BEHAVIORAL PRESCRIPTION & PRESCRIPTION STEPS AS AN EFFECTIVE TOOL IN THE OFFICE Family Medicine Residency Program - West Suburban Medical Center – River Forest, IL Michelle Domanchuk, MSN, APN/CNP Kenneth Blair, MD Z. Harry Piotrowski, MS Katherine Walsh, MD WORKSHOP TEACHING EXERCISE AND EVALUATION METHODS RESULTS: WORKSHOP CASE STUDY, CHART REVIEW, COMPUTER EXERCISE BACKGROUND Workshop: Case Study – Readability Chart Review: BPPS and Steps 60 Minute Workshop: Residents PURPOSE Standard Observed Flesch Reading Ease >= 70 86.3 (FRE) 0-100 Flesch-Kincaid Grade 7 3.9 Level (FKGL) Conclusion: The BPPS simplifies language with action verbs and complete sentences leading to patient-centered behavioral change 40 BPPS 98 steps Average steps were 2.5 per BPPS Background: Self-Efficacy Theory Chronic Care Model Disease Management Model Practice reading dialogues aloud Motivational Interviewing Techniques How to establish Prescription Steps Divide into groups of 3: Patient Practitioner Facilitator/Recorder From a Case Study, each 3-resident group develops a BPPS Group discussion Confidence Levels (CL) Develop an effective curriculum for Family Medicine Residents on motivational interviewing techniques during a routine office visit with a patient - centered approach to guide patients towards healthy behavioral changes using Behavioral Prescription Steps. CL 7 8 9 10 % 17.3% 30.6% 15.3% 36.7% Long Term Goal 23/40 BPPS (57.5%) did not record a long term goal 1 7 9 How to Do a Behavioral Prescription Start with Prescription Steps: What would you like to change? What are some things you can do to make that change? What might get in the way of accomplishing this goal? What can you do to overcome these barriers? Is there any other help you need to accomplish this goal? How confident are you that you can achieve this step at the present time on a scale of 1-10? (<7, redefine step) At follow-up visit, review the steps and document on previous prescription, what % of the time they were able to comply Redefine long-term goal and revise steps accordingly Workshop: Case Study – 7 Criteria 18 residents completed a BPPS Assessment of 18 resident BPPS’s using 7 criteria yielded a 77.0% average score (97/[7 criteria x 18 BPPS]) Most commonly missed elements were: Using abbreviations (Criteria 1) Confidence level missing (Criteria 6) Chart Review: 7 Criteria (81.8 % Average) 4 EVALUATION of Resident Learning 8 10 1. Workshop: Resident presented with new case study and prepares a BPPS 2. Chart Review: BPPS used with patients Computerized Self–Learning Exercise: Case Study and BPPS 2 Computerized Self-Learning Exercise : Case Study, Preparing & Revising a BBPS 5 Learning Sequence Activity 7 Criteria Results 1. Read the Case Study AA 59 male, HTN diabetes 2. Write a BPPS 24 residents write a BPPS that 85.7% includes 69 Prescription Steps Average Score 3. Guided Self-Assessment of 18 of 24 residents made corrections 93.5% Prescription Steps Using 7 Criteria in several Prescription Steps Average Score BEHAVIORAL PRESCRIPTION □ FMC □ PCCA □ PCCL □ PCCS □ AIM FOR:____________________________ DATE:___________ PRESCRIPTION STEPS 7 Assessment Criteria For BPPS Used active voice/first person (I will) Avoided the use of abbreviations Avoided symbols or signs Avoided spelling errors Used short simple language (action verbs and complete sentence) Written to be achievable at a confidence level of 7 or higher Written to be frequency-specific On a scale of 1-10, how confident are you that you can do each step? 2 3 4 5 6 7 8 9 10 (Not at all (Totally Confident) Confident) STEPS NUMBER 1. ___ 2. ___ 3. ___ 4. ___ 11 CONCLUSIONS A one-hour workshop is sufficient to learn to appropriately write BPPS A Chart Review indicated adoption of BPPS in resident’s patient panel Residents are able to self-assess the appropriateness of Prescription Steps & make necessary adjustments in the BPPS Patient readability, which is essential, is enhanced with a BPPS BPPS encourages realistic goal-setting with the patient in the office Future research to focus on reviewing patient charts to assess patient behavioral changes and health outcomes attributed to the BPPS 6 *Long Term Goal: Patient Signature:___________________________________ Practitioner Signature: ______________________________ ©Behavioral PSX/Prescription Steps (BPPS)- developed at West Suburban Medical Center 3 12 STFM, San Francisco 2006. Supported by HRSA Residency Training Grant, D58HP00249, CFDA 93.884. For further information contact Michelle Domanchuk, michelle.domanchuk@reshealthcare.org (708) 763-2193