Implementing an integrated information prescription model in family medicine Francesca Frati, MLIS In collaboration with Roland Grad, MDCM, MSc, CCFP Herzl Family Practise Centre, Montreal QC STFM Conference for Practise improvement: health education and patient education Newport Beach, CA, November 10, 2007

Agenda This session reviews 1. Background How the information needs of the community were determined Existing health information models with a focus on the Information Rx model 2. Implementation 3. Challenges 4. Lessons learned several months after implementation.

Empowerment 1 It is increasingly believed that an informed patient is an empowered patient, better able to act as partner with his or her health professional (HP) with the goal of achieving improved health outcomes. This type of partnership approach is known variously as shared or informed decision making, evidence based patient choice, or concordance. 1. Coulter A, Ellins J. Effectiveness of strategies for informing, educating, and involving patients. BMJ 2007;335: Available from

The setting: summer /fall 2007

Needs assessment: summer 2006 It was perceived that the health information needs of the community were being met with room for improvement. Health consumers and HPs surveyed Confirms that both consumers and HPs want better access to consumer health information, and information literacy instruction. We felt that the addition of a librarian to the health care team on site could help meet this need.

Review of existing models 1. Patient and family resource centres in the library setting Consumer health information provided by librarians 2.a. Patient and family resource centres within the hospital community Patient education provided by nurses 2.b. Patient and family resource centres within the larger community (clinics, malls etc.) Patient education provided by nurses

Continued review reveals a third model 3. A review of existing resources revealed a service model with a librarian acting on-site as a member of the health care team with the support of the affiliated hospital library. Based on an innovative InformationRx model first implemented at the Monkfield Medical Centre in UK (see Information Prescription section of article available from: ve/archive2004/december/grimwood ). ve/archive2004/december/grimwood

Innovative how? Consumer is referred to a service InformationRxs are usually filled by a medical or public library a participating bookstore or by the patient him or herself with the use of recommended online resources MedlinePlus InfoRx (

Our solution The in-house InformationRx service Health information needs addressed for consumers and for HPs by a librarian on site as a new member of the health care team. supported by the adjacent hospital library

Where does Rx come in? HPs are encouraged to refer their patients to the Patient Information Coordinator (librarian) HPs can write a prescription for information i.e. the question Rx is filled by librarian In person By phone/ /fax

Why on site? Avoid out of sight out of mind (we have a library?) Librarian is better placed to understand the needs of the community HP needs are addressed, not just consumers Integrated into practise Documented in charts Trust

The InfoRx pad Pads were created to make prescribing easier Family health topics were chosen with the help of the Patient Education Committee Pads are in each consultation room and in the observation rooms

Consults All consults are documented Question Recommended resources Websites Books Pamphlets etc. 1 copy given to referring HP with Rx attached who then puts in the chart Treated as clinical encounter- schedule in appointment scheduling software

Support for HPs Giving patients the information & instruction (teach them to fish) Assist with the creation of patient level materials Provide guidance and instruction to HPs on the topic of consumer health resources & literacy issues Provide updates on new consumer resources

Operation Librarian on-site 7 hours per week Library provides support by Handling overflow Print collection PFRC website to include family medicine topics Patient Education Committee provides support for decision making- predated service Drop in encouraged Pamphlet collection in room

Use of service to date Opened 4 months ago Seeing patients for 1 month 13 consults Compare to library: 6-7 per month, mainly divided between 2 people

Challenges Meeting the health information needs of consumers and HPs in a timely manner can be difficult. Meeting these needs in a family practice setting presents unique challenges. Meeting these needs at point of care means changing the way the team works.

Big challenge #1- change (based on my experience) Support staff May not understand the need May not recognise the authority of unfamiliar professional Nurses May not see how service is different from Patient Education May not recognise the skills a librarian brings to position Concern that librarian might provide inappropriate info or advice Physicians May have trouble developing new habits (writing Rx) Librarian May need to adapt communication style Learning curve specific to clinical setting

Big challenge # 2: time Coordinator only on site 7 hrs per week All administrative aspects included in 7 hours Start up issues Support staff Learning about service Booking appointments Ordering materials (signs, pads, furniture, computer etc.) Nurses Learning about service Assisting with the evaluation of print materials Physicians Learning about service Writing InfoRx Promoting service to Residents, consumers Librarian Doing it all in 7 hrs

Support from on high Clinic chief meets with librarian on weekly basis Brings cases to librarian Assesses needs Problem solves

Creative solutions InfoRx cases blog Cases & challenges documented Opportunity for discussion Eventual wider audience

Evaluation The chief of the unit is evaluating the service as part of his patient perspective initiative The library will include evaluation of the service as part of its patient satisfaction survey It was initially thought that a user post- consultation mini-survey would be administered as part of day-to-day operation of the service- it was decided that this is not practical

Lessons learned talk is cheap – clinic chief Residents use service more than FP Teachers- thought it would be opposite Nurses dont use the service Patience! Too soon to tell

Thank you!