1. How to Do a Behavioral Prescription Start with Prescription Steps: 1.What would you like to change? 2.What are some things you can do to make that change? 3.What might get in the way of accomplishing this goal? 4.What can you do to overcome these barriers? 5.Is there any other help you need to accomplish this goal? 6.How confident are you that you can achieve this step at the present time on a scale of 1-10? (<7, redefine step) 7.At follow-up visit, review the steps and document on previous prescription, what % of the time they were able to comply 8.Redefine long-term goal and revise steps accordingly Chart Review: BPPS (FM only) 74 BPPS 198 steps 2.68 Average Steps per BPPS Long Term Goal 28/74 BPPS (37.8%) did not record a long term goal Workshop: Case Study – Readability StandardObserved Flesch Reading Ease>= 7086.3 (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 31 residents completed a BPPS Assessment of 31 resident BPPS’s using 7 criteria yielded a 78.3% average score (170/[7 criteria x 31 BPPS]) Most commonly missed elements were:  Not using the Active Voice (Criteria 1)  Using abbreviations (Criteria 2)  Confidence level missing (Criteria 6) Chart Review: 7 Criteria (FM only) (83.4 % Average Score) Confidence Levels (CL) CL 7 8 9 10 % 21.5% 27.3% 19.8% 31.4% Conclusions 7 Assessment Criteria For BPPS 1. Used active voice/first person (I will) 2. Avoided the use of abbreviations 3. Avoided symbols or signs 4. Avoided spelling errors 5. Used short simple language (action verbs and complete sentence) 6. Written to be achievable at a confidence level of 7 or higher 7. Written to be frequency-specific 1. Workshop: Resident presented with new case study and prepares a BPPS 2. Chart Review: BPPS used with patients 3. Computerized Self–Learning Exercise: Case Study and BPPS RESULTS: WORKSHOP CASE STUDY, CHART REVIEW, COMPUTER EXERCISE 1.Background: Behavior-driven chronic health conditions Chronic Care & Disease Management Models Self-Efficacy Theory 2.Motivational Interviewing Techniques 3.Practice reading dialogues aloud 4.How to establish Prescription Steps 5.Role play (groups of 3) Patient, practitioner, facilitator Develop a BPPS from a Case Study 6.Group discussion on Case Studies & BPPS 7.Turn in completed BPPS from a Case Study Purpose Develop an effective curriculum for Family & Internal Medicine Residents on motivational interviewing techniques during a routine office visit with a patient-centered approach to guide patients towards healthy behavioral changes using the Behavioral Prescription and Prescription Steps (BPPS). WORKSHOP TEACHING EXERCISE & EVALUATION METHODS BACKGROUND 60 Minute Workshop: Residents Evaluation of Resident Learning BEHAVIORAL PRESCRIPTION □ FMC □ PCCA □ PCCL □ PCCS □ AIM FOR:____________________________ DATE:___________ PRESCRIPTION STEPS *Long Term Goal: Patient Signature:___________________________________ Practitioner Signature: ______________________________ ©Behavioral PSX/Prescription Steps (BPPS)- developed at West Suburban Medical Center On a scale of 1-10, how confident are you that you can do each step? 1 2 3 4 5 6 7 8 9 10 (Not at all (Totally Confident) Confident) STEPS NUMBER 1.___ 2. ___ 3. ___ 4. ___ Using The Behavioral Prescription To Help Patients Achieve Healthy Lifestyle Changes Family Medicine Residency Program - West Suburban Medical Center – Oak Park, IL Michelle Domanchuk, APN Z. Harry Piotrowski, MS Kenneth Blair, MD Scott Levin, MD Margaret Cassey, MPH, RN, BC Computerized Self-Learning Exercise : Case Study, Preparing & Revising a BBPS (FM& IM) Learning SequenceActivity7 Criteria Results 1. Read the Case Study AA 59 male, HTN, diabetes 2. Write a BPPS41 residents write a BPPS that 62.5% includes 137 Prescription StepsAverage Score 3. Guided Self-Assessment of13 of 41 residents made corrections79.7% Prescription Steps Using 7 Criteriain several Prescription StepsAverage Score (P=.003) A one-hour workshop is sufficient to learn to appropriately write BPPS Using Motivational Interviewing techniques with a patient-centered approach along with the BPPS helps residents to assess patient readiness for change and increases goal attainment 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 1 2 3 4 5 6 9 7 810 11 12 STFM, Denver, CO, Nov. 2006. Supported by HRSA Residency Training Grant, D58HP00249, CFDA 93.884. For further information contact Michelle Domanchuk, michelle.domanchuk@reshealthcare.org (708) 763-2193michelle.domanchuk@reshealthcare.org Workshop: Case Study- 7 Criteria (FM & IM)