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Patient Mediated Interventions

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

Download: Presentation (PDF, 1.1MB)

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

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
Three Reviews
Graph: Decision Aids Reduce Rates of Discretionary Surgery

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
Screen capture: Saskatchewan Health – Healthwise Knowledgebase Main
Screen capture: Health Symptom Checker
Screen capture: Health Symptom Checker
Screen capture: High Blood Pressure
Screen capture: High Blood Pressure
Screen capture: Osteoarthritis
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
Screen Capture: Dartmouth-Hitchcock Medical Center

Decision Aid

Icon

Personal Decision Form

Knee Osteoarthritis 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