Archive for the ‘health professionals’ category

Advancing primary care in BC

June 12, 2011

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?

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Psychotherapist excels at social media

March 2, 2010

I e-met Dr. Susan Giurleo during a recent #hcsm session [healthcare communication and social media tweet chats held weekly and archived here]. I was impressed to learn that she was using social media to educate the public on mental health issues and on e-chatting with her, I discovered that she is a highly regarded licensed psychologist who works with kids and families living with ADHD and autism. Her blog is both a marketing vehicle for her practice and – more importantly from a public service perspective – a valuable parenting resource for families and the public at large.

Below are her insightful responses to my questions.

Which social media tools are you using?
I use primarily a blog and twitter.

What is your audience – patients, public at large?
Public at large, some of whom become clients

What strategy do you have in place? Do social media complement your other communication efforts?
Social media is my primary marketing approach. It is cost effective, easy to implement and has immediate turn around.

What policy do you have in place? What type of info do you disseminate? What commitment do you make re: responding to your audience comments
I share research findings, mental health tips (targeted to my specialty) and useful information on where people can go to learn more about a certain topic. I respond to most comments on my blog. I get emails as well and respond to those, even if it is just a quick, “thanks for your comment.”

How do you know what is working?
I measure informally (but all this can be easily measured via Google Analytics, if you use a blog). When I am consistent with sharing this information, my practice is booming. I also get emails from all over the world regarding my blog and newsletters. And this is dedicating 1 hr a week to it! The power of social media is amazing. If I did any more than what I currently do, I’d be swamped in my practice.

What time and staff resources are you spending on this?
The staff is me :-). I might dedicate 1-2 hrs a week on this. Like I said, the turnaround is fast and you don’t need to search too far to find relevant topics of interest.

How have you addressed privacy concerns and any other risks?
I don’t see any privacy concerns. Some people do email me with their specific concerns but I just email them back asking they call or if they live too far for me to help them, give them resources in their area. I never share any patient information, not even in ‘story’ form (i.e. “I have a client who…..”)
People intuitively seem to know that I can’t help them online if they are suicidal (never had any email contact regarding that issue) or in danger. I do put disclaimers on things like: “This content is for informational purposes only and does not constitute a therapeutic relationship or advice. If you feel you require more specific, personal support please contact…..”

Any concerns re: alienating those not yet in the social media space?
No. I feel people need to get on board. That is my bias, of course. In a few years it will be very difficult to find this information off line. With the slow death of newspapers and magazines and the fast growth of smart phones and tablet computers, we need to help people get online, not enable them to be passive and wait for the information to come to them. #hcsm is a great forum to explore all that. I think adding networked computers to medical waiting rooms should be the next wave in client support.

What I learned from Susan:
  • Social media works: Susan revealed that her social media strategy is so successful that her practice can hardly keep up with the demand for her services. A social media strategy can be cost-effective, providing immediate results – very attractive indeed.
  • Social media is very versatile: Susan is using social media to reach two audiences: a) educate the public about mental health at http://www.childdevelopmentpartners.com/blog/ and b) consult with health care professionals on how to develop ethical online business and marketing strategies at http://susangiurleo.com
  • Whatever resources you have are adequate: As the sole staff resource, she spends minimal time on social media activities and yet has remarkable success with an enviable ROI.  Her secret is creating high value content.
  • Social media can be used responsibly: Rather than shying away from social media altogether due to privacy concerns, Susan has created a sensible framework for using the tools to educate the public and recruit patients. She uses disclaimers and has set her own ethical standards – such as communicating with patients using appropriate channels and never sharing patient stories.

Dr. Susan Giurleo is a licensed psychologist who consults with health care professionals on how to develop ethical online business and marketing strategies. You can learn more by stopping by her blog, http://susangiurleo.com

Innovative BC doctors embrace patients as partners Part II

December 15, 2009

A previous post introduced the Patients as Partners Health Literacy Prototype (PAP) sponsored by the British Columbia Ministry of Health Service, Primary Care Division; Legacies 2010; and Impact BC with support of the British Columbia Medical Association.

Four health care teams from four different communities participated in the PAP Health Literacy Collaborative.  They were from Vancouver/Burnaby, the TriCities, Victoria and Hazelton/Gitsegukla. Each participating team was made up of a physician’s office practice and an adult literacy program. The teams  made changes in order to improve health literacy with  gratifying results which they reported during the Get Real: Partnerships for Moving Health Literacy Forward event on December 10 2009. The presentation is available here.

The Hazelton team

  • This unique team brought together Gitsegukla Health Center, Storytellers Foundation, University of Northern British Columbia and the Northern Health Authority – a remarkable partnership. Student nurses provided education and support to community members with high blood pressure.
  • The team wanted to address a unique problem in Gitsegukla. The area is served by newly graduated health practitioners who lack an understanding of the Gitsegukla First Nations culture. To address this problem, they created a cultural primer for health professionals who come to practice in the area so that they can be more sensitive to the cultural needs of the patients. The video will be a valuable tool in the recruitment of physicians.

Burnaby team
To “take patient values and preferences into account,” Dr. Hii’s practice implemented a number of changes with the remarkable results below :

  • assessing and documenting patient’s health literacy on intake by asking questions on formal education, preferred language, English fluency and daily reading habits.
  • use of patient education materials for diabetes self management to ensure patients understand the concepts of ABC (Hemoglobin A1c, BP and Cholesterol) control. They also use the teach-back and “close-the-loop” strategy to enhance understanding although this is very time consuming. More diabetes patients have their blood pressure and cholesterol under control.
  • proportion of patients answering “strongly agree”  to
    • My doctor asked about my ideas, beliefs & what I wanted when we planned my care went up from 30% to 60%. The goal is 80%.
    • My doctor explained things to me in a way that was easy to understand went up from 40% to 70%
    • I felt comfortable asking questions went up from 50% to 70%
    • It was easy for me to tell the doctor when there was something I did not understand went up from 40% to 70%
  • proportion of patients that explained medications and doses as prescribed; did not miss more than one dose in the last 7 days; did not start or stop any medications on their own went up from 70% to 90%.

Literacy learners at Douglas College:

  • learned about H1N1 (at least 10/12 learners could explain what H1N1 is, how it is spread, how to avoid spreading it and what to do if they thought they had it
  • participated in a pedometer challenge to increase their walking as part of a healthy lifestyle
  • learned that nurses were approachable from 3 nursing students who spoke to their class to about the nursing profession

Tri-Cities

To encourage clear patient-physican dialogue, the Tri-Cities team surveyed literacy (English-as-Second-Language) learners on how they would describe their relationship with their doctor:

  • 17/24 reported that they had a good-okay relationship;
  • 4/24 reported difficulty in talking to their doctor;
  • 16/24 reported having little to no confidence in asking their doctor questions.

The literacy learners suggested that they could improve the relationship with their physician by bringing a family member to an appointment and preparing questions that they would ask the doctor.

The Tri-Cities team assessed the literacy learners’ knowledge and use of the BC provincial non-emergency health information resource (811).

  • 21/28 were unaware of the resource while 7/28 had heard of it but did not know much
  • 26/28 had never used the resource while 2/28 had used the service and found it very beneficial
  • on learning about the resource, 18/25 reported feeling comfortable about using it
  • learners were particularly pleased to know that translation is available  into over 100 languages.

The Victoria team

  • created a prompt card (adapting the It’s Safe To Ask materials) to help their literacy learners communicate with their physicians, ask questions and seek clarification when something was not understood. The proportion of patients with confidence to speak up when there was something they did not understand increased from 3/8 to 7/8.
  • surveyed their patients and found that 28/30 of them did not know which internet sites can give me helpful and reliable information about my health. In response, the practice set up a computer with recommended plain language websites in the reception area. A tracking system was put in place to track use and request feedback on this resource.  90% of the patients used the selected resources. This intervention was in response to the high proportion of patients who brought in flawed information printed off the internet.
  • created a video to help literacy learners navigate their way to the practice location.

The results generated by these teams demonstrate that small changes can lead to significant improvement with far reaching impact on patients’ well being.  The 8 month pilot project has ended but all the teams are determined to find ways to continue the partnerships. Certainly, the participating medical practices will profoundly changed their approach to dealing with patients as they move forward. Their accomplishments can inspire other health professionals to find meaningful changes that could improve their patients’ health literacy. Only a few months ago, in an earlier post, I wrote ” We are a long way from having a robust health literacy strategy like that of Iowa …” so I am thrilled to be proved wrong because the Primary Health Care Charter provides a framework which has been translated into the 3 pronged change package strategy (build relationships, ensure understanding, partner).

Next steps

Some questions remain: what are the characteristics of the practices that volunteered to participate in this project? How can this awareness diffuse from these early adopters to others? How can the Victoria initiative to provide access to reliable online health information be further developed through partnerships with libraries across the province? How can technology be harnessed to empower patients (see my earlier post on e-patients)?  How can the barriers to a wider adoption of patient-centred care be addressed? Many physicians cite time constraints as the biggest barrier to more patient-friendly practice. The physicians at the event suggested these approaches to addressing these problems:

  • organize patient group sessions – for example to teach diabetes self management
  • partner with pharmacists to enhance medication compliance and safety
  • use of volunteer coaches to work with the patient
  • refer patients to libraries for consumer health information (the partnership between Vancouver Coastal Health and Richmond Public Library is an excellent example in this regard)
  • place computers in doctors’ offices to support access to reliable online health information (as in the example by the Victoria practice above)
  • support sharing of tools such as forms and patient resources to avoid reinventing the wheel. A good example is a medical clinic walk-about check-list.
  • involve medical office assistants and other office staff

The common thread in the above suggestions is the involvement of as many players as possible outside the traditional medical community  to extend the physician’s reach in optimizing physician-patient communication. This is a pragmatic approach that seeks to address the reality of overworked physicians in BC. As the awareness is now in place, the next step is identifying creative ways to incorporate these suggestions and other “low-hanging fruit”  in physician practices using the available resources. The ultimate progress will be accomplished when health literacy is considered important enough to merit ongoing and sustainable support across the province.

More information is available from the ImpactBC site or from the Collaborative Co-Directors: Connie Davis, ImpactBC, cdavis@impactbc.ca or Kelly McQuillen, Ministry of Health Services, kelly.mcquillen@gov.bc.ca

Health literacy 101 for physicians

November 7, 2009

There is a lot of interest about patient centred health care but before getting caught up in all the hype about using technology to engage e-patients, why not first start with the basics. The  average American reads at 8th grade level but most health communication is written at college level. How do you address this terrible disconnect? I recently watched this excellent video on how health professionals can acknowledge and cater to their patients’s health literacy. The video is part of the American Medical Association Foundation’s Health Literacy Kits.

Poor health literacy can have devastating consequences. A woman in the video signed a form authorizing a hysterectomy without knowing it. The video powerfully challenges the common assumption that low health literacy is only associated with the unskilled and unemployed. Many of the patients are skilled workers including a pharmacy technician and a machinist. Why expect an engineer to understand medical jargon any more than a doctor should understand engineering terminology? The video makes such good, practical points that they bear featuring here.

  • Create a shame-free environment: patients who have limited reading skills tend to be ashamed of this – they shouldn’t be but they are. One patient reported that they dealt with their frustration by covering up their reading limitations, getting angry and even walking out of the consulting room. Health professionals can support patients by making it easy for them to get help. Staff need to be non-judgemental and alert to cues that patients are having difficulty – for example, front desk staff can discreetly observe how long a patient takes to fill a form and whether they seem unsure and hesitant.
  • Understand patient needs: administer a questionnaire to assess reading level; take the patient’s social history – find out their cultural background, ask them how happy they are with their reading level
  • Improve communication skills: in taking to patients, health professionals should:
    • slow down when they speak
    • emphasize important concepts
    • use lay language: in one interview, the patient said to him, “hypertension” means one who is “hyper” or restless. The doctor was surprised to learn that the concept of high blood pressure was not getting across to him.
    • employ the use of visuals such as models, posters and graphics. A good example is taping an actual pill to the sheet with medication instructions. Patients with limited reading skills rely on the color and shape of the pill to identify it.
    • use familiar analogies. A good example in the video is a physician who compares arthritis to a joint in the door frame that lacks oil
    • involve family members who can help patients understand the information better
    • use the teach back method: Rather than ask “do you understand?”, ask “how would you explain this to someone else?”

Clinical pharmacists want to keep current

September 25, 2009

This week, I enjoyed the privilege of teaching a session to our academic detailers. Academic detailers are clinical pharmacists who visit and educate doctors, encouraging them to follow evidence based prescribing practice. All too often, doctors lack the time to keep up to date with current literature. At the same time, pharmaceutical companies are busy promoting their products and their representatives can scarcely be trusted to provide objective information when they call on doctors.

My role during the academic detailer workshop was to a) orient them to the Sharepoint portal I have developed for them and b) teach them about current awareness tools. The purpose of the portal is two-fold:

a) a library of core readings and literature on the detailing topics

b) a forum to share knowledge and experiences – a community of practice.

At the beginning of the class, I asked how many were familiar with current awareness tools such as blogs and RSS feeds and only one had heard of these. By the end of the session, it was gratifying to see how keen they were to sign up for and use these technologies: the valuable potential of blogging about and sharing experiences; the idea of gathering all your updates (whether from Pubmed, the Weather network, your favorite knitting blog or E-bay) in one place is uhhm…cool or what? They were such a delightful group and they asked whether I would do similar sessions at subsequent workshops!  I look forward to working with them as they experiment with these fun and useful tools. It’s been very rewarding despite my frustrations with Sharepoint (for example, the user alerts are very clanky and there is no known way of reading authenticated RSS feeds.) While I have had to work with Sharepoint to develop the portal and blog, I hope to gradually make the case to move to an open source forum which has the required security capability.