1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 8 Patient Education

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Study the chapter on communication (Chapter 7) before you begin this chapter. The information supplied in that chapter also applies to patient education and should be integrated with the material presented here. Pick a topic pertinent to the medical office where you work or the field in which you are interested in working and develop a patient education plan. Ask your peers, supervisors, and physicians to critique it and provide input. Review Tip

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins The emphasis on patient education in the health care setting continues to grow. The Joint Commission and the National Committee for Quality Assurance (NCQA), both of which accredit health care organizations, have multiple patient education standards and requirements. ■ Result is that more responsibility in this area is placed on the medical practice. ■ Federal and state governments, health plans, insurance companies, hospitals, physician offices, other health care agencies, and the public spend millions of dollars each year publishing patient information pieces. ■ Better-informed patients tend to be more compliant with care and more apt to participate in preventive services. ■ The intended outcome is improved health ■ Patient education frequently contributes to quality improvement in health care outcomes Overview

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Maintain and promote health ■ Prevent illness ■ Restore health ■ Cope with impaired function Purpose of Patient Education

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins The role of the medical assistant or medical administrative specialist includes educating patients. A few of the many topics encountered in patient education are: ■ Medication administration ■ Medical equipment use and care ■ Diet restrictions and modifications ■ Prediagnostic test or procedure instructions ■ Postdiagnostic test or procedure instructions ■ Physical exercises ■ Activity modification ■ Preventive health schedules (e.g., immunizations, well-woman exams) Topics for Patient Education

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Rehabilitative modalities ■ Other resources, such as indigent food programs ■ Health warning signs ■ Self-exams (e.g., for testicular and breast cancer) ■ Health monitoring (e.g., blood pressure readings and glucose testing) Topics for Patient Education, cont’d.

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Several areas must be considered when developing plans for patient education. These include the following. Domains of Learning Domains of learning = areas of a person’s being that affect his or her capacity to learn. The educator should be aware of the person’s domains of learning when formulating the teaching plan. The domains are: ■ Cognitive (knowledge, comprehension) ■ Affective (values, attitudes, opinions) ■ Psychomotor (mental and physical abilities, sensory skills) Considerations for Patient Education

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors Influencing Patient Education In addition to domains of learning, other factors, both internal and external to the patient, influence the teaching plan and the likelihood that the patient will comply or not comply with the plan. Some of these factors are: ■ Motivation (refer to Maslow’s hierarchy in Chapter 7) ■ Goals ■ Adaptation to illness ■ Age ■ Developmental age ■ Impairments (e.g., hearing, sight) ■ Pain Considerations for Patient Education, cont’d.

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Language ■ Cultural or religious barriers ■ Socioeconomic barriers ■ Ability of the educator to convey information) Considerations for Patient Education, cont’d.

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Environment Conducive to Learning After accounting for the domains of learning and other factors influencing patient education, the health care provider must also consider the learning environment. A person is less likely to assimilate information in a chaotic environment than in one that is conducive to learning. Selecting and preparing the environment is part of the teaching plan. An environment conducive to learning is: ■ Quiet ■ Comfortable ■ Private ■ Free from interruptions ■ Trusting ■ Appropriate for any needed equipment or materials Considerations for Patient Education, cont’d.

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Teaching Aids and Modalities The tools and materials selected by the educator to provide patient instruction are important to the success of the teaching plan. As an example, you do not want to provide only written material to a person who has a low reading level. Many types of instructional tools and methods are available. They include: ■ Pamphlets and other written material ■ Braille materials ■ Hearing devices ■ Videos, compact discs, DVDs, slides, tapes ■ Oral presentations and discussions ■ Demonstrations/return demonstrations ■ Anatomic models, dolls Considerations for Patient Education, cont’d.

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Posters and other illustrations ■ Record-keeping logs and journals ■ Support groups ■ Referral programs ■ Family participation ■ Feedback Considerations for Patient Education, cont’d.

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Sources of Materials and Information for Patient Education Sources of patient educational materials are plentiful. Some sources will provide material at no cost; other sources may charge to cover their cost or to make a profit. In some cases, the insurance company will assume the cost. Use only credible sources with medically known and professionally accepted authors, advisors, and reviewers. All materials used or proposed should be approved by the physician or appropriate supervisory person in the medical office. Sources include: ■ Professional organizations, such as the American Medical Association (AMA) ■ Government agencies, such as Centers for Disease Control and Prevention (CDC) Considerations for Patient Education, cont’d.

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Nonprofit organizations, such as the American Diabetes Association (ADA) ■ Commercial publishers of books and videos or DVDs ■ Internet websites ■ Computer programs designed to individualize information ■ Libraries (public, private, and medical) ■ Educational and medical supply companies for models, compact discs, and videos (catalogs are usually available) ■ Insurance and health care companies (these frequently publish informational materials for members) Considerations for Patient Education, cont’d.

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins After arming yourself with the tools required for educating a patient, you are ready to begin creating the individual patient educational plan. The Joint Commission and NCQA standards recommend a multidisciplinary, or team, approach to developing the plan. The steps of the plan are: 1. Identify the purpose and topic. 2. Assess the patient’s individual needs and abilities (domains of learning). 3. Develop the plan. (Who will do the teaching? What will be taught and what materials are needed? Where will the teaching occur? How will it be done?) ■ Review the plan with the physician or the supervisor as appropriate. ■ Include appropriate patient support personnel and medical team members. Educational Plan

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins 4. Implement the plan. 5. Evaluate the patient’s understanding of your plan. ■ Use feedback from the patient to evaluate the effectiveness of your teaching. ■ Revise or repeat instruction if needed. 6. Provide a form of written instruction for the patient to take home (frequently patients sign documents that confirm that they have received and understood information). 7. Document the education provided in the patient’s medical record. 8. Reevaluate effectiveness using follow-up visits, letters, e-mails, or telephone calls per office policy and procedure. Educational Plan, cont’d.

17. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins ■ Some offices compile pertinent standardized information in packets that may contain videos, DVDs, calendars, compact discs, and even bound books. ■ The medical record documentation should note whether a prenatal packet was given and explained and any areas of special emphasis. ■ Accrediting bodies, governmental agencies, and contracted insurance plans also audit medical records to determine the extent and appropriateness of patient education at the medical practice. Other Considerations