Coughs and colds self care modelCoughs and colds self care model

GP

/NP

Nurse

Patient

/carer

Reception

Practice M

gr

Pha

rmacist

HC

A

HV

/AH

Ps

1. Patient contacts reception with cough or cold – advice given

2. Give literature to support verbal advice

3. Advise patient to see pharmacist about symptom control

4. Advice given about symptom control and OTC medicines

5. Patient implements symptom control

6. If symptoms change, worsen or don’t improve after 2 weeks contact reception to make appt

Coughs and colds self care model Coughs and colds self care model contcont

• W W Who is the appointment for? Who is the appointment for?

• HH How long have you (or they) had the complaint?How long have you (or they) had the complaint?

• AA Anything taken?Anything taken?

• M M Medication (existing)?Medication (existing)?

(Developed by Gemma Ravenscroft, Ashfields Primary Care Centre, (Developed by Gemma Ravenscroft, Ashfields Primary Care Centre, Sandbach, Cheshire)Sandbach, Cheshire)

Management of sore throats in adults and Management of sore throats in adults and childrenchildren

How long have you had a sore throat?

More than 2 weeks?

Yes No

Do you have any ongoing problems or take long term meds or is your

child prone to having sore throats?

No

Give self care information

See a Doctor

Yes

Have you got the self care information

on sore throats?

No, well pick up the information now and try that for 2 to 3 days

and if you are no better ring us

back again

Yes, you’ve tried that and You are no better?

Oh dear, youhad better come in

No, you still think you want to see the doctor? Ok I will just enter this

information for thedoctor now, can you come in at……..…

Management of sore throats in adults and Management of sore throats in adults and children children cont.cont.

Instructions to receptionistsInstructions to receptionists

• Please supply the following choice of information for the Please supply the following choice of information for the patient:patient:– leaflets leaflets – NHS Direct printout on sore throatsNHS Direct printout on sore throats– prodigy PILs leafletprodigy PILs leaflet– telephone number and directions to the pharmacytelephone number and directions to the pharmacy

• Finally enter a note on the computer that you have had Finally enter a note on the computer that you have had this discussion with the patientthis discussion with the patient

((Developed by Weaver Vale Surgery, Winsford, Cheshire)Developed by Weaver Vale Surgery, Winsford, Cheshire)

Self Care CaptionsSelf Care Captions

• Lots of juice keeps you loose

• With too much booze life’s no cruise• Be wise – immunise

• Walk a mile – makes you smile• Lose weight – feel great

• Stub it out – don’t die out• Coughs & sneezes are not diseases

• Smiles & jokes – healthy folks(Developed by the staff at the Tudors Surgery, Nantwich, Cheshire)

Self Care MessagesSelf Care Messages

• If you have ‘flu do not ask your GP for antibiotics as these are ineffective on viruses

• Regular movement and avoiding one position for long periods of time can help minimise the risk of developing back pain

• Did you know that a child with chicken pox is contagious until the last spot has crusted over?

• Your local pharmacist can provide you with advice and over the counter remedies for most minor ailments

• For back pain help yourself by moving within your pain limits, applying ice or heat to the affected area and taking pain killers

• Head lice treatment is only advised if you inspect the head and see a live louse

• Self care for a cold - plenty of rest, plenty of drinks, take paracetamol based medicine, ask your pharmacist for advice!

P.A.R.T. model for self careP.A.R.T. model for self care

The The P.A.R.T.P.A.R.T. model is used to illustrate pathways for model is used to illustrate pathways for self care – self care –

PP PPreventrevent the condition developing

AA AAwait resolutionwait resolution of the symptoms

RR Use self management for RRelief of symptomselief of symptoms

T T Learn to TTolerate symptomsolerate symptoms that do not resolve or cannot be reasonably alleviated

2. WONCA. The European definition of general practice/family medicine. Barcelona: WONCA Europe,2002.

• See Page 2 of Tool 13 – PART / workload assessment

• 4 groups to categorise each of the listed conditions

• Plot each condition on the flip chart– High demand, high complexity

– Low demand, high complexity

– High demand, low complexity

– Low demand, low complexity

Conditions and ailments

GP workload associated with common conditions in general practice

HH

HH LL

LL

GP

/Pra

ctic

e t

eam

wo

rklo

ad a

sso

ciat

ed

wit

h c

on

dit

ion

Complexity of conditionH = HighH = High L = LowL = Low

PART Model

• Take one condition from low complexity / high demand quadrant

• On flip chart (page 2) indicate who (patient and / or practice team member) is best placed to provide:– Prevention

– Await Resolution

– Relief of symptoms

– Tolerance

And list some activities around these areas

PART model

PreventionPrevention ToleranceToleranceRelief of Relief of

symptomssymptomsAwait Await

resolutionresolution

Patient

Peer

Family

GP

Practice nurse

Health care assistant

Receptionist

Pharmacist

Condition:Condition:

P.A.R.T model - Coughs & ColdsP.A.R.T model - Coughs & Colds

Condition -Condition - Coughs & Coughs & coldscolds

PreventionPrevention Await ResolutionAwait Resolution Relief of symptomsRelief of symptoms ToleranceTolerance

PatientPatient •Wash hands frequently•Wash surfaces, articles and toys•Exercise regularly •Avoid smoke•Eat good mixed diet with plenty of fruit and vegetables•Consider complementary medicines e.g. Echinacea, camomile, ginseng & zinc•Check that herbal remedies will not affect other medication or illnesses

•Consult NHS Direct flow chart on self care for coughing adults & children•If chart rules out serious underlying cause then likely to be upper respiratory tract infection (URTI)•Many children still have nasal discharge & cough 1 week after symptoms start•Although fever may subside after few days, symptoms may persist for 2-4 weeks in adults & children•Decisions on use of antibiotics should be based on likely presence of

bacterial not on length time of illness

•Rest•Increase fluid intake of water & fruit juices•Avoid conditions that might make cough worse especially smoky, very dry or dusty environments•Help moisten the airways by hanging wet towels on radiator, placing bowl of water by heat source or by making bathroom steamy.•Use steam inhalations with bowl of hot water but be very careful especially with children• Make drinks of lemon & honey in warm water•Echinacea or Vitamin C may help to shorten illness•Use extra pillows or for children prop up whole top of mattress•Ask pharmacist for advice about medicines for pain and fever relief , cough & decongestants

•If symptoms continue without improvement check the NHS Direct flowchart to ensure that symptoms have been checked correctly•Persistent cough or other symptoms may require medical examination or investigations

P.A.R.T model - Coughs & ColdsP.A.R.T model - Coughs & Colds

Condition -Condition - Coughs & Coughs & coldscolds

PreventionPrevention Await ResolutionAwait Resolution Relief of symptomsRelief of symptoms ToleranceTolerance

GPGP •Inform sufferers, carers & parents about preventative measures listed under Patient•Put up posters & supply leaflets to help inform people•Have a policy that, as far as possible, toys in the surgery are washable •Keep cross infection techniques in mind

•Give information about the illness & length of time research indicates that symptoms last.•Only half of children with cold and cough will have recovered completely by 10th day after symptoms started•Cough and catarrh may last 2-4 weeks •Supply patient information leaflet e.g. Prodigy PILS•Advise sufferers that antibiotic treatment for URTI is not supported by current evidence from randomised trials•

•Avoid prescribing•Encourage use of simple home remedies•Give advice listed under Patient•Reinforce with leaflet

•Advise the sufferer check the NHS Direct flowchart to ensure that symptoms have been checked correctly, if symptoms continue without improvement•Persistent cough or other symptoms may require medical examination or investigations•Participate in audit activities to ensure that people do not self care inappropriately

Summary and questions Summary and questions

• Examples of self care at practice level Examples of self care at practice level

• How the P.A.R.T. model can be used in self care How the P.A.R.T. model can be used in self care pathwayspathways

• Questions?Questions?