SELF-CARE FIRST

A Self-Care Framework for Ireland proposed by the

Switch-On to Self-Care Working Group

Self-Care First A Self-Care Framework for Ireland 2012

SELF-CARE FIRST
EXECUTIVE SUMMARY
Following on from the establishment of the Switch-On to Self-Care Working Group, its
members agreed that the best approach would be to propose a Self-Care Framework for
Ireland. This document reflects the Working Groups vision that in healthcare, self-care
should come first.
The definition of self-care for the purpose of establishing the proposed Self-Care Framework
is the care taken by individuals of their own health and well being.
This Framework is based on six pillars:

Stay fit
and
maintain
good
physical
and
mental
health

Meet social
and
psychological
needs

Prevent
illness or
accidents

Avoid
unnecessary
risks

Use over
the
counter
(OTC)
medicines
to treat
minor
ailments

Reduce
the risk of
long-term
conditions

The Switch-On to Self-Care Working Group recommends the following actions to support the
Self-Care Framework:
1. Legislators need to place a high value on the role of self-care in the healthcare system;
2. The regulatory environment must be balanced, proportionate and focused on meeting
the needs and expectations of patients and other stakeholders;
3. Healthcare professionals should be encouraged to support and facilitate the concept of
self-care;
4. The role of the pharmacist should be expanded;
5. Patients should have access to good quality information so that they are fully empowered
and confident to embrace self care, seek care at the appropriate level and, thus, enhance
their independence within the healthcare system;
6. The range of medicines made available to patients should be expanded through
switching1.

Switching is the process of expanding self-medication through a change in the method of supply of some
medicines from prescription-only to pharmacy-only status.

Self-Care First A Self-Care Framework for Ireland 2012

Self-Care First- A Self-Care Framework for Ireland 2012

1.

INTRODUCTION

At a meeting entitled Switch-On to Self-Care, held in 2009, all the stakeholders present
agreed that it was necessary to explore how the benefits to public health and the healthcare
system of greater utilisation of self-care and self-medication in Ireland could be more fully
realised.
Following on from this meeting, a Switch-On to Self-Care Working Group (see Annex 1) was
established. It is composed of representatives from key stakeholder organisations including
the Irish Pharmacy Union (IPU), the School of Pharmacy and Pharmaceutical Sciences at
Trinity College Dublin, the Department of General Practice at University College Cork and
representatives of the pharmaceutical industry. It also includes an observer from the Health
Service Executive (HSE).
In its first meeting, the Working Group agreed that the best approach would be to propose a
Self-Care Framework for Ireland and to use that in order to advocate for change and/or
action. This document reflects the Working Groups vision that in healthcare, self-care should
come first.2
2.

BACKGROUND

Healthcare in Ireland is going through a period of significant change an increasing and

ageing population, evolving health structures, greater private sector involvement in the health
arena, a growing incidence of chronic diseases, ever increasing public expectations of the
service and the development of new treatments which offer hope to patients but which also
pose a strong financial challenge to the State. This challenge is compounded further given
the current state of the public finances and the States requirement to control healthcare
expenditure.
In Ireland, conditions like cardiovascular and chronic respiratory diseases, diabetes and
obesity, which constitute the biggest burden on the health bill3, are often caused by known
and avoidable risk factors, such as an unhealthy diet, a lack of physical activity and smoking.
Clearly, effective prevention in these areas would significantly reduce the burden these
diseases have on the healthcare system4. At the establishment of the HSEs Quality and
Clinical Care Directorate, which heralded the establishment of 20 programmes under the
leadership of a multi-disciplinary team of clinical experts, Dr Barry White indicated the group
was focusing on solutions which will improve patient care, remove waiting lists and save
money.
This is where self-care comes into play. We now live in a world where if a condition is
diagnosed early, it can often be quickly, effectively and efficiently treated using modern
medicines, other medical interventions and behaviour modification. We are at a crucial point
as a society and unless small but significant changes in the behaviour of adults and children
are encouraged we face a potential health crisis which could overwhelm the system in the
years ahead5.

The framework reflects similar work undertaken in the UK by the Self Care Campaign which was established in
March 2009. For their proposals see Self Care: Ethical Imperative
http://www.selfcarecampaign.org/uploads/20100316_self_care_campaign_white_paper.pdf
3
Tackling Chronic Disease A Policy Framework for the Management of Chronic Diseases Department of
Health and Children 2008
4
Approximately 80% of GP consultations and 60% of hospital bed days are related to chronic diseases and their
complications. Chronic diseases account for two thirds of emergency medical admissions to hospitals.
5
For example, the Survey of Lifestyle, Attitudes and Nutrition (SLAN) Report of 2007 estimated that over 39% of
Irish adults are overweight and 25% are obese. According to the National Taskforce on Obesity of 2005,
estimates for Irish children are also very worrying with more than 300,000 thought to be overweight and obese,
with the number increasing at a rate of over 10,000 a year. The Taskforce estimated that about 2,000 deaths a

Self-Care First A Self-Care Framework for Ireland 2012

Self-Care First- A Self-Care Framework for Ireland 2012

Self-care is not only about treating illness but also about encouraging people to take better
care of their own health. Harvard Professor Dr David Nathan completed a three-year clinical
trial studying 3,000 people who although not diagnosed as diabetics, were overweight and
had elevated blood glucose levels. The Study found that participants who made lifestyle
changes lowered their risk of developing the disease by 58%. These changes were relatively
small - they walked about 30 minutes, five evenings a week and lost about 7% of their body
weight only about 15 pounds each. The impact of the lifestyle changes was even greater
among people over the age of 60, where the risk of diabetes was reduced by 70%6.
Although no economic studies have been carried out in Ireland, studies have been carried
out in other jurisdictions to measure the aggregate cost savings of OTC medicines as used
for the most common self-treatable conditions and their results are relevant to Ireland. One
study in the US evaluated how consumers would treat these conditions if they did not have
access to OTC medicines. The study identified considerable savings from avoided clinical
visits and diagnostic testing and the use of less costly OTC medicines, rather than
prescription medicines. The study also found that by keeping the workforce healthy and at
work, OTC medicines offered potential additional productivity benefits from doctors visits
avoided and time not having to be away from work for medical appointments.7
A further UK study has shown that GP treated ailments that could be self-treated are costing
the NHS 2 billion every year 8
Simple and strategic changes in the way self-care is defined and organised in Ireland can
make a difference to the long-term well being of the Irish people.
3.

SELF-CARE FRAMEWORK

In 2001, the Government published Primary Care A New Direction9. In it, primary care
was defined as: An approach to care that includes a range of services designed to keep
people well, from promotion of health and screening for disease to assessment, diagnosis,
treatment and rehabilitation as well as personal social services. The services provide firstlevel contact that is fully accessible by self-referral and have a strong emphasis on working
with communities and individuals to improve their health and social well-being.
The objective of the 2001 primary care strategy was to provide forces to run counter to those
driving people into secondary care (see Figure 1 below), i.e. to move care, where
appropriate, from secondary to primary level, from primary level to self care and from self
care to a no care requirement.

year could be attributed to obesity and the numbers were growing relentlessly. It estimated that these deaths
alone may be costing the State as much as 4 billion per year.
6

Wall Street Journal The medical community wants you to be scared of diabetes but not too scared (23
September 2003)
7www.yourhealthathand.org/images/uplpoads/The_Value_of_OTC_Medicine_to_the_United_States_Bo
ozCo.pdf
8 Minor ailment workload in general practice; December 2007; IMS Health
9
Primary Care. A New Direction. Quality and Fairness a health system for you, Health Strategy, Department
of Health and Children, 2001.

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Self-Care First- A Self-Care Framework for Ireland 2012

rd

The definition of self-care for the purpose of establishing the proposed Self-Care Framework
is the care taken by individuals of their own health and well being.

This Framework is based on six pillars:

Stay fit
and
maintain
good
physical
and
mental
health

Meet social
and
psychological
needs

Prevent
illness or
accidents

Avoid
unnecessary
risks

Use over
the
counter
(OTC)
medicines
to treat
minor
ailments

Reduce
the risk of
long-term
conditions

Providing forces to run counter to those driving people into secondary care is possible
because, in Ireland, patients are no longer passive recipients of healthcare and advice.
Instead, they want to become more knowledgeable about their health, with better access to
quality information about illnesses (prevention and treatments) and gain more control about
decisions affecting their health.
Irish patients are particularly well-prepared to handle self-medication. The attitudes of people
to self-care in Ireland were presented at the Switch-On to Self-Care conference held in 2009,
which featured data from Irish respondents in an international survey carried out by Nielsen10
and shed some light on their behaviour towards OTC medications.
10

Self Medication & Self Care: A Multi-Country Study Exploring Consumer Attitudes & Behaviours, Robert
Buckeldee, Nielsen, 2009.

Self-Care First A Self-Care Framework for Ireland 2012

Self-Care First- A Self-Care Framework for Ireland 2012

From the responses gathered, it was concluded that the Irish patient is more open to a multistranded healthcare engagement (manufacturers, doctors, pharmacies, government) than
the European average and this will enable the burden of health awareness to be shared
across all relevant parties.
The study findings also showed that Ireland has the highest incidence of minor ailments in
Europe, with 3.5 out of a list of 14 minor ailments identified as affecting respondents in the
previous month. That may be why patients tended to be more discerning as their choice of
OTC medicines was guided by their confidence in the product (45% of Irish respondents
versus an average of 33% of Western European respondents) and by whether they
considered it safe (44% of Irish respondents versus 36% of Western European respondents).
Irish patients see health education and advice from the pharmacist as key ways to help them
take care of their health and minor ailments. The confidence that Irish patients have in their
pharmacist may be coupled with the fact that they lead the way in Europe in the view that
more medicines should be made available without a prescription from the doctor. It is the
only country where a majority of respondents agreed.
Further research findings, published in April 2010 by the Irish Medicines Board (IMB), looked
at how consumers source information about the medicines they take and found that 3 in 4
Irish adults read product information before taking new medicines11. This demonstrates that
Irish patients are being proactive when it comes to seeking information about their health.

4.

RECOMMENDATIONS

Taking into consideration the above remarks, the Switch-On to Self-Care Working Group
recommends the following:
1. Legislators need to place a high value on the role of self-care in the healthcare
system
The 2001 Government Health Strategy included a series of proposals to promote health
and well being. Some of these, such as those around smoking and alcohol, have been or
are currently being implemented. The Switch-On to Self-Care Working Group believes
that other initiatives, in particular around the promotion of childrens health and mens
health, now need to be taken forward to ensure that healthcare is delivered at the lowest
appropriate level.
The recommended actions include:
i.

Intensive health promotion from an early age through school and into the
workforce. Clear measurable targets are necessary for proper evaluation;

ii.

The encouragement of physical exercise, not just in the sense of competitive

sports but also in terms of walking or swimming, as a routine part of a healthy
lifestyle;

iii.

The provision of appropriate funding to general practitioners to engage in

preventive medicine and to encourage pharmacists to be further involved in health
promotion initiatives.

11

Consumer Views on Sourcing Information about Medicines National Survey Results, Irish Medicines Board,
April 2010.

Self-Care First A Self-Care Framework for Ireland 2012

Self-Care First- A Self-Care Framework for Ireland 2012

2. The regulatory environment must be balanced, proportionate and focused on

meeting the needs and expectations of patients and other stakeholders12
The need to manage quality, safety and efficacy of medicines should be balanced by the
positive health benefits to society of the increased availability of over-the-counter
medicines.
3. Healthcare professionals should be encouraged to support and facilitate the
concept of self-care
This could consist of a joint declaration of commitment by the various organisations of
healthcare professionals and allied healthcare professionals to coordinate their work
more closely in order to ensure that patients access treatment at the lowest appropriate
level rather than, as too often happens, seeking treatment at a higher level than
required.
4. The role of the pharmacist should be expanded
Pharmacists could play a key role in this new Framework in providing sufficient
information and support to enable patients to make an informed choice. Pharmacists
could undertake stronger advisory positions in their community, including the possible
actions outlined below:
i.

The development of Minor Ailment Schemes that would enable medical card
(GMS) patients to receive treatment of common illnesses free of charge, direct
from their community pharmacist;

ii.

The provision of evidence-based prevention and health promotion activities, as

recommended by the Pharmaceutical Society of Irelands Pharmacy Ireland 2020
Working Group Interim Report;

iii.

The enhancement of the pharmacists advisory role to support compliance and in

ensuring that the right medicine is advised to patients for the right purpose.

iv.

The regulation of pharmacy has increased significantly in recent years and

pharmacists have risen to the challenge of increased compliance and the
responsibilities entailed. This increased regulation and pharmacist demonstration
of continued competency has highlighted that the pharmacy is an environment
where reclassified products can safely be supplied. It would follow that more
products should be reclassified to Pharmacy Only supply to allow pharmacists to
fulfil their role as fully as possible.

This expanded advisory position has the potential to complement the role of other
healthcare professionals, in particular GPs, and given that all pharmacies from the 1st
November 2010 have private consultation areas they have appropriate facilities to allow
them greater one-to-one interaction with patients.
5. Patients should have access to good quality trustworthy information so that they
are fully empowered and confident to embrace self care, to seek care at the
appropriate level and, thus, to enhance their independence within the healthcare
system
Currently, there are few educational campaigns centred around the benefits of self-care
to entice the public to be more proactively involved in self-care. It is the view of the
Switch-On to Self-Care Working Group that it is essential that all stakeholders including
12

The Switch-On to Self-Care Working Group notes the establishment of a Consultative Panel on the Legal
Supply Classification of Medicines by the IMB which is currently deliberating

Self-Care First A Self-Care Framework for Ireland 2012

Self-Care First- A Self-Care Framework for Ireland 2012

the Health Service Executive (HSE), in particular the Population Health department,
relevant patient and consumer organisations, professional medical and pharmacy
organisations (IPU, ICGP, IMO etc.), regulators (IMB and PSI) and industry should work
together on health promotion campaigns centred around self-care to communicate the
following key messages to the public:
i.

Stay healthy through illness prevention and wellness;

ii.

Seek advice from a pharmacist when using OTC medicines in order to ensure
safe use, particularly for products whose method of supply has recently been
changed from prescription-only to OTC.

The pharmaceutical industry plays an important role in providing trustworthy information

to patients and is already offering quality information through the www.medicines.ie web
portal, through patient information leaflets which accompany all medicines, through
disease awareness campaigns and consumer advertising of some OTC medicines.
6. The range of medicines made available to patients should be expanded through
switching
Ireland should adopt a partnership with relevant stakeholders in order to discuss what
steps need to be taken to make more OTC medicines available in order to enhance the
appropriate use of self-medication, supported by increased level of advice by
pharmacists. The partnership model developed in recent years in the UK, involving the
regulator, pharmacy and doctors bodies, the industry and patient groups, has shown the
possibilities for expanding self-medication through a change in the method of supply of
some medicines from prescription-only to pharmacy-only (a process known as
switching).13 This led to the preparation of a list of potential candidates for switching,
background information about the process and a report outlining the information and
training considerations necessary to accompany any switching application. Examples of
UK switches can be found in Appendix 2.
The European Medicines Agency (EMA) has also considered the pan-European
classification for a number of medicines which could potentially be switched. Examples of
recent EMA switches include orlistat and pantaprazole, indicating the EMAs confidence
in self-medication.
Following the switching of levonorgestrel by the IMB in February 2011, the IMB set up a
Consultative Panel on the Legal Supply Classification of Medicines whose aim is to
advise the IMB Management Committee. The Switch-On to Self-Care Working Group
welcomes the establishment of this panel and looks forward to the outcome of its
deliberations. We believe that local Irish reclassification initiatives, led by a pro-active
policy that recognises the value of switching to population health, should play a major
part in future Irish switching decisions.
Industry and pharmacists have collaborated to produce educational tools and protocols
following such switches to assist pharmacists in supplying these medicines. The Working
Group would advise that 3 months notice be given for future switches to facilitate the
development and roll out of these protocols and education programmes to community
pharmacists.

13
Switch on to Self-Care booklet, IPHA, 2009, page 6. In early 2001, the Medicines Control Agency, now the Medicines and
Healthcare products Regulatory Agency (MHRA), brought together all relevant stakeholders including the Proprietary
Association of Great Britain, the Association of the British Pharmaceutical Industry, the Royal Pharmaceutical Society of Great
Britain, the Royal College of General Practitioners and patient associations. As a result, the medicines outlined in Annex 2 are
available without prescription in the United Kingdom while they remain prescription-only in Ireland.

Self-Care First A Self-Care Framework for Ireland 2012

Self-Care First- A Self-Care Framework for Ireland 2012

5.

CONCLUSION

The proposed Self-Care Framework requires a change in the value attributed to self-care by
all stakeholders, particularly by the legislator, the regulator, healthcare professionals and
patients themselves.
The current resource constraints constitute an opportunity to reorganise the way healthcare
is provided in Ireland, by encouraging patients to take better care of their health (through
illness prevention and wellness) and by ensuring that patients access treatment at the lowest
appropriate level rather than, as too often happens, seeking treatment at a higher level than
required.
6.

ANNEX 1: MEMBERS OF THE SWITCH-ON TO SELF-CARE WORKING GROUP

Members of the Switch-On to Self-Care Working Group are:

Dr Colin Bradley, Member of the Irish College of General Practitioners and Head of the
Department of General Practice at University College Cork

Dr Martin Henman, Senior Lecturer in Pharmacy Practice, School of Pharmacy and

Pharmaceutical Sciences, Trinity College Dublin

Ms Pamela Logan, Director of Pharmacy Services, Irish Pharmacy Union

Mr Niall OShea, Head of Regulatory & External Affairs, GlaxoSmithKline Consumer

Healthcare

Dr. David Hall, Commercial Director Ireland, Johnson and Johnson (Ireland)

Mr. Sergio Schuler, Country Division Head, BCC Ireland, Bayer

Ms Michelle Anderson, HSE Pharmacist, Corporate Pharmaceutical Unit, Health Service

Executive [Observer status only]

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Self-Care First- A Self-Care Framework for Ireland 2012

7.

ANNEX 2: PRESCRIPTION-ONLY TO
SWITCHES IN THE UK, 2002 TO 2012

Medicine
Alclometasone Dipropionate
Aspirin 75mg
Azelastine Hydrochloride
Azithromycin
Chloramphenicol
Clobetasone Butyrate
Diclofenac
Econazole
Felbinac
Fluconazole
Fluticasone Propionate
Flunisolide
Flurbiprofen
Griseofulvin
Hydroxyzine Hydrochloride
Hyoscine
Lidocaine
Lodoxamide Trometamol
Mebeverine Hydrochloride
Naproxen
Omeprazole
Prochlorperazine Maleate
Simvastatin
Sumatriptan Succinate
Tamsulosin Hydrochloride
Terbinafine
Tranexamic acid

PHARMACY-ONLY

Indication
Eczema and dermatitis
Prevention of heart attack and stroke
Allergic rhinitis
Treatment of chlamydia
Acute bacterial conjunctivitis
Eczema and dermatitis
Anti-inflammatory
Fungal skin infections
Topical anti-inflammatory
Oral treatment of vaginal candidiasis
Allergic rhinitis
Allergic rhinitis
Anti-inflammatory throat lozenges
Anti-fungal foot spray
Pruritus
Gastro-intestinal spasm
Local anaesthetic
Allergic conjunctivitis
Gastro-intestinal spasm
Dysmenorrhoea
Acid reflux
Nausea and vomiting in migraine
To reduce the risk of a first coronary
event
Acute relief of migraine attacks
Benign prostatic hyperplasia
Anti-fungal
Dysmenorrhoea

Self-Care First A Self-Care Framework for Ireland 2012

Self-Care First- A Self-Care Framework for Ireland 2012

MEDICINES

10