4. Select and implement self-care promotion intervention(s)
Select and implement self-care promotion intervention(s)
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 Heartburn (without indigestion) for the selected target issues (reduce incidence; reduce severity of cases; reduce unnecessary visits to GPs).
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)
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 Heartburn (without indigestion), 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 – Gastroesophageal reflux diseases 
- 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.
For the highlighted most vulnerable groups
- Targeting population
- Active information or distribution of written information to target patients in primary care centers, hospitals, etc. to help them recognize situations where they should visit their GPs.
- Active distribution of information or documentation illustrated with tips to follow for a healthy life (quality of life and reduce amount of severe cases).
- Active distribution of information or documentation for the correct use of antacids.
- Training and information by paediatricians and nurses to parents of children under 2 years old.
- Targeting professionals
- Receive general training in communication skills.
- Receive specific training in patient education roles and methods of healthy lifestyle for population as well (including patients with symptoms of heartburn and GERD).
- Be provided with elements of support to inform and educate (charts, internet, advertisement, screen on centres, etc.).
- Have professional training specialists.
- Information campaigns/broadcasting in social clubs for elderly people.
- Specific groups: pharmacists
- Agree on strategies to identify patients who self-medicate and refer them to doctor’s GP.
- Alert patients who go to pharmacy and ask counter PPI or antacids with neither prescription nor pharmacist’s advice.
- Targeting managers
- Designing training and information programs through internet for patients who suspect presence of heartburn can make appointment and clear doubts and perhaps avoid unnecessary visits (consumption) and especially not to delay first consultations (late diagnosis or alarm symptoms).
- Promote development of treatment protocols agreed from GPC of proven sources at local or regional level.
- Coordination programs with pharmacies
- Software to know consumption of antacids and adherence to treatment in chronic patients.
- 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 directly consulting to the GP). This approach has been tested and adapted in the UK in several NHS areas, with some different characteristics. However, most programs included two key aspects:
- Including the treatments that the pharmacist might suggest in the prescription system for (people meriting the free-of-charge or discounts).
- Establishing a fast-track for GP consultation if the pharmacist decides to refer.
The piloting of those schemes has reported promising results.
For some 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
Help patient to detect which foods cause reflux more often and avoid their consumption.