The Self Care Situation
From easing minor ailments to treating major illnesses and preventing the risk of life threatening diseases, people are increasingly taking an active role in their own health care. They are becoming better empowered to take an assertive role in managing their health.
This is true for the individual self-recognizing an acute health problem, like a tension headache, and self-selecting an over-the-counter medicine. It is also true for a patient prescribed a prescription medicine and actively engaged in self-managing its use between medical check-ups. This includes, for example, patients making the right choices about self-use of products according to label directions, using self-monitoring devices, self-assessing possible side effects, and making personal health choices about diet, exercise, and sleep.
However, this trend, called consumer healthcare empowerment, hasn't always been apparent.
Not so long ago, the emphasis in health care was on the treatment of the disease, as health professionals sought to define the course and cure of the disease itself with less emphasis on the behavioral needs of the patient to help optimize self-compliance with and self-adherence to medications. Today, this paternalistic approach to health care is increasingly being replaced by a focus on the patient, as a consumer of health care. This new focus seeks to understand and respect the individual's behavioral needs, values and desire for personal choice about medical interventions. This is termed consumer-centered self-care.
Part of the reason for this movement to focus on the consumer/patient is a result of societal changes over the past 50 years. The growth of the electronic age from black-and-white television to the internet now gives consumers easy access to information about health, disease and treatments. From high-top canvas sneakers of the '50s to special cross-training footwear of today, the exercise industry has responded to the continuing emphasis on active lifestyles. The health food movement and government requirements on food labeling have placed importance on smart food choices. With this continuing emphasis on health, it's not surprising that over half of consumers say they've taken a vitamin/mineral supplement in the last 6 months, and one in five prescription drug users say they also take a dietary supplement.
The other major driver awakening the health professionals to the value of consumer-centered self-care is a growing body of research showing that this approach improves therapeutic and risk reduction outcomes.
• Often for major diseases with potentially serious negative outcomes, these approaches include self-monitoring, regular medical review, and a disease action plan do seem to reduce morbidity and the use of healthcare resources.
• For less serious ailments, such as migraine, vaginal yeast infections, recurrent heartburn, and others, more convenient access to medicines by making them available without a prescription has empowered consumers to more fully engage in their own care. Today, over 700 OTC medicines use ingredients and dosages and dosage forms that were available only by prescription less than 30 years ago. Americans buy about 5 billion OTC medicines yearly to treat routine health problems. 
Yet, despite the promising developments in consumer-centered care and the continuing societal trends supporting these developments, there remain significant challenges.
• By 2020 there will be more than 70 million people over age 65; 9 million over age 85.
• Chronic disease is more prevalent in older populations, though certain diseases span younger age groups as well. For example, diabetes is associated with significant morbidity and mortality. It affects 18 million people today, has increased 61% since 1991, and is expected to double by 2050.
• According to the National Adult Literacy Survey (NALS), 66% of U.S. adults age 60 and over have inadequate or marginal literacy skills, and 50% of Hispanic Americans and 40% of African Americans have reading problems.
- Inadequate literacy was an independent risk factor for hospital admission among 3,260 elderly managed care enrollees. 
- Health literacy problems were independently associated with worse glycemic control among 408 English- and Spanish-speaking patients with diabetes. 
- 75% of Americans who reported having a long-term illness (six months or more) had limited literacy, suggesting they may know less about their conditions or how to handle symptoms. 
- Emergency room patients with inadequate literacy are twice as likely to be hospitalized as those with adequate literacy—even after adjusting for self-reported health, health insurance and socioeconomic characteristics (32% vs. 15% in a study of 979 patients). 
• Adherence to medication regimens is less than adequate. This is tied to health literacy and also to non-literacy related patterns of health-seeking behavior in various segments of the population, and is seen across chronic disease management and acute self-treatment paradigms. For example,
- Overall estimates for adherence in both the pediatric and the adult asthma populations are about 50%. 
- A recent national survey of consumer OTC medication-taking behavior shows that a third of Americans report using more than recommended doses of OTC medicines. 
In summary, as its mission the UCSF Center for Consumer Self Care seeks ways to help people take a central role in their own health care. The Center's research, education and health policy programs are targeted at gaps in current health professional practice and consumer self-care to find solutions that will optimize how people self-care.
For additional information, this page is linked to others expanding selected topics relating to consumer-centered self-care.
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