4. Select and implement self-care promotion interventions
Select and implement self-care promotion interventions
4.1. Linking intervention(s) with the hindering/facilitating mechanisms
Once the hindering or facilitating mechanisms have been identified a key next step can be to link interventions to those mechanisms.
There are numerous interventions that could potentially contribute to the promotion of self-care in cold for the selected target issues (reduce incidence; reduce severity of cases; reduce unnecessary visits to GPs and reduce inappropiate use of antibiotics).
The table presented in point 4.2 highlights types of interventions that could target those issues addressing the detected hindering or facilitating mechanisms, with special attention three key areas of hindering or facilitating mechanisms highlighted before: the patients’/general population knowledge and skills, organizational factors and the specific most vulnerable groups in the general population.
4.2. Selecting intervention (s)
As it was highlighted in the subjective evaluation of mechanisms there are three key areas of mechanisms to consider:
- Patients and general population knowledge and skills, which might help to address all four issues.
- Organizational factors, which might be particularly useful to address the unnecessary visits to GPs and the inappropiate use of antibiotics (for both cases professionals clinical practice should be also considered).
- Specific vulnerable groups that should have some special considerations.
The following tables illustrate types of self-care promotion interventions that could address those mechanisms with the final goal of improving the key issues highlighted.
From this analysis the following type of interventions could be recommended:
It is important to bear in mind that most interventions are multifaceted so include more than one area, however to facilitate the analytical line the interventions have been divided in information strategies and organizational strategies.
- Information, with a special focus on symptom recognition and evaluation.
One of the identified potentially hindering mechanisms was the lack of knowledge regarding what to expect when someone has common cold, to be aware of treatment options and recommendations for symptom relieve. Information strategies can have some beneficial results to tackle this issue. Some examples of those initiatives are:
Examples of similar practices in:
- UK: NHS Choices – Common cold 
- France: Améli.Santé – Rhume 
- Netherlands: Zelfzorg.nl 
- Sweden: 1177 Vårdguiden – Förkylning 
- Know who to turn to: as one of the hindering mechanisms identified is the poor knowledge of navigation health systems, it might be of interest to review information strategies specifically addressed to cover this issue, that usually also entail evaluation of symptoms and treatment decision making.
This style of information campaign has been applied in multiple primary care trusts across the UK. For some examples see:
NHS Scotland: Know who to turn to 
With a combination of those two complementary information strategies would help to address two of them most relevant aspects: symptom recognition and information on navigation of health system.
Note: An information campaign should be tailored to the needs of its target population, so depending on the ethnic composition of the implementing context, the material of the interventions might have to be translated to multiple languages and be adapted to some cultural traits (see implementing intervention sub-section)
Note: One important consideration would be the different mechanisms to be used for such information campaigns, to that regard see WP2 – Communication tools.
- Mass media campaigns
Public campaigns have been widely used for topics related to common cold. The authors of a review of public campaigns focused on improving the use of antibiotics in outpatients between 1990 and 2007  found that although there is still missing evidence to prove a cause-effect relation, the available data suggests that public campaigns had a positive effect on the use of antibiotics. Particularly multifaceted campaigns repeated over several years had the greatest effect.
- Example (UK experience)
In this retrospective study, there was incomplete reporting of adjuvant interventions undertaken by the PCOs intervention and comparison areas, so isolating the intervention, and attributing cause and effect is difficult. In this pragmatic evaluation the campaign was found to significantly reduce the volume of antibacterial drugs during the winter months of the intervention years. There were 21.7 fewer items prescribed per 1000 population (P < 0.0005), for the intervention populations over these winter months, equivalent to a 5.8% absolute reduction in prescribing. 
- Example (New Zealand experience)
A study  in New Zealand compared public views and use of antibiotics for the common cold before and after an education campaign. The authors found no change between 1998 and 2003 in public awareness that antibiotics are not helpful in treating viral infections (38%). However they did find a significant reduction in those attending doctor for the common cold (24% to 15%) and a reduction in of antibiotic prescriptions in favor of delayed prescriptions for those consulting with a GP.
For the highlighted most vulnerable groups
- Children under 3 – partnership with nurseries to educate both educators and parents in the recognition of symptoms.
- Delayed prescriptions: in some cases the prescription is for self-care for a given period of time. If in this period of time the symptoms do not improve significantly the patient can get the prescribed antibiotic without returning to the GP consultation (important: the antibiotic is only available after a given number of days from the prescription and not before).
This strategy can help reduce the use of antibiotics as in many cases the symptoms will subside after some days of proper self-care.
In addition the prescription of self-care encourages a conversation about the importance and effectiveness of self-care in minor conditions.
- Minor ailments schemes, partnerships between GPs and community pharmacists
These types of program are based on directing people with minor ailments to the community pharmacist as the first health professional (instead of consulting to the GP as the first access point). Minor ailments schemes are a national health program in Scotland, Northern Ireland, Wales and some primary care trusts in England.
This approach has been adapted with some different characteristics however, most programs include two key aspects:
- Including the treatments that the pharmacist might suggest in the prescription system, so if someone is eligible to free prescriptions or a discount when they consult with their GP they will also have those free or discounted prescriptions if they consult with the community pharmacist.
This eliminates one of the barriers that might inhibit people from consulting with pharmacists: the payment barrier.
- Establishing a fast-track for GP consultation if the pharmacist decides to refer to GPs.
A European study  found that Minor Ailments Schemes have shown the potential to substitute for other health service and to reduce GP consultations for minor ailments (in Scotland, where the scheme has been in place since 2006).
The same study analysed the cost/benefit of the Minor Ailments Schemes, factoring the time dedicated to consult the pharmacists vs. the GP among other variables. They found that patients exempt of prescription charges benefit from about 8£ by consulting with a pharmacists instead of a GP (compared to a benefit of 5.73£ if there is no minor ailment scheme).
To see estimated results of the cost/benefit analysis for GPs, pharmacists and overall health system, see: A cost/benefit analysis of self-care systems in the European Union (link to study).
For some specific examples see:
- Greater Manchester Minor Ailments Scheme – Pharmacy First 
- NHS Scotland – NHS minor ailment services 
Remember that before implementing a piloting of the interventions is recommended. For tips regarding Implementation of interventions see the section in the general guideline