Self-managing skin conditions

Both GPs and patients can benefit from self-management but patients need support, explains Dr Fiona Cowdell.

Give a demonstration of how topical therapy should be used (Photograph: SPL)

Self-management is at the heart of NHS aspirations; reducing the pressure on both time and resources of GPs by encouraging patients to effectively manage common long-term health conditions themselves.

In reality, long-term skin conditions can be very difficult to manage and this can have a significant impact on the patient's quality of life.

Between 22 and 33 per cent of the population have a skin problem that can benefit from medical attention, with 54 per cent of the UK population experiencing a skin condition in a given 12 month period.

This includes eczema, psoriasis, acne and skin lesions among many others. Psoriasis is a chronic condition affecting 2-3 per cent of the population.

Quality of life for patients with psoriasis can be significantly impaired and it is commonly associated with significant psychosocial morbidity.

Large numbers of patients are expected to self-manage their long-term skin conditions and sales of OTC skin treatment products are rising year on year. In 2007, skin treatment products comprised 18 per cent (£413.9m) of OTC sales in the UK.

However, limited attention has been given to studies of self-management in this area, with little understanding of how effective self-management is for these patients.

Through a Psoriasis Association-funded study at Bournemouth University it has been shown that self-management interventions can be enhanced greatly if they are based on patients' knowledge of their skin problems and beliefs regarding effective strategies.

Supporting self-management
The study found that there are five key components of supporting self-management that need to be considered with long-term skin conditions.

Personal contact
The first component is personal contact between the patient and healthcare professional. Be a 'trusted advisor' available to ease concerns and answer questions as a patient adapts to a new method of managing their condition.

What patients value most when coping with a long-term condition that is difficult or unlikely to be cured, is for their GP to listen to what they have to say; listen to their experience, concerns and the impact of their condition on their lifestyle.

Working together
Working together, GPs and patients should agree an individualised action plan that fits around the patient's daily life and takes account of lifestyle constraints.

This is not an easy one-size-fits-all approach but by considering the individual the chances that the planned treatment will be adhered to and effectively administered are much improved.

Give a demonstration of how topical therapy should be used. This may be provided by the GP or a nurse.

It is an essential part of ensuring that treatments are used regularly and correctly rather than the erratic, short-term application that is so common.

Provision of evidence about which treatments are effective can give patients reassurance that the prescribed treatment is going to be effective.

Patients may have been dealing with their condition for a long time and use a process of trial and error in using treatments, many of which may not have been effective.

Restoring this trust in treatment can encourage the patient to stick with the prescribed treatment, having the knowledge that it is known to work for conditions like theirs.

Variety of information
Finally, it is important to have any information available in a variety of formats, for example, online, in print, visual poster, large print and in a variety of languages.

Assessment tool
One specific research project involved in this body of research was the development and validation of the person-centred dermatology self-care index.

This resulted in a simple, 10-point assessment measure to identify the education and support needs of patients with long-term skin conditions using topical treatments to support the concordance process.

Practitioners and patients agree a course of treatment that is acceptable and manageable for the patient and one to which they are therefore more likely to adhere. The tool is based on social learning theory which embraces self-efficacy.

This is the belief that a person has the ability to successfully initiate and complete the healthcare actions required in specific situations to achieve particular outcomes.

This means that patients need to be equipped with the knowledge of what the treatment is, how to use it and when to seek additional medical advice to enable them to successfully manage their own condition.

The tool was developed in collaboration with the Skin Care Campaign and is available on the Bournemouth University website to download (see resources). GPs can print out this information and use it to work collaboratively with the patient to identify their education and support needs.

Self-management and self-care is a growing agenda in the NHS. Whilst it may require additional resource initially to adapt to a new method of practice, the long-term benefits mean that a greater number of patients with common long-term health conditions can self-manage their treatment.

This reduces pressure on resources, leaving more time for GPs to spend working with patients whose conditions are unsuitable for self-management. Effective education is the key.

By equipping patients with as much information and guidance as possible, self-management can be just as effective as supervised treatment.

  • Dr Cowdell is a research fellow at Bournemouth University.


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