How clinical librarians can link health professionals with the evidence

Posted June 21, 2011 by shebamuturi
Categories: Uncategorized

I attended the CHLA conference a couple of weeks ago and was thoroughly refreshed and inspired by the program. I will share some of the highlights over a few blog postings.

One of  the most fascinating speakers was Dr. Eddy Lang, who gave a most insightful key note entitled: Information Science in the Evidence Based Era: Meeting the Perceived and Unperceived needs of Evidence Consumers. He is an eminent academic emergency physician and researcher who is passionately interested in Evidence-Based Medicine (EBM) and Knowledge Translation (KT).

Some of the gems from his talk included four scenarios of when evidence would be needed in clinical practice and what the gaps might be.

  • Treating a 25 year old female in the emergency ward with anxiety attack and symptos of a pulmonary embolism. Should you recommend a CAT scan or not? A CAT scan delivers a high amount of unnecessary radiation. To make a decision, the physician needs access to a validated decision tool – the pulmonary embolism rule out criteria – which may establish that in fact, the embolism is not the primary problem and preempt unnecessary radiation exposure. Physicians lack the the skills to find this information at the point of need during critical decision points.
  • A resident presenting on atrial fibrillation excluded key onging trials within Calgary – found in the Clinical Trials.gov site
  • In developing clinical tools such as orders sets, health professionals lack embedded decision support for levels of evidence.

Drawing on Alison Brettle’s study, Dr. Lang identified 4 models of clinical librarian integration that can help physicians access information at the point of need:

  • Questions and Answers
  • Questions and Answers + Critical appraisal
  • Outreach: proactively engaging and embedding librarians
  • Outreach + Critical appraisal + Synthesis

Credits

“Evidence stamp” from http://clinicigo.wordpress.com/home/

Advancing primary care in BC

Posted June 12, 2011 by shebamuturi
Categories: Consumer health, doctors, pharmacists

Why is primary care so important?

“Primary care is the first point of contact a person has with the health system – the point where people receive care for most of their everyday health needs. Primary care is the first point of contact a person has with the health system – the point where people receive care for most of their everyday health needs. Primary care is typically provided by family physicians, and by nurses, dietitians, mental health professionals, pharmacists, therapists, and others” (What is primary care?)

Divisions of Family Practice

Under the auspices of the General Practice Service Committee, the Divisions of Family Practice was designed to both improve patient care and address family doctors’  influence on health care and professional satisfaction.  Family doctors in a community organize themselves into a non-profit to work towards common health care goals. They are able to receive funding towards their initiatives.

I learned about this initiative when I listened to a presentation made to seniors by the White Rock South Surrey Division.  One of the first of three to be established in BC, this division seeks to improve:

  • population health
  • the patient/provider experience
  • system sustainability

I was impressed that this division of 73 members has 3 staff members. Their programs promote enhanced hospital care, local citizens’ access to a family doctor (through the attachment initiative), recruitment of additional doctors to ease the shortage and continuing education programs for doctors.

Their key initiative is the Primary Care Access Clinic which supports unattached patients (lacking a family doctor) who require care upon discharge from Peace Arch Hospital. The clinic is staffed by a multidisciplinary team which includes nurse practitioners, mental health care staff and social workers and home health workers who can refer patients to needed services and monitor complex cases.

When I mentioned this interesting model to a pharmacist colleague, he had an interesting comment. He said that progressive practices will usually recognize the need to have nurse practioners, social workers…but for some reason, they don’t seem to see the need for a pharmacist. This is partly because pharmacists are often perceived as retail, business rather than clinical specialists. In addition, the physician-pharmacist interactions tend to be negative because pharmacists will usually only call physicians with bad news – that they made a mistake.

With 24 divisions, the Divisions of Family Practice model seems to be really taking off and advancing primary care. Their progressive and patient-centric approach is extremely important and they can be important allies in promoting health literacy and other key but often-neglected patient oriented interventions. However, is my colleague right – that they are failing to include pharmacists in their care teams? What are pharmacists doing to improve their interactions with and perceptions by physicians?

BC launches new prescription for health program

Posted June 1, 2011 by shebamuturi
Categories: Uncategorized

Last week, the BC government announced a $68.7-million Healthy Families BC strategy to “help families make healthy choices and introduce innovative approaches to challenges facing the health care system.”

The first program of this strategy is the $24-million Prescription for Health program intended to equip B.C. doctors with tools to assess and work with patients to develop a health promotion and illness prevention plan appropriate for them. The key elements of the program include the following:

  • Prescription for Health is available to patients with at least one of these risk factors: smoking; unhealthy eating; physical inactivity and medical obesity.
  • Patients can identify a lifestyle change goal, which will be documented by the physician on a Prescription for Health.
  • The patient’s Prescription for Health may refer them to free-of-charge lifestyle programs to help patients achieve their individual lifestyle change goals. Examples of lifestyle support resources: the Physical Activity Line, Dietitian Services at HealthLink BC, QuitNow Services, a tobacco-cessation service and information resource, the Patient Voices Network peer coaching program.
  • As an incentive, 50,000 participating patients can receive up to $50 toward programs that support their goals: gym membership, physical activity programs or nutritional programs.

For more information on Healthy Families BC or Prescription for Health, please visit www.healthyfamiliesbc.ca

I consider this a significant leap away the from the traditional focus on treatment to the more cost-effective prevention strategies – potentially avoiding up to $2 billion in yearly health-care costs. Obesity alone costs up to $830 million a year to the economy. What’s really fascinating is that patients get a financial incentive – it’s a really good idea to reward good behaviour. It will be interesting to see what the uptake of the program will be like, and what outcomes will result.

Patients Voices Network

Posted April 28, 2011 by shebamuturi
Categories: Consumer health, Social media

Earlier this year, I had the privilege of attending a Patients Voices Network (PVN) training session. PVN is a program that recruits, trains and supports patients and their families to participate in primary health care changes.  For an interesting and informative overview about their work, see the video below which is also on their website.

PVN provides impressive opportunities for consumer participation:

  • An online community or virtual network of patients that register to provide input through response to surveys
  • Activated network of trained patients who can be involved at three levels:
    • Shaping the system: participating in focus groups, patient advisory committees and panel discussions; patient journey mapping
    • Community Activation: working in patients’ local communities to improve primary health care
    • Peer to Peer Coaching: supporting and motivating individuals to achieve healthy living goals.

One point that stood out for me was the positive approach that was emphasized by PVN. Patients’  may first be compelled to become activated members of PVN due to negative experiences with the healthcare system. While their frustration is understandable, it is important that theyare motivated by a desire to provide constructive feedback rather than hostile criticism.

Another highlight of the workshop was listening to Johanna Trimble speak about her involvement with PVN and what she has learned along the way. She had many positive experiences to relate but also cautioned participants to be balanced and acknowledge their limitations ie. not to volunteer for each and every opportunity.  Johanna, a steering committee member, has spoken at international conferences about her experience with the health care system and her presentation Is Your Mom on Drugs? – Find out what to do about it” is most compelling.

It’s good to ask…about your medications

Posted January 13, 2011 by shebamuturi
Categories: Uncategorized

This year, we are doing a fantastic series of workshops in the community to promote medication safety. The workshop is titled It’s Good to Ask about your Medications based on the It’s Good to Ask Program which encourages patients and consumers to participate more actively in their health care. Given that the average person only spends 12 hours per year with health professionals, it is essential that they are equipped to manage their own health for the rest of the 364.5 days.*

Our key messages include

  • Why its good to ask questions about your medications: What medication am I  taking? Why am I taking this medication? How do I take this medication?
  • Ways to ask questions to get the answers you need.

Our presentation to the Health Watch Program was very well received and we learned a great deal from the participants too.

  • There were about 16 participants, many of whom listened while attending to important business such as taking weight and blood pressure readings and receiving massage sessions.
  • They were an eager and engaged audience asking questions and making insightful comments through out the session. For example:
    • Do doctors keep as uptodate as pharmacists?
    • What does it mean to take medication with food? Does it have to be a full meal or can it be a snack such as a muffin?
    • Are vitamins better absorbed in powder rather than tablet form?
  • We learned that the group actively supports members in taking charge of medication safety through:
  • supply of medication booklets which members fill and carry
  • keeping uptodate medication history records at the centre
  • supply of vials used to store a dose of all of a patient’s drugs and corresponding list to be kept in the fridge. Emergency responders would be able to find this vial if the patient was unconscious.
vial for emergency medication

Vials for storing medication accessible to emergency responders if patient is unconscious

  • Despite being a group that interacts with pharmacists regularly, they picked valuable points. For example, they were not aware that all prescriptions dispensed in B.C. are tracked in the PharmaNet system and patients can walk into any pharmacy and the staff there will have access to their information.
  • They recognized that
    • pharmacists are the most handy and accessible health care profession : “it is easier to talk to a pharmacist than a doctor”
    • pharmacists are a good source of information about the recommended daily requirements for vitamins and other supplements
    • 811 is the number to call for non emergency health information
    • the patient is the most important member of the healthcare team.
*Barlow, J. Interdisciplinary Research Centre in Health, School of
Health & Social Sciences, Coventry University, May 2003.

Seniors take charge of their health

Posted January 13, 2011 by shebamuturi
Categories: Consumer health, Health literacy, Seniors

Seniors taking an active role in their health

Health Watch program in Burnaby, British Columbia struck me as a really unique program for promoting wellness among seniors. This calendar outlines some of their weekly activities.  Healthwatch along with three other programs  is part of the Burnaby Partners in Seniors Wellness. It is an excellent model of what can be done when seniors come together and are supported to take charge of their own health.

  • The group is run by a volunteer board which plans and manages its activities. They request for funding from the Fraser Health Authority and have to report back on their activities.
  • The funding is used to hire a coordinator who is shared by two programs.
  • Retired health care workers have been recruited as volunteers to conduct screenings, monitor blood pressure and pulse etc.
  • The group has secured permission to collect and maintain the health records of the participants. Volunteers fill out a medical card with vital information and give participants a wallet card. Weight and blood pressure are recorded each visit and an uptodate record of medications is maintained.
  • Trained volunteers offer massage, conduct chair exercises
  • Speakers are regularly invited to speak on various topics of interest to seniors such as our medication safety session.
  • The seniors also enjoy socializing with their peers
  • Partnering with local pharmacists t0 run a clinic  where seniors can bring in their drugs and have the pharmacist “critique” them. One of the seniors brought 21 different medications.
  • Encourage their members to maintain an uptodate medication list.

Image credit: Used under creative common license Pocmont Resort and Conference Centre

mHealth Summit 2010: Notable tweets

Posted November 22, 2010 by shebamuturi
Categories: Global health, Mobile health

Tags:

This is the final of a series of posts summarizing the recent 2010 mHealth summit‘s highlights from my own perspective and through the lens of insightful tweets of avid tweeple who attended the conference in person. Previous posts include an overview, Patricia Mechael’s pearls of mHealth wisdom, mHealth is not about technology, mHealth and the evidence and mHealth in western vs global contexts.

Below are succinct snippets of mHealth wisdom not captured in the previous posts:

  • lundelle RT @eedgerton mHealth can help throughout value chain: prevention/info; data collection; diagnosis; treatment/intervention; homecare. #mhs10
  • RT @Hallicious: Right on: mHealth technology doesn’t have to be perfect. It just needs to be better than what exists today. – Dr Joseph Smith
  • downeym Great point from audience member – don’t forget illiterate, tech-unsavvy users when making #mHealth solutions. Design well! #HCI #mHS10
  • alshar Misalignment: Docs paid for procedures and hospitalization. Patients want avoid both. #mHS10 -
  • stevemuse No real strategy in mHealth, gov, private sector doing innovative things, supply led direction, but what does society want #mhs10
  • chloevdc audience member: ‘data is great for research and providers, interaction is needed for patients’ #mhs10
  • chloevdc Rural telemedicine is happening in rural India already. Check out http://www.globalhealthpoints.com Big announcement tomorrow morning! #mhs10
  • Mhealth is not  fad, delivers real outcomes – real value across chain; 30% of consumers willing to pay $2 on consultation Lisa D. Ellis, McKinsey & Company
  • @billgates The major problems in a developing country are insolvable at a 3% per year population growth. #mhs10 (via @clickwisdom)
  • mPuleio mHealth consideration: what is the key metric you are trying to improve?-Gates #mhs10

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