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In recent years, as employees have been asked to bear a larger percentage of their health insurance costs, there has been an attendant movement to place a greater responsibility on employees for their own health status as well. Among the leading strategies emerging from this movement is the concept of self-care, which empowers employees to make decisions about injuries and health emergencies with the assistance of guidebooks and nurse phone lines.
"Self-care is a series of skills that teach an employee to make better health care decisions based on having more information and more empowerment, and helping them produce a partnership with providers in shared decision-making," says Don R. Powell, PhD, president of the American Institute for Preventive Medicine in Farmington Hills, MI.
The potential savings are enormous, and thus have significant implications for occupational health programs. "All organizations want to reduce health care costs, and the [Centers for Disease Control and Prevention (CDC)] research shows that each year there are approximately 760 million visits to doctors and an estimated 25% of those are unnecessary," notes Powell. "There are stubbed toes, sore throats and so on, that employees could have treated themselves. That comes out to approximately 189 million unnecessary visits, and an average cost of $55 per doctor visit."
The same applies to emergency department (ED) usage, Powell adds. "In 1999, according to the CDC, there were 103 million ED visits, of which 55%, or 57 million, were unnecessary. The average cost of an ED visit is $360."
The benefits of self-care extend beyond mere dollars, although the potential savings are significant, notes Powell. "There are a great deal of unnecessary costs related to relatively minor health issues, and as part of the occupational health mission employees of hospitals and those seen in occupational health clinics can help realize savings in health care costs.
"But as an outgrowth of that, research shows you can also reduce absenteeism," Powell continues. "Employees are on the job more often, and you also see an increase in productivity because they feel good and take better care of themselves. This helps avoid presenteeism’ — being on the job but working less productively because you’re not dealing appropriately with an illness or stressful situation. So, just as occupational health programs are designed to either help keep injured employees on the job or help them return to work quickly, self-care can also help keep them on the job."
There are two major areas in which self-care programs can be most effective. The more common of the two, says Powell, is the way in which self-care helps employees address everyday health problems such as cold, flu, sore throat, headaches or heartburn. "If employees are advised about making decisions relating to these conditions, they’ll know better what to do when these symptoms present themselves," he explains. Even so, many self-care programs present flow-chart diagrams that go through various symptoms with an if A, then B, type of format. Depending on the answer, the employee either goes to the next step or calls the appropriate health care provider. (See "Flowchart format for strains and sprains," in this issue.)
Self-care also can be applied to disease management programs, says Powell. "If an employee is diagnosed with a condition, self-care procedures can be used to help avoid hospitalization or relapses," he explains. (See "New standards guide DM programs," in this issue.)
Like any type of health care intervention, a multi-component approach in self-care is most effective. Such a program, Powell advises, should contain five basic elements:
• A self-care guide: Print versions of the material should be given to each employee. This may include a booklet, a brochure or a book — or all three. The materials should include a flow-chart format and/or icons for the appropriate level of care.
• Workshop: Instead of giving the guides out directly at your clinic, you may wish to sponsor a seminar at which an instructor presents the benefits of self-care and explains how to use the guide. "On-line versions of workshops are available, too, as well as videos," notes Powell.
• Nurse advice line: In addition to consulting the guide, employees can speak to a registered nurse "24/7" through a nurse advice line. "Interestingly, utilization of the nurse line is not as high as that of the guides," Powell notes. "The guides have between 50% and 75% utilization; you’re lucky to get 10% with the nurse line." Generally, he notes, the publications have a shelf life of three years, while a facility has to renew its nurse line every year. Plus, the booklets cost around $3 per copy, and books $6, while a nurse line costs $10 to $12 per employee per year.
• On-line self-care information: Self-care information also is available on the Internet, but a vast majority of employees prefer to get their information in print format. "When you have an emergency you don’t want to boot up your computer," says Powell. "If, on the other hand, you have a chronic condition and want to learn more about it, you will go online."
• Promotional materials: Self-care is a process, not a one-time event, Powell asserts. "You need continue to reinforce your message with these materials; you almost need a quarterly advertising campaign," he says.
You can obtain information about self-care vendors on the Internet, Powell notes.
[For more information, contact: Don R. Powell, PhD, President, American Institute for Preventive Medicine, 30445 Northwestern Highway, Suite 350, Farmington Hills, MI 48334. Telephone: (248) 539-1800. Fax: (248) 539-1808. Web: www.healthylife.com.]
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• Powell DR, Sharp SL, Farnell SD, Smith PT. Implementing a self-care program: Effect on employee health care Utilization. AAOHN Journal 1997; 45(5): 247-53.
• Lewis S. Large self-care study demonstrates significant results. Employee Health & Fitness 1998; Vol. 20: No 3.