Members of the public prefer self-care to consulting a health professional for minor illness, and there is a growing body of evidence to support encouraging such self care in primary care for both physical and psychological conditions, and for acute and long-term conditions. With around 40% of GP time spent seeing patients who could have self treated, Department of Health policies encourage the promotion of greater reliance on self care, which can enable patients to feel more empowered (obtaining control of one’s own life) and may also support improved communication between healthcare professionals and patients. However, the public, whilst keen to perform self care, often require support for their decision making and over three-quarters say that they would have greater confidence to take care of their own health if they had guidance and support from an NHS professional. Although easily accessible information may reduce the need for GP consultations for self-limiting illness, there is little evidence about the extent of impact in practice.
The emergence of the internet has created new ways by which patients can gain knowledge and support. Surveys consistently show that the majority of internet users have used it to obtain health information, and two-thirds of those using the internet for such purpose claim that it had some impact on their healthcare decisions. Reported advantages include anonymity, convenience, accessibility and low cost.
Harnessing the power of online health advice through formal, coordinated models of online healthcare has the potential to bring cost-savings to both the health service and patients, and is supported by NHS policy:
- increasing consumer involvement in healthcare;
- the recognition of the importance of health literacy;
- the role of the informed expert patient;
- the importance of self-management in chronic disease;
- and the provision of health information, health records and health services online through NHS Connecting for Health.
Communicating via the internet may enable structured self-assessment to be undertaken at a time and place that suits the patient. It allows an exact record of the assessment to be kept. Attachments and web-links can be used to disseminate information and so allow easy retrieval of advice. Such developments may empower patients to become increasingly self-reliant in managing their health needs, may substitute for the need for face to face contact, and so enable practices to make more effective use of their appointments. NHS Direct Online meets some of the self-assessment needs of patients, but it has a number of limitations. These include:
- NHS Direct Online provides generic algorithm based feedback but is not tailored to the individual;
- no local geographic tailoring of the information to the local health economy is possible (although NHS Choices is helping in this regard).