Connecting Patients, Providers and the Community with Quality Health Information Using the Information Prescription in the Primary Care Setting Peggy Carey MD and Marianne Burke MLS University of Vermont College of Medicine Presented at the SFTM 2008 Conference on Practice Improvement Savannah, GA December 6, 2008

Outline of the Presentation Present rationale for using Internet consumer health information and Information Rx for patient education and patient self-efficacy Describe MedlinePlus consumer health information database Describe an educational project using an information prescription protocol at a FM practice and resident education site Present results of pre and post knowledge and use of the Info RX protocol by attendings and residents Continuation of project and discussion

Reasons to use Internet based consumer health information

Patients participate in decisions about their health or disease. Patients help manage their own chronic conditions Coleman MT, Newton KS. Supporting self- management in patients with chronic illness. American Family Physician 2005; 72: Chronic Care Model: Patients Participate

2. Patient Education Patient education is required in hospital outpatient setting (JCAHO) Physician provides and discusses printed information related to diagnosis, treatment Patients prefer to receive health information from provider-physician But there is little time for discussion during office visit Handouts can be hard to manage or keep up to date

3. Patients/families find Internet health information on their own Web use numbers are high or growing in all age groups including over 65 Over 50% of adults use the Internet for health information Health information #2 use of the Internet Women search/surf for family members most often Source: Madden M., Fox S. Finding answers online in sickness and in health, May

Problem with patient Internet health information seeking? High quality consumer-friendly health information is available on the Internet Many families have their own computer and high speed internet access at home has increased But, Patient may be overwhelmed with quantity Be influenced by dubious quality or advertising Not find what they want or need, and The health care provider is out of the loop

Information Prescription Program: Information Rx Developed by National Library of Medicine (NLM) & American College of Physicians (ACP) Foundation Promotes physician recommendation of high- quality health information to patients Toolkit of promotion and education materials like pre-printed prescription pads and ideas for implementation in medical practices in cooperation with community groups and public libraries

ACP Foundation/NLM InfoRx Program

The Information Prescription Protocol Health care provider: –Writes a relevant health topic, condition, or drug on a prescription-like note with a recommended pre-printed quality website –Gives the written “prescription” to the patient. Recommends the patient go to the quality website (MedlinePlus.gov pre-printed on pad) –Encourages patient or family member to find out more information about the condition or health topic

Who is appropriate for an Information Rx ? Patients who are already using the Internet to find health information Patients who have good Internet access at home or at work or other location such as the public library When you know about a good source of information relevant to your patient and feel comfortable recommending it

Why MedlinePlus? Comprehensive umbrella; over 700 topics Links to respected sites like Mayo Clinic, Family Doctor, Senior Health, Kidshealth Commercial-free Standardized tested format Options from basic and low literacy to PubMed searches

MedlinePlus Highlights Over 700 disease, health and wellness topics Tested format and ease of use Commercial free Low to high literacy Easy reading links Audio-video tutorials support different learners Latest research with PubMed linked searches and clinical trials Drug and herbal supplement information Medical encyclopedia dictionary Vermont Go Local: Support groups, health associations, Vermont resources Health check and cool tools Kids, teens, seniors, and special population resources

When would you give an Information Rx? Help understand a new diagnosis Become comfortable with a new treatment plan Better manage a chronic condition or keep up with research Reinforce basic health and wellness

Typical MedlinePlus topic page: Diabetes

Project Objectives Integrate the InfoRx program into community- based family medicine practice (MFP) –Increase provider knowledge and use of Internet consumer health information (MedlinePlus.gov) Develop capacity of the town public library to provide health information (& to follow-up on patients’ information prescriptions) Family medicine residents learn how to access high quality consumer health information Outreach project funded by the NN/LM New England region sub-contract. 15 months

Setting of Study Milton Family Practice is University of Vermont (UVM) associated Family Medicine Residency Training Site 15 miles north of Hospital & University Milton Town Library nearby

Study Populations Physicians (11 attending and 18 residents) at Milton Family Practice 15 Nurses and 20 Medical Staff Librarians and Staff at Milton Town Library (4)

Method: Collaborative Partnership UVM College of Medicine Family Medicine Department UVM Dana Medical Library Milton Family Practice (UVM and Fletcher Allen) Milton Public Library

Collaborators interested in Medical Home Principles –Increasing knowledge and use of technology for health (Internet health information) –Patient education –Shared-decision making –Chronic illness collaboration & continuous ongoing care with provider –Liaison to community resources

Educational Methods Group educational sessions: Attending meetings Resident education sessions Individual sessions on MedlinePlus Display of MedlinePlus & Info Rx tool kit educational materials in all 18 exam rooms Distribution of Info Rx pads to providers

Classes for Residents Specific instruction on the features of the MedlinePlus database Case examples of when you might give an information prescription and recommend MedlinePlus Rationale for Information Rx Computer hands-on when possible

Improved Technology Access Installation of Internet accessible computer and printer dedicated to patient education for provider use at time of visit Designated patient education Internet accessible computer/printer and room created at Milton Family Practice for patients to “fill” Information Rx’s

Public Library Outreach Education sessions on MedlinePlus and responding to health information reference questions for staff Distributed quantities of informational materials on MedlinePlus for the public Provided 200 new books on consumer health topics for the collection Conducted a class on finding health information at the Senior Center sponsored by the library

Why the Public Library? The Public Library is a good source for Internet available computers Print books and magazines on health topics are available Librarians provide help with finding health information Many segments of the community use the library

Display of MedlinePlus handouts on 18 exam room bulletin boards as prompt for both physician and patient

Information Rx pads used by physicians for prescribing health information during the office visit

Installed patient use workstation at Milton Family Practice – Patient Education Room

Computer and printer dedicated to finding patient education information (Physician Use)

Evaluation Pre- and post questionnaires asked attendings and residents about their knowledge and behaviors related to Information Rx and Internet consumer health information

Results Pre-project survey: Attendings and residents were: –Somewhat knowledgeable about MedlinePlus.gov and FamilyDoctor.org –Able to access patient ed info for patients themselves, but not during the office visit –Uncertain about quality of consumer websites –Limited by lack of time from discussing consumer health info with patients

Results Post-information survey: –Attendings’ knowledge of MedlinePlus remained the same. Most said they were knowledgeable (Pre m 3.6/ Post m 3.4) – Residents’ knowledge of MedlinePlus increased. (Pre m 3.0/ m Post 4.0) 33% said they were knowledgeable pre vs. 60% post.

Recommend MedlinePlus.gov Attendings: n = 10Residents: n = 9

Use Info Rx Pad to Recommend Internet Health Information Site Attendings: n = 10 Residents: n = 9 8 out of 10 Attendings and 8 out of 9 Residents agreed with the statement “I encourage patients to look up information on the Internet”

Conclusions Info Rx program is effective, practical methodology to assist patient-provider-physician communication and education Liaison with public library furthers goals of Info Rx and use of Internet health information Institutional practices and policies need be considered from initiation of program to maximize acceptance and use Hands-on educational sessions provide greatest support to busy, multi-tasking physician-providers Can be integral part of a patient-centered health home

Connecting Patients, Providers and the Community with Quality Health Information The project is funded by the National Library of Medicine and the National Network of Libraries of Medicine New England Region. The project team: Marianne Burke MLS AHIP, Dana Medical Library PI Peggy Carey MD, Department of Family Medicine Co-PI Alan Lampson MLS, Frymoyer Community Health Resource Center, Community Health Improvement, Fletcher Allen Laura Haines MLS, Dana Medical Library Fred Pond MLS, Dana Medical Library In partnership with the Department of Family Medicine College of Medicine and the entire staff at Milton Family Practice. Special thanks to Dr. John Ferguson MD, and Holly Van Winkle LPN, Practice Supervisor In cooperation with Fran Ferro, Director, and Librarians from the Milton (VT) Public Library

References Coleman MT, Newton KS. Supporting self-management in patients with chronic illness. American Family Physician 2005; 72: Joint Commission International Center for Patient Safety (accessed April 10, 2008) Madden M., Fox S. Finding answers online in sickness and in health May (accessed February 13, 2008) Siegel ER et al, Information Rx: Evaluation of a new informatics tool for physicians, patients, and libraries. Information Services and Use. 2006; 26(1): 1–10 The InfoRx toolkits included pre-printed prescription pads are distributed by both NLM and ACP Foundation and may be ordered online at and ttp://nnlm.gov/hip/infoRx/placeorder.html

MedlinePlus tour link

Order or download Info Rx toolkit items MedlinePlus health provider tri-fold (download and print) MedlinePlus patient trifold (download and print) Info Rx pads, brief information cards and poster – order online (free)