The principles of supported self care in action

An elderly lady attends her GP surgery with an exacerbation of her multimorbidity condition. She has diabetes, COPD and congestive heart failure and has put on weight, has oedematous legs and is depressed.

Approach 1
There are no initial personal questions asked and the practitioner progresses immediately to a medical intervention.

Her HBA1C is raised and an increased dose of insulin is prescribed but due to her depressed state she is not eating and is now at an increased risk of a hypoglycaemic episode. In addition, she is not moving around her flat which has precipitated an increase in fluid retention, so an increased dose of diuretic is prescribed. Consequently, she reduces her fluid intake leading to an increased risk of confusion and dizziness and an increased risk of falling. Ultimately her risk of heart failure and hospital admission is significantly increased.

Approach 2
An initial question of ‘What has changed in your life recently?’ elicits the response that her dog has died. She explains that she now has no need or desire to go out walking every day and she is staying at home instead. The practitioner now progresses to a social prescribing intervention.

A whole team approach is explored considering how various people in the local healthcare system could support the patient. Dog sharing with a neighbour is suggested with additional support and company available to accompany her to visit local neighbourhood groups and shops. An option for home visits is suggested to reduce her loneliness.

The lady’s weight stabilises and returns to previous levels, her diabetes status is well controlled and her mental wellbeing improves.

References

• NHS England