Report of the National Review of Primary Care Out of Hours Services, Monday, November 30, 2015)
Start Year 2010
 
Description Self-management of chronic pain DCE 
Organisation The Health Foundation
Country Denmark 
Sector Charity/Non Profit 
PI Contribution I was co-applicant and researcher on this HF funded study which conducted a DCE to determine preferences for personalisation of support for self-management of chronic pain
Collaborator Contribution The study was funded by the Health Foundation
Impact This was a multi-disciplinary research team comprising health service researchers, health economists and a GP
Start Year 2014
 
Description Sir Hugh Linstead (1) 
Organisation Aberdeen Royal Infirmary
Department Department of Outpatient Oncology
Country United Kingdom 
Sector Hospitals 
PI Contribution A funding application for a fellowship awarded by the Pharmacy Practice Research Trust (for Mrs Frances Notman) was submitted and was successful in attracting funding (Sir Hugh Linstead Fellowship). The project team comprises health services researchers from the Centre of Academic Primary Care and NHS consultant oncologists. I will oversee the study which involves qualitative interviews with cancer patients to explore the actions they took to manage symptoms prior to diagnosis. Other members of the research team will advise on and monitor the research.
Collaborator Contribution NHS consultants are responsible for informing cancer patients about the study and directing them to the researcher for further information and, if agreeable, recruitment onto the interview study.
Impact This collaboration resulted in the award of funding for a fellowship. The fellow will simultaneously undertake an MSc by research. It is a multi-disciplinary collaboration (medics and pharmacists)
Start Year 2011
 
Description Sir Hugh Linstead (2) 
Organisation NHS Grampian
Country United Kingdom 
Sector Public 
PI Contribution A funding application for a fellowship awarded by the Pharmacy Practice Research Trust (for Mrs Frances Notman) was submitted and was successful in attracting funding. The project team comprises health services researchers from Academic Primary Care, University of Aberdeen and NHS consultant oncologists. I will oversee the study which involves a quantitative survey with cancer patients to explore the actions they took to manage symptoms prior to diagnosis. Other members of the research team will advise on and monitor the research.
Collaborator Contribution Collaborating consultants from three oncology departments in NHS Scotland will recruit patients with lung or colorectal cancer to take part in a survey about their pre-diagnosis management of symptoms.
Impact This collaboration resulted in the award of funding for a fellowship. The fellow (Mrs Notman) will simultaneously undertake an PhD. It is a multi-disciplinary collaboration (medics and pharmacists)
Start Year 2012
 
Description Sir Hugh Linstead (2) 
Organisation NHS Greater Glasgow and Clyde (NHSGGC)
Country United Kingdom 
Sector Charity/Non Profit 
PI Contribution A funding application for a fellowship awarded by the Pharmacy Practice Research Trust (for Mrs Frances Notman) was submitted and was successful in attracting funding. The project team comprises health services researchers from Academic Primary Care, University of Aberdeen and NHS consultant oncologists. I will oversee the study which involves a quantitative survey with cancer patients to explore the actions they took to manage symptoms prior to diagnosis. Other members of the research team will advise on and monitor the research.
Collaborator Contribution Collaborating consultants from three oncology departments in NHS Scotland will recruit patients with lung or colorectal cancer to take part in a survey about their pre-diagnosis management of symptoms.
Impact This collaboration resulted in the award of funding for a fellowship. The fellow (Mrs Notman) will simultaneously undertake an PhD. It is a multi-disciplinary collaboration (medics and pharmacists)
Start Year 2012
 
Description Sir Hugh Linstead (2) 
Organisation NHS Tayside
Country United Kingdom 
Sector Public 
PI Contribution A funding application for a fellowship awarded by the Pharmacy Practice Research Trust (for Mrs Frances Notman) was submitted and was successful in attracting funding. The project team comprises health services researchers from Academic Primary Care, University of Aberdeen and NHS consultant oncologists. I will oversee the study which involves a quantitative survey with cancer patients to explore the actions they took to manage symptoms prior to diagnosis. Other members of the research team will advise on and monitor the research.
Collaborator Contribution Collaborating consultants from three oncology departments in NHS Scotland will recruit patients with lung or colorectal cancer to take part in a survey about their pre-diagnosis management of symptoms.
Impact This collaboration resulted in the award of funding for a fellowship. The fellow (Mrs Notman) will simultaneously undertake an PhD. It is a multi-disciplinary collaboration (medics and pharmacists)
Start Year 2012