Section 3.5.6: Patient Mediated Interventions

[ Table of Contents ]

A O'Connor, RN, PhD, FCAHS
Professor, University of Ottawa
Senior Scientist, Ottawa Health Research Institute


Key Messages: Patient-Mediated Interventions

  • Aim to actively engage patients to improve their knowledge, experience, service use, health behaviour, and health status
  • Patient education and information improve knowledge; other outcomes improve with more specific and personalized information, and added professional and other support
  • Research gaps: underlying frameworks, essential elements & duration, cost-effectiveness, best implementation strategies

Topics

  1. Case Study
  2. Effective Interventions
  3. Exemplars

1. Case Study

Mrs. C

"I've had a sleepless night… "

Knee pain affects sleep → not sure re surgery that was offered

Husband feverish → not sure re going to ER

Forgot to fill new script → not sure how important it is

Mrs. C Is Not Alone…

  • 924 patients were questioned
  • From 5 family practices in Quebec
  • after making a decision with MD

Survey Results

Unsure Uninformed Unclear Values Unsupported
TOTAL 55% 15% 7% 38%
Vaccination 71% 29% 36% 36%
Diabetes 60% 20% 0% 27%
Pain 59% 14% 10% 31%
Depression 58% 15% 5% 30%
Hypertension 57% 17% 5% 40%
Lifestyle 58% 15% 5% 30%
Cholesterol 55% 18% 18% 27%

Data from France Legare, U Laval

2. Effective Interventions

BMJ logo

Effectiveness of strategies for informing, educating, and involving patients

Angela Coulter and Jo Ellins

BMJ 2007;335;24-27
doi:10.1136/bmj.39246.581169.80

25 Reviews: Health Literacy Interventions

22 Reviews: Clinical Decision Making Interventions

67 Reviews: Self Care & Chronic Disease Self Management Interventions

Health Literacy

Definition

A person who is health literate is able to access, understand, evaluate, and communicate information as a way to promote, maintain and improve health in a variety of settings across the life course.

Expert Panel on Health Literacy. A Vision for a Health Literate Canada: Report of the Expert Panel on Health Literacy. Canadian Public Health Association, 2008.

Interventions

  • Written health information materials (e.g. brochures)
  • Alternative format resources (e.g. internet)
  • Targeted approaches for disadvantaged groups with low health literacy (e.g., pictograms, videotape, interactive computer)

Clinical Decision Making

Interventions

  • Communication skills training for clinicians
  • Question prompts for patients and coaching to develop skills in preparing for a consultation, deliberating about options, and implementing change
  • Patient decision aids: explain options, present probabilities benefits vs. harms, clarify features of options that matter most, and provide structured guidance in deliberation and communication

Self Care & Self Management Interventions

  • Aim to improve people's practices in maintaining and managing their disease
  • Self management education to help people cope with their disease and manage daily problems
  • Self monitoring and self-administered treatment
  • Self help groups and peer support
  • Patient access to personal health information
  • Patient-Centered tele-care
Three Reviews

Decision Aids Reduce Rates of Discretionary Surgery

Graph: Decision Aids Reduce Rates of Discretionary Surgery

RR=0.76 (0.6, 0.9)
O'Connor et al., Cochrane Library, 2009

Review Conclusions

  • Patient education/ information ↑ knowledge
  • To ↑experience, service use, health outcomes, behaviour change…
    • ↑ specificity/personalization of information
    • combine interventions with professional or other social support
    • extend duration for long term behaviour change
  • Research gaps: underlying frameworks, essential elements & duration, cost-effectiveness, best implementation strategies

3. Exemplars

Screen capture: Saskatchewan Health - Healthwise Knowledgebase Main
Banner: Saskatchewan Health - Healthwise Knowledgebase Main Screen capture: Health Symptom Checker Screen capture: High Blood Pressure Screen capture: Osteoarthritis

Challenge #1

  • Need to train potential users:
    • High school students
    • Post secondary students
    • Health science students
      day 1 of training
    • New mothers
    • Health departments
    • Call centers and help-lines

Big Challenge #2

  • Embed 'just in time' information for the individual as part of the process of care

Wagner Chronic Care Model

Diagram: Wagner Chronic Care Model

Implementation: Clinical Care

  • Dartmouth HMC, VA, Mass Gen. & FIMDM Network
  • Group Health Cooperative
  • NHS Urology & Orthopedics
  • Ottawa Pilot: Orthopedic Intake Clinic; Breast/Prostate Ca Center

Delivery Model

Screen Capture: Dartmouth-Hitchcock Medical Center

Decision Aid

Icon

Personal Decision Form

Knee Osteoarthritis Personal Decision Form

Summary Report for Surgeons


Summary Report for Surgeons

Stacey, D. et al. BMJ 2008;0:bmj.39520.701748.94v2-bmj.39520.701748.94

Online Quality Reports

Summary Report for Surgeons

Summary Report for Surgeons

Key Messages: Patient-Mediated Interventions

  • Aim to actively engage patients to improve their knowledge, experience, service use, health behaviour, and health status
  • Patient education and information improve knowledge; other outcomes improve with more specific and personalized information, and added professional and other support
  • Research gaps: underlying frameworks, essential elements &s duration, cost-effectiveness, best implementation strategies
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