Patient Education and the Internet - University of Calgary

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18 Νοε 2013 (πριν από 3 χρόνια και 7 μήνες)

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Patient education:

New developments in practice
and research

FAMILY MEDICINE FORUM 2009
FORUM EN MÉDECINE FAMILIALE
Cathy MacLean, MD, CCFP, FCFP

Lynn
Dunikowski
, MLS

1

Session Objectives


Guided tour of patient education resources, with
emphasis on web
-
based resources


Ideas about how to incorporate more patient
education into physicians’ practices



Recognize barriers such as literacy


Synopsis of recent research and evidence on
patient education


Participants share experiences with colleagues

2


3

Opportunities for Pt. Ed.



Teachable moments during visits


During a periodic health exam


When the patient has web information


New diagnosis / new medication


Health promotion / prevention


Chronic Disease Management


Hospitalization


4

Patient Education and the Internet


Brochures and handouts


Newsletters


Patient Aides and Tools


Internet Interventions


Guidelines for Internet sites


Self Care/decision making tools


Information for Physicians



5

Patient Education and the Internet

Newer technologies & directions


Video and YouTube


RSS feeds and Podcasts


Blogs, Wikis, Twitter


EMR advancements


More Interactive Sites


Increased role for email



6

Concerns


Impact on the visit
-

time


Undermining trust


role of
misinformation


Usurping decision making


Challenges of finding common ground /
shared decision making


New approaches


information
prescriptions, internet interventions


7

Web versus Print Resources


Patient Control versus MD controlled


No filing papers


Need for a printer


Point of care access possible


Selection and review of resources


Maintenance of electronic files


Changing technology

8

Assessing Internet Sites


Information from top
-
level domain
names .org, .gov, .edu, .com


Canadian sites


HON
-

Health on the Net


Recommendations by hospital or librarian


Major health
-
related organizations











9

Health on the Net
www.hon.ch



Watch for the Logo and check the logo
for authenticity

10

General Considerations


Accuracy


Appropriateness


Ethnicity/language choice


Literacy Level


Consistency


Authorship/sponsorship


Links


Ease of use


Animation/illustration


Interactivity


No validated or reliable tools available



11

The Importance of Literacy:


Your naicisyhp has dednemmocer that you
have a ypocsonoloc. Ypocsonoloc is a test
for noloc recnac. It sevlovni gnitresni a
elbixelf gniweiv epocs into your mutcer.
You must drink a laiceps diuqil the thgin
erofeb the noitanimaxe to naelc out your
noloc.

12

AMA Literacy Program

Health Literacy



Literacy is a determinant of health.



~ 22% of Canadians have serious difficulty
with any type of printed materials.


Use Plain Language


Avoid medical jargon


Literacy assessment tools


Cultural sensitivity


Consider numeracy issues as well

13

Health Literacy Issues


Canadian Public Health Association
Health
Literacy Portal


Canadian Council on Learning
Health Literacy


American Sites:



National Institute for Literacy



American Medical Association Health
Literacy



www.plainlanguage.gov


14

Language & Culture and Patient
Education


Diagnosis
-

High “pertension” levels


Use of Medical jargon
-

Vomit


Taking meds


route of administration


Exploring health care beliefs


Other examples?



15

Altoona List of Medical Analogies
http://www.altoonafp.org/analogies.htm


Use analogies:



Taking medication on a regular basis is like
watering a garden. If you wait until the plants
are wilted it’s too late. You have to water
every day.



16

Health Literacy in Primary Care


Gloria G Mayer; Michael Villaire.
Health literacy in
primary care : a clinician's guide
New York : Springer
Pub., ©2007.


Chapters include: Creating a patient
-
friendly
environment; Assessing patients' literacy

levels; Understanding and avoiding

medical errors; Factoring culture into


the care process; Designing easy
-
to
-
read


patient education materials … more



17

Accessing Information on the Internet




Collaborating with
Dr. Google



No best medical search engine



Prescribe a specific URL



www.alexa.com

Web traffic site to see
most visited sites (under Health)


18

Patient Ed Resources from Journals
and EBM sites


JAMA Patient Page
www.jama.com

(towards foot of screen)


Annals of Internal Medicine
http://www.annals.org/patientinformatio
n/patientinformation.shtml


TRIP database


filter by Patient
Education
http://www.tripdatabase.com/



19

JAMA Patient Education Page

20

Getting Patient Ed pages from Medical
Journals


Go to
www.pubmed.gov/


Type your topic in the query box


Click on the Limits tab


scroll down the page


In the Type of Article menu


scroll down and
click on the “patient education handout” box


Move to bottom of page and hit “Go”

21

22

Health Canada Sites


Public Health Agency of Canada




Areas customized for Children, Youth, Adults,
Seniors, Aboriginal Health


Your
H1N1 Preparedness Guide

(
Or Google
“Canada H1N1 preparedness” to get there)


Healthy Living e
-
Bulletin
(quarterly)





23

New information channels
at PHAC


RSS feeds


social media tools,
Facebook

& Twitter


a mobile friendly URL


online videos on the PHAC YouTube
Channel; can embed them on your own
blog or personal Web site.



encourages information sharing,
collaboration, and interactivity


24

Health Related Agencies


Canadian Cancer Society

http://www.cancer.ca/

Facebook, Twitter, YouTube,
and more


Arthritis Society
http://www.arthritis.ca/

Open
Forum Community discussion boards


Canadian Heart and Stroke Foundation
http://www.heartandstroke.com

Facebook, Twitter,
He@lthline e
-
newsletter




25

Health Related Agencies


Thyroid Foundation of Canada
http://www.thyroid.ca/



Canadian Diabetes Association
http://www.diabetes.ca/

Facebook, Twitter, YouTube,
RSS feeds, and more




26

Medical Organizations


Canadian Pediatric Society
www.caringforkids.cps.ca


Society of Obstetrics and Gynecology
www.menopauseandu.ca


CFPC
www.cfpc.ca

> For Patients


CMA
www.cma.ca

> Public section


Centre for Effective Practice
http://www.effectivepractice.org


Foundation for Medical Practice Education
www.fmpe.org




27


Teens and Sex


great sites



www.sexualityandu.ca




www.hpvinfo.ca



http://www.goaskalice.columbia.edu


28









H1N1 Flu


29









Good to Share
-

adapted from National
Institutes of Allergy NIH (US)

http://www.goodtoshare.com


Your
H1N1 Preparedness Guide

(PHAC)


Fightflu.ca

(PHAC)


Medline Plus
H1N1 Flu (Swine Flu)


CDC
H1N1 Flu (Swine Flu)



Alberta Sites


Alberta Health Services / CHR
http://www.calgaryhealthregion.ca/patie
nts/index.htm


Family Health
www.familyhealthonline.ca











30

Test Information for Patients


Lab tests online


www.labtestsonline.org



Test information at Medline Plus (from US
National Library of Medicine)

www.nlm.nih.gov/medlineplus/tutorial.html

31

32

Compliance
www.askme3.org


What is my main problem?


What do I need to do?


Why is it important for me to do this?


Ask patients to repeat back to you what
they understand


33

US Sites


AAFP
-

Patient Education
on main site


Also at AAFP’s site for patients,
http://familydoctor.org


Health Finder
www.healthfinder.gov


CDC
www.cdc.gov


MedlinePlus
http://medlineplus.gov/


FDA
www.fda.gov/cder



34

Getting on Board


Bookmark best sites


EMR use
-

SOAPE


Patient computer in waiting rooms


Email subscriptions


Information therapy:


Internet “prescriptions” +/
-

email
reminders


Web sites


personal or UofC DFM

35

36

University of Calgary Department of Family
Medicine:
Recommended sites

37

Having your own Web Site


www.mydoctor.ca/drcathymaclean


Links to the Patient Education sites you
recommend


38

39

40

Recent research


Cochrane Consumers and Communication
Group


Research from Medline


Major biomedical database


20 million + references


Back to ~1966



41

Cochrane Consumers and
Communication Group


One of Cochrane Collaboration groups


Cochrane Library now free in Canada on a trial basis


Previously subscription only


High quality systematic reviews


Research about effectiveness of patient education
interventions


Information for public and health professionals


Cochrane Library is here

42

Cochrane Consumers and Communication
Group: Examples of protocols


Mobile phone messaging telemedicine for facilitating
self management of long
-
term illnesses


Negative versus positive framing of health information


Notification and support for people exposed to the
risk of Creutzfeldt
-
Jakob disease (CJD) through
medical treatment (
iatrogenically
)


Peer support strategies for improving the health and
well
-
being of individuals with chronic diseases


Physical rehabilitation involving goal setting for older
people living in the community


Shared decision making interventions for people with
mental health conditions


43

Cochrane Consumers and Communication
Group: Examples of completed reviews


Contracts between patients and healthcare
practitioners for improving patients' adherence to
treatment, prevention and health promotion activities


Decision aids for people facing health treatment or
screening decisions


Disclosing to parents newborn carrier status identified
by routine blood spot screening


Family
-
centred care for children in hospital


Interactive Health Communication Applications for
people with chronic disease


Interventions before consultations for helping patients
address their information needs

44

Research from Medline


MeSH


Medical subject
headings used for
patient education topics
in Medline


PATIENT EDUCATION AS
TOPIC


SEX EDUCATION


CONSUMER
PARTICIPATION


SELF CARE


HEALTH PROMOTION


COUNSELING


HEALTH EDUCATION


CONSUMER HEALTH
INFORMATION




45

Research from Medline


Link to a collection of 162 selected review articles
on patient education from 2008
-
2009 from
PubMed
here


Some common topics: wikis and blogs, self
-
management, diabetes education, health literacy,
knowledge transfer


Some examples follow:


46

Jack BW, et al.. A reengineered hospital discharge program to
decrease rehospitalization: a randomized trial.
Ann Intern Med.
2009 Feb 3;150(3):178
-
87

OBJECTIVE: To test the effects of an intervention designed to minimize
hospital utilization after discharge. I

INTERVENTION: A nurse discharge advocate worked with patients during
their hospital stay to arrange follow
-
up appointments, confirm
medication reconciliation, and conduct patient education with an
individualized instruction booklet that was sent to their primary care
provider. RESULTS: Participants in the intervention group (n = 370) had
a lower rate of hospital utilization than those receiving usual care (n =
368). CONCLUSION: A package of discharge services reduced hospital
utilization within 30 days of discharge.


News item from AHRQ
here

47

Laurent MR, Vickers TJ. Seeking health information online: does
Wikipedia matter?
J Am Med Inform Assoc. 2009 Jul
-
Aug;16(4):471
-
9.

Epub 2009 Apr 23.

OBJECTIVE To determine the significance of the English Wikipedia as a
source of online health information. DESIGN The authors measured
Wikipedia's ranking on general Internet search engines by entering
keywords from MedlinePlus, NHS Direct Online, and the National
Organization of Rare Diseases as queries into search engine
optimization software. RESULTS Wikipedia ranked among the first ten
results in 71
-
85% of search engines and keywords tested. Wikipedia
surpassed MedlinePlus and NHS Direct Online, and ranked higher with
quality articles. Wikipedia ranked highest for rare diseases. Based on
its search engine ranking and page view statistics, the English
Wikipedia is a prominent source of online health information
compared to the other online health information providers studied.


48

Scott SD, Plotnikoff RC, Karunamuni N, Bize R, Rodgers W. Factors influencing
the adoption of an innovation: An examination of the uptake of the
Canadian Heart Health Kit (HHK).
Implement Sci. 2008 Oct 2;3:41
.

There is an emerging knowledge base on the effectiveness of strategies
to close the knowledge
-
practice gap. The Healthy Heart Kit (HHK) is a
risk management and patient education resource for the prevention of
cardiovascular disease (CVD) and promotion of cardiovascular health.
Use of the HHK was associated with intention to use the HHK, relative
advantage, and years of experience. Relative advantage and the
observability of the HHK benefits were also significantly associated
with physicians' intention to use the HHK. Physicians working in solo
medical practices reported experiencing more individual and
environmental barriers to using the HHK.


PMID: 18831766



49

Byrd J, Thompson L. "It's safe to ask": promoting
patient safety through health literacy. Healthc Q.
2008;11(3 Spec No.):91
-
4.
http://www.safetoask.ca/

The Manitoba Institute for Patient Safety launched "It's Safe to Ask" in
January 2007. The communication and health literacy initiative is aimed at
Manitoba's vulnerable populations and their primary care providers. Tools,
available in 15 languages, provide patients and family members with three
key questions to ask in healthcare interactions, tips on how to ask


questions, and room for notes and listing of medications. The initiative will
promote involvement in healthcare by patients, stronger communication
between patient and provider, and reduction of risk for adverse events.
"It's Safe to Ask" has been implemented in over 65 sites across Manitoba.


PMID: 18382168


50

Adams SA. Blog
-
based applications and health information: Two
case studies that illustrate important questions for Consumer
Health Informatics (CHI) research.
Int J Med Inform. 2008 Aug
11
.



Weblogs (blogs), together with podcasts and wikis are part of the
larger body of next
-
generation communication applications
dubbed "web 2.0.“ In this study, a literature review on blogs
and blogging practices was conducted, followed by case
studies. This paper explores the diverse purposes for which
blogging applications can be (or are being) used in relation to
health and introduces the idea of "health goal
-
oriented"
blogging. PMID: 18701344


51


Summary


The importance of literacy


Qualities of a good site / HON


Recommended sites


Incorporating Pt Ed into your practice
using web sites


Being aware of new research, &
translating it into practice

52

Questions?

53

Thanks!


Cathy MacLean

cmaclean@ucalgary.ca

Lynn
Dunikowski

clfm@uwo.ca