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Rapid Responses: Rapid Responses published:
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Support for self care for patients with Epilepsy
- S. Nizam Ahmed (12 November 2007)
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Patient record access and self-care
- Brian H Fisher, London SE26 6JQ (17 November 2007)
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Whole System Change is Achievable
- Natalie Grazin, Natalie Grazin (29 November 2007)
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S. Nizam Ahmed, Epileptologist University of Alberta, Edmonton Alberta, Canada T6G 2B7
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Kennedy et al eloquently present their model for self care for patients with chronic disease (1). I present a brief overview of the support system available at the University of Alberta Hospital (UAH) in the care of adult patients with epilepsy. Our philosophy is optimizing service use rather than "reduce service use". The epilepsy program at the UAH comprizes a multidisciplinary team consisting of epileptologists, specialist nurses, community coordinator, neuropsychologist, epilepsy surgeon and telemedicine coordinator. Patients referred from the pediatric to adult epilepsy program are seen by nurses in the transition clinic and educated about the active role they may have to play in their ongoing care. All patients seen in the clinics are counselled about their diagnosis, management plans, safety issues, pregnancy, driving, potential side effects of medications, job situations etc. Patients are introduced to the epilepsy nurses who are available through telephone clinics to offer help and advice during regular business hours on all weekdays. Patients from group homes and supervised settings are provided with written information on the use of prn medications, use of emergency services and safety issues. Community care coordinator is available to address issues pertaining to work, rehabilitation and habilitation. Patients seen in the epilepsy clinic do not require a reconsult for every visit but are rather seen by regular followup visits in the conventional clinics or through telemedicine. This structure optimizes the use of resources, reduces unnecessary visits to the emergency room, helps enhance patient confidence, enhances participation of patients in self care and thus optimizing rather than reducing service. 1). Kennedy A et al. Support for self care for patients with chronic disease. BMJ/November 10 2007/Volume 335. Competing interests: None declared |
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Brian H Fisher, GP, Lead for Record Access Collaborative Wells Park Practice, London SE26 6JQ
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I agree that promotion of self-care requires system-wide change. I should like to make two points: 1. The current paradigm is that, for health care to work well, the patient needs to trust the professional/clinician. Underlying the changes needed in professional behaviour to support self-care is a shift to a mind -set where, in addition, the clinician trusts the patient. Once this can be achieved, shared decision-making and supporting self-care can move ahead. 2. One concrete way in which self-care can now be supported is by patients having access to their full GP record: access to consultations, results and letters. Access to the data, in some systems, is now linked to extensive information linked to problem titles, thus effectively giving patients tailored information prescriptions. This enables patients, particularly with long-term conditions to understand their care and work more closely with professionals. Competing interests: I am co-director of a company that enables patients to see their full GP record. |
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Natalie Grazin, Assistant Director, The Health Foundation The Health Foundation, 90 Long Acre, London WC2E 9RA, Natalie Grazin
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Kennedy et al’s assessment of the benefits of self-management for people with long term conditions is a welcome contribution to the groundswell of evidence that supports the mainstream introduction of self- management support. Last week, The Health Foundation launched Co-creating Health, a £5 million [not £5 as originally published] initiative that aims to demonstrate that Kennedy et al’s vision is realistic - that it is possible to use whole-systems change to create a context in which self-management can thrive. We too believe that self-management support requires a whole systems perspective that engages the patient, practitioner and service organisation. To this end, Co-creating Health consists of a set of interventions designed to deliver Kennedy’s vision of informed patients receiving support and guidance from trained practitioners working within a healthcare system geared up to support self-management. Co-creating Health’s Advanced Development Programme will not only expose clinicians to consulting strategies that can support self- management but will also directly address the more challenging issues that Kennedy et al identify to clinicians’ values, professional responsibility, attitudes to risk and existing routines. 200 patients at each of our 8 sites will also participate in a newly created self-management programme. The programme breaks new ground by combining generic self-management skills with condition-specific content, as well as bringing lay and professional tutors together to co-lead the programme and integrate self-management into existing systems of care. Finally, our service redesign supports clinicians to examine how far their services build patients’ confidence, helps them to monitor their own condition and empowers them to access services based on their own, informed understanding of their condition. As Kennedy et al comment, this will not be achieved by marginal tinkering with the current system of professionally-led care. It demands that the philosophy of self-management is inherent in the design of fundamentally different service arrangements. Co-creating Health will be independently evaluated by Coventry University and will run until 2010. Competing interests: The Health Foundation, Executive Sponsor, Co-creating Health |
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