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

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

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

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

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

Decision Aid

Personal Decision Form

Summary Report for Surgeons

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

Online Quality Reports

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

Date modified:

2010-08-09