Working with Dr.

Patient Education Strategies for Learners

Preceptors Workshop, October, 2015

Cathy MacLean, MD, CCFP, FCFP

1 Family Medicine

Family Medicine

No conflict of Interest to declare with a

pharmaceutical or device company or other

industry support; distant honorium for Guide

Your Patients to a Smoke Free Future project

CFPC Patient Education Committee Chair

COI

What would you like to get out

of this session?

3

Family Medicine

Objectives of the Session

Participants will be able to:

1. Find quality patient education sites on

the internet that can be recommended to

learners and patients.

2. Utilize strategies in an office practice

and when teaching, to enhance patient

self care and learners’ education.

4

Family Medicine

Patient Education

• Encompasses - health promotion,

prevention, disease specific information,

tools, communication and guidelines.

• Includes more than the transfer of

information; facilitates behaviour

change and encourages self

management.

Task Force on Patient Education CFPC 2008 5

Family Medicine

Opportunities for Patient Ed

• With learners

• Teachable moments during visit

• During a periodic health exam

• New diagnosis / new medication

• Health promotion / prevention

• Chronic Disease Management

• Hospitalization

• When the patient has web information

Family Medicine

Getting

health

info

from

the

internet

7

Patient Education on the Internet

•Brochures and handouts

•Newsletters

•Patient Aids and Tools

•Videos, demonstrations

•Guidelines for Internet sites

•Self Care/decision making tools

•Information for Physicians

….

8

Family Medicine

Newer directions

• Videos and YouTube

• RSS feeds and Podcasts

• Blogs, Wikis

• Twitter

• EMR advancements

• More Interactive Sites

• Increasing role for patient email

• Secure Patient Portals

9

Family Medicine

Assessing Internet Sites

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

•Canadian sites

•Recommendations by hospital or librarian

•Major health-related organizations

•HON - Health on the Net

10

Family Medicine

Health on the Net

www.hon.ch

•Watch for the Logo and check the

logo for authenticity

11

Family Medicine

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

12

Family Medicine

Options for practice

• Health Literacy assessments

• Translation options on-line

• Techniques to improve patient ed skills – 6 A’s

• Where to get on line resources- organizations

• Government sites – Can, US and UK

• Well baby to Seniors care – sites to visit

• Self care sites

• Prescribing -recommended sites

13

Family Medicine

Health Literacy

• Literacy is a determinant of health

• Know the literacy levels of your

population

• Use Plain Language

• Avoid medical jargon

• Literacy assessment tools

• Cultural sensitivity

• Consider numeracy issues as well 14

Family Medicine

15

Try this:

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.

AMA Literacy Program 16

Family Medicine

Health Literacy

• Gloria G Mayer; Michael Villaire.

New York : Springer Pub., 2007

• Can. Public Health Assoc.

http://www.cpha.ca/

• http://novascotia.ca/dhw/primaryhealthcare/resources.asp

17

Family Medicine

Health Literacy

• http://www.ahrq.gov/health-care-

information/topics/topic-health-

literacy.html

• http://www.phac-aspc.gc.ca/cd-mc/hl-

ls/index-eng.php

18

Family Medicine

Translation

• http://www.babblefish.com/

• https://translate.google.ca

19

Family Medicine

Language Options

For pamphlets in multiple different languages:

• http://www.nlm.nih.gov/medlineplus/lan

guages/languages.html

• www.hon.ch

• http://rhin.org/

• http://www.healthlinkbc.ca/

20

Family Medicine

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.”

21

Family Medicine

Patient Ed Resources from

Journals and EBM sites

• Bandolier

• Annals of Internal Medicine

http://www.annals.org

• BMJ

• Cochrane

www.thecochranelibrary.com

• JAMA Patient Page www.jama.com

• AB Tools for Practice http://www.acfp.ca

22

Family Medicine

JAMA Patient Education Page

23

Family Medicine

24

Patient Ed in Medical Journals

• Go to www.pubmed.gov/

• Type your topic in the query box

• Search

• In the left hand menu – scroll down and

click “patient education handout” as

your filter

• Ideal for – difficult topics, other

languages, current from diverse sources

25

Family Medicine

Government Sites

• Public Health Agency of Canada

• Health Canada

http://www.hc-sc.gc.ca/index-eng.php

http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/index-eng.php

It’s Your Health Newsletter

26

Family Medicine

NL Government Sites

• http://www.easternhealth.ca/WebInWeb.

aspx?d=3&id=1856&p=1552

• http://www.health.gov.nl.ca/health/index.

html

27

Family Medicine

Eastern Health

• http://www.easternhealth.ca/OurCommunit

y.aspx

• http://www.easternhealth.ca/WebInWeb.as

px?d=2&id=1552&p=1547

28

Family Medicine

Medical Organizations

• CFPC http://www.cfpc.ca/Home/

Preventioninhand.com

• Choosing Wisely Canada www.choosingwisely.ca

• Canadian Pediatric Society www.caringforkids.cps.ca

• Centre for Effective Practice

http://www.effectivepractice.org

• Foundation for Medical Practice Education

www.fmpe.org

29

Family Medicine

Medical Organizations - CMA:

Patient handouts through -

• MD Consult

• AccessMedicine

• Lexicomp

www.cma.ca

30

Family Medicine

Well Baby Care

• http://www.rourkebabyrecord.ca/

• http://immunize.ca/en/app.aspx

• http://www.caringforkids.cps.ca/

• http://www.beststart.org/

• http://www.aboutkidshealth.ca/En/Pages/default.aspx

• http://www.cfpc.ca/

• www.safechildren.ca

• http://machealth.ca/programs/18-month/p/as-direct.aspx

31

Family Medicine

Nutrition Sites

• For Nutrition : Dieticians of Canada - national

info re: nutrition - http://www.dietitians.ca/

• NutriSTEP - screening for toddlers and

preschooler nutrition adequacy -

http://www.nutristep.ca/

• Eat Right Ontario - dieticians giving advice on

a variety of topics -

http://www.eatrightontario.ca/en/default.aspx

32

Family Medicine

Chronic Pain

• The Canadian Pain Society

www.canadianpainsociety.ca

• Canadian Pain Coalition

www.canadianpaincoalition.ca

• Living well with chronic pain:

http://livewellwithpain.ca/

• Breathing/yoga and pain http://www.lifeisnow.ca/

• Mindfulness for chronic pain

http://www.neuronovacentre.com/

33

Family Medicine

Mental Health

• http://keltymentalhealth.ca/healthy-living

• http://strongestfamilies.com

• http://www.camh.ca/en/hospital/health_in

formation/Pages/default.aspx

• http://www.aboutkidshealth.ca/en/news/d

rpat/pages/default.aspx Ask Dr. Pat Advice

• http://www.heretohelp.bc.ca/

34

Family Medicine

Health Related Agencies

• Canadian Cancer Society

http://www.cancer.ca

• Lung Associate

www.lung.ca

• Canadian Diabetes Association

www.diabetes.ca

• Arthritis Society

http://www.arthritis.ca

• www.motherisk.org

35

Family Medicine

More Canadian Sites…

• Thyroid Foundation of Canada

http://www.thyroid.ca/

• Canadian Heart and Stroke Foundation

http://www.heartandstroke.com

• http://www.hypertension.ca/en/

• Sexuality and You www.sexualityandu.ca

• Women’s Health Matters

http://www.womenshealthmatters.ca/

36

Family Medicine

More Canadian Sites…

• www.hpvinfo.ca

• http://menopauseandu.ca/index_e.aspx

• www.healthlinkbc.ca

Family Health Magazine – on line

• www.familyhealthonline.ca

37

Family Medicine

Geriatrics

http://www.canadiangeriatrics.ca/

38

Family Medicine

Palliative Care

• Virtual Hospice -

http://www.virtualhospice.ca/en_US/Main+Site+Navigation/Home.

aspx

• Canadian Hospice Palliative Care Association -

http://www.chpca.net/

• Palliative.org - http://palliative.org/

• Pallium Canada - http://www.pallium.ca/

• Speak Up - http://www.advancecareplanning.ca/

39

Family Medicine

Additional Sites - US

• AAFP - http://familydoctor.org

• Health Finder www.healthfinder.gov

• CDC www.cdc.gov

• MedlinePlus http://medlineplus.gov/

• FDA www.fda.gov/cder

• AHRQ http://www.ahrq.gov/patients-

consumers/index.html

40

Family Medicine

More Sites

• http://www.goaskalice.columbia.edu

• http://health.nih.gov/

• http://www.patient.co.uk/

• NICE Guidelines with consumer information

https://www.nice.org.uk/guidance

41

Family Medicine

Test Information for Patients

• Lab tests online www.labtestsonline.org

• Test information at Medline Plus (from US National Library of Medicine) https://www.nlm.nih.gov/medlineplus/diagnostictests.html

• Ottawa Decision Aids

https://decisionaid.ohri.ca/decaids.html

42

Family Medicine

Choose Wisely Canada

http://www.choosingwiselycanada.org/m

aterials/

http://www.youtube.com/watch?v=FqQ-

JuRDkl8&feature=youtu.be

43

DFM – Website Links

• http://www.med.mun.ca/familymed/

patients.aspx

44

Family Medicine

Effective Pt. Ed Program models

• http://patienteducation.stanford.edu/

programs/

45

Family Medicine

46

Prescribe a web site

Family Medicine

Prescribing - Exercise

• http://www.exerciseismedicine.ca

48

Family Medicine

Prescribing Sites

49

•INR Management

http://www.aafp.org/fpm/2005/0500/p77.html

•Rx files www.rxfiles.ca

Family Medicine

Prescribing

Medical Letter: http://secure.medicalletter.org/

CMA Drug information through member log in

Natural Database (requires subscription)

Toxicology Data Network: http://toxnet.nlm.nih.gov/

50

Family Medicine

Adherence 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.

Family Medicine

Doing a family history

• https://familyhistory.hhs.gov

• http://www.cdc.gov/genomics/fa

mhistory

52

Family Medicine

YouTube

• http://www.youtube.com/user/NHSChoices

?blend=2&ob=1

• http://www.youtube.com/watch?v=WWv8rg

353XQ …for the fun of it!

53

Family Medicine

Canadian content –

multiple topics including

PSA testing, etc.

http://www.youtube.com/user/DocMikeEvans

54

Family Medicine

Have your own site

and provide links

55

Family Medicine

Getting on Board

• Bookmark best sites

• EMR/progress notes use – SOAPE

E = Education

• Patient computer in waiting rooms

• Email subscriptions/email reminders

• Information/bibliotherapy

= Internet “prescriptions”

• Web sites – personal, clinic or discipline 56

Family Medicine

Other ideas for learners

57

•Have students write patient ed handouts

•Show patients their Framingham scores

and how the scores can change

•Use of pictures on line – great for visual

learners – Google Images or Apps

•Download inhaler pictures so patients

can show you which they use and how

Family Medicine

Medical Student Patient

Education Project

• Phase 1 – Patient Education

Recommended resources

• Phase 2 – Office Set up and

Health Literacy in NL

• Phase 3 – Presenting at FMF

Jessica Dwyer

58

Family Medicine

Summary

• Opportunities to use web based resources

• The importance of literacy and addressing

barriers/concerns. Teach about plan language.

• Qualities of a good site / HON

• Recommended sites – select your favourites

and bookmark them. Write web scripts.

• Set up your practice to use best sites – for

you, your patients and your learners.

59

Family Medicine

References

• CFPC Patient Education Task Force Report

• Hartzb and, Pamela and Jerome Groopman.

“Untangling the Web- Patients, Doctors and

the Internet,” NEJM 36(12) 1063-66, March 24,

2010.

• MD Scope, April, 2010.

• MacLean, C. President Page, CFP, 56: 1396,

July, 2010.

• Powers, et al. “Can This Patient Read and

Understand Written Health Information”,

JAMA, 304(1): 76-84, July 7, 2010.

60

Family Medicine

Thanks!

cmaclean@mun.ca

Family Medicine

61

Family Medicine

62

http://philbaumann.com/2009/01

/16/140-health-care-uses-for-

twitter/

63

Podcasts Most Available on i Tunes

• Cochrane

• Tools for Practice/Therapeutics

Initiative

• InfoPoems

• NEJM

• BMJ

• The Lancet

• Annals of Internal Medicine

64

e-Patients

http://epatientdave.com/for-patients/

http://participatorymedicine.org/

“e-Patients are Empowered, Engaged,

Equipped and Enabled.”

Dr. Tom Ferguson 65

Family Medicine

Self Care

• http://www.wikidoc.org//index.php/WikiPatie

nt

• http://www.caringbridge.org/

• http://www.patientslikeme.com/

• http://www.inspire.com/

• http://www.medhelp.org/

• www.acor.org for patients with cancer

• http://consumers.cochrane.org

66

Family Medicine