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Long-term conditions: taking care of yourself

Monday 16th February

People with chronic illness can do a lot to help themselves. Lesley Dobson looks at the positive impact of self-management.

Patients with a long-term or chronic condition will generally be given advice about their ailment so that they can look after themselves and understand when to seek medical intervention. This is known as self-management and it has become a vital part of our healthcare.

There are many conditions that fall into this category. One good example is asthma, which causes three deaths every day. “There’s a very strong case for self-management in asthma, and for health professionals giving the one in 11 people with asthma the support they need to self-manage,” says Emily Humphreys, Asthma UK’s head of policy and public affairs. “The key component for self-management in asthma is a written action plan. You are four times less likely to end up in hospital if you have one than if you don’t. They’re effective and cost-effective. The time it takes to give somebody advice, the asthma action plan, and help them know how to manage their asthma, is far less costly than the time it takes to admit them to hospital.”

There’s also strong evidence to support self-management of asthma for financial reasons. The National Institute for Health and Care Excellence (NICE) estimates that an asthma review costs just over £30, and a hospital admission over £700.

Meanwhile, there are 3.8 million people in the UK living with diabetes. About 90 percent of them have type 2 diabetes, which is largely linked to lifestyle (type 1 diabetes isn’t and therefore can’t be avoided). If not managed well, diabetes can cause serious complications, including blindness, amputations (over 100 a week for diabetics) and even premature death.

Figures published in The Cost of Diabetes report, produced by Diabetes UK last year, show that the NHS spent £9.8 billion on diabetes in 2010/11. Of this, £2.1 billion was spent on treatment, and £7.7 billion was spent on complications.

“We need to change our mindset so that people with type 2 diabetes can manage their diabetes, so they’re in control and so this becomes second nature to them,” says Tracy Kelly, head of care at Diabetes UK.

Whatever your condition may be, the basic premise remains the same: self-management is about empowerment through knowledge.

For asthma patients

A written asthma action plan is a step-by-step guide which you fill in with your GP or asthma nurse to help you stay on top of your asthma. Your asthma action plan is personal – it’s all about you and your asthma. The plan works as a written record of what medicines you need to take, what symptoms to look out for and what to do if your asthma gets worse. You can download one from Asthma UK’s website.

For diabetes patients

Diabetes UK runs a number of programmes to help people understand and manage their condition. Type 2 Diabetes and Me is a free e-learning programme (produced in partnership with BUPA) that includes details about treatments, diet and where to go for information. Living with Diabetes days are free one-day events (with partners Tesco) where trained Diabetes UK volunteers and health professionals provide information and advice. Ask your GP about type 2 education programmes such as Desmond (diabetes education and self-management for ongoing and newly diagnosed) available in your area.

You can talk to someone with type 1 or type 2 diabetes through Diabetes UK’s peer support contact system. Call 0843 353 8600 or visit Diabetes UK to find out more about how this works.

The charity’s care line is open Monday to Friday, 9am to 7pm, on 0345 123 2399.

For musculoskeletal problems

Physiotherapy can be helpful for any musculoskeletal problems. “The most common conditions we see are back, neck and shoulder problems,” says physiotherapist Rosie Hancock, the musculoskeletal service lead at Rehabworks, which provides physiotherapy services to benenden members.

“We give guided self-management over the phone, or face-to-face physiotherapy when appropriate.” Patients receive a bespoke programme, tailored to their situation. “Your physiotherapist is there to guide you,” says Rosie, “but you’re the one who makes the difference.”

For mental health issues

“We know that social isolation is one of the things that is strongly associated with poor mental health,” says David Crepaz-Keay, head of empowerment and social inclusion at the Mental Health Foundation. “Peer support is very important. It gives people a chance to help others, and they can get as much out of this as they do from being helped.” If you need help and support with mental health problems, ask your GP, nurse or specialist for information on what’s available locally. You may also want to contact one of the following organisations:

Mind

0300 123 3393 (Mon-Fri, 9am-6pm)

Rethink Mental Illness

0300 500 0927 (Mon-Fri, 10am-2pm)

Samaritans

08457 909090 (24 hours, 7 days a week)

Mental Health Foundation

(Contact via email, the MHF doesn't operate a telephone helpline)

For osteoarthritis (OA) patients

“The case for self-management in osteoarthritis is compelling,” says Dr Tom Margham, a GP in Tower Hamlets and primary care lead for Arthritis Research UK. “Osteoarthritis is a big problem. More than 8 million people in the UK have osteoarthritis and, given that it is a condition that people have for many years, they are self-caring most of the time.”

Often the health professional’s main role is to advise on things that might help you to help yourself. With OA, self-management includes losing weight if you are overweight (to reduce the load on the joints) and exercise to strengthen muscles and bones (to keep you mobile and your joints stable).

“There’s a huge association between being overweight and developing knee pain as you get older, and even a modest reduction of, say, five kilos (11lbs) can lead to improvements in symptoms,” adds Tom.

Managing your condition

To find out about self-management for other chronic and long-term conditions, ask your GP about what information and support may be available online. Your GP surgery is also a good first port of call when looking for support groups and education initiatives in your area.

This article first appeared in benhealth magazine (issue 30, spring 2015).