Patient Education Sessions Research Articles

Impact of Pharmacist Care in a Shared Medical Appointment Model for the Management of Type 2 Diabetes in a Micronesian Population

More than 25 million people have diabetes in the United States and its complications make it a leading cause of death. Pacific Islanders, specifically Micronesians, experience even higher rates of diabetes, and pharmacist care for these individuals may improve health outcomes. Objective: To better address health disparities in this population, a health center serving Hawaii Island added clinical pharmacy services into their shared medical appointment program for diabetes management. Methods: Standard care (n= 21) consisted of weekly education sessions for patients provided by a multi-disciplinary team, after which patients had one-on-one appointments with a primary care provider if they met threshold clinical criteria. The intervention group (n=36) received the same services, plus a medication management service provided by a pharmacist during the one-on-one appointments. Results: There was no statistically significant difference between the pharmacist care and standard care groups on clinical measures including glycosylated hemoglobin, low density lipoprotein and blood pressure at the end of the eighteenmonth intervention period. Conclusion: Pacific Islanders face unique health care challenges including low socioeconomic status, language barriers and differences in cultural perceptions of health care. The value of clinical pharmacy has been well-documented in the literature but further study of the role and impact of these services is warranted for high-risk populations.

Cross-sectional study of self-care safety skills in 677 patients on biodrugs for inflammatory joint disease

RationaleBiodrugs carry specific risks that patients must be aware of and capable of managing. Until now, few studies have addressed the self-care safety skills of patients taking biodrugs. The primary objective of this study was to describe the self-care safety skills of patients taking biodrugs for chronic inflammatory joint disease. MethodsWe conducted a nationwide cross-sectional survey. To obtain the most representative sample possible of patients taking biodrugs, we selected rheumatologists at random from the directory of the French Society for Rheumatology (SFR). Each rheumatologist was to include 5 consecutive patients receiving biodrugs. The BioSecure questionnaire was used to collect information on patient self-care safety skills. ResultsOf the 677 included patients, with a mean age of 53 years, 33% were males, 62% had rheumatoid arthritis, and 47% had previously received a therapeutic patient education (TPE) session. The median BioSecure score (percentage of correctly answered items) was 73% (interquartile range, 60–82). The dimensions with the lowest scores were the symptoms requiring a physician visit (median, 75), vaccinations (median, 75), contraception (median, 50), and subcutaneous biodrugs (median, 68). The replies to theoretical items (assessing knowledge) and those to problem-case items (assessing adaptive skills) were discordant. ConclusionThis study provides concrete data of use for improving the information and TPE of patients taking biodrugs. Skills regarding the symptoms that require a physician visit, vaccinations, contraception, and subcutaneous treatments need to be improved. Interesting information can be obtained by simultaneously testing knowledge and coping.

Multi-modal physiotherapy and high tibial osteotomy can mitigate risk factors for disease progression in patients with varus gonarthrosis

Multi-modal physiotherapy and high tibial osteotomy can mitigate risk factors for disease progression in patients with varus gonarthrosis

Educator challenges using participatory methods in group-based patient education

Purpose – The purpose of this paper is to explore educators’ experiences of putting a participatory and patient-centered education model, “The Health Education Juggler,” into practice after having attended a one-day seminar. The model consists of four educator roles in participatory group-based patient education in chronic illness: embracer (takes care of the group), facilitator (generates dialogue and participation), translator (communicates professional knowledge) and initiator (motivates action in patients). Design/methodology/approach – Qualitative analysis of observations of eight group-based patient education sessions and seven in-depth semi-structured interviews with 11 educators. Findings – Educators find it difficult to include disease-specific knowledge when working with a flexible patient-centered approach. They tend to stay in the role they find most comfortable during education sessions (most often that of embracer), rather than adopting new and more challenging roles in the teaching process. Educators theoretically understand the role of facilitator, but they do not know how to perform in this role in practice. The ability to juggle all educator roles depends on the ability to master each. Practical implications – The Health Education Juggler model shows promise in promoting participation and patient-centeredness and as a reflection tool for educators and an analytic tool for quality assessment of patient education. These findings support further development of model use. Originality/value – This model of educator roles in group-based patient education in chronic illness provides a new approach to patient education. It indicates the need for various professional competencies among educators to provide patient-centered education in a flexible way, with a strong focus on patient-identified problems and challenges, social learning processes and generation of internal motivation in patients.

That’s one small book for a man, one gian leap for CPAP compliance. Association between patient education and CPAP comliance in an urban and a rural setting in Canada

Many patients and many physicians do not appreciate the health ramifications of sleep apnea or the economic impact of low treatment rates. Placing this information in an easily and repeatedly accessible form can have many benefits including education, personal relevance for those affected with CPAP compliance difficulties. Patient education can have long term positive impact of patient outcome. For example, a single enhanced patient education session delayed initiation of dialysis by 4.6 months (Devins et al., 1993). The objective of this study was to determine the association between patient education and CPAP compliance. 200 consecutive patients of an urban sleep clinic and 200 consecutive patients in a small rural facility were enrolled in the study. 100 patients in each location received the standard consultation with their physicians after the diagnosis of obstructive sleep apnea before receiving their CPAP machine. The other 100 patients in each location received an educational booklet (Sleep Apnea, CPAP and Me by Shapiro G, Zalai, D. Trajanovic N, & Mallea, J) on sleep apnea in addition to the standard consultation with their doctors. All patients had a one month and a one year follow up follow up with the consultant. CPAP compliance was assessed at the one year follow up visit. Compliance was defined as a regular CPAP use five or more nights per week and a minimum of 5 h each night. At one year follow-up 75% patients in the standard consultation group in the urban location were compliant CPAP users. The compliance rate of patients who received the booklet in addition to the consultation was 87% at follow up. There was a significant association between the receiving the booklet and CPAP compliance ( ÷ 2 = 4.68, p < .05) in this group. In the rural location the compliance rate of 89% in the special education group was not significantly higher than the compliance rate of 82% in the control group. Education clearly helps but this may be less so in an already highly compliant group. In a review we have previously showed very high compliance rates at the rural center. There may be several reasons for this and these should be explored. On the basis of “Bang for Buck” the provision of this $10 booklet appears to be valuable and has become a pattern for a number of CPAP suppliers when so asked by physicians running a sleep clinic. At this point in time there is the need to translate the book into other languages. Any takers?

Targeting motivation and self-regulation to increase physical activity among patients with rheumatoid arthritis: a randomised controlled trial

The purpose of this study is to evaluate the effects of targeting both the motivation and action phases of behaviour change in a 5-week intervention to increase physical activity (PA) among patients with rheumatoid arthritis (RA) not meeting current PA recommendations. In a randomised controlled trial, a control group—which received a group-based patient education session led by a physical therapist—was compared to a treatment group which received the education session plus a motivational interview from a physical therapist and two self-regulation coaching sessions from a rheumatology nurse. Outcomes included leisure-time PA, days per week with at least 30 min of moderate-intensity PA, self-efficacy and autonomous motivation (cognitions which predict PA initiation and maintenance), disease activity, functional status, depressive symptoms and fatigue. Effects were assessed using mixed models repeated measures. Of the 78 patients randomised, 76 and 67 completed the post-treatment and follow-up assessments, respectively. Significant treatment effects were found for leisure-time PA (p = 0.022), active days/week (p = 0.016), self-efficacy (p = 0.008) and autonomous motivation (p = 0.001). At post-treatment and 6-months follow-up, significantly more treated patients than controls met current PA recommendations. No significant effects were found for disease activity, functional status, depressive symptoms or fatigue. Combining motivation- and action-focused intervention approaches improved PA-related cognitions and led to improved uptake and maintenance of leisure-time PA. However, further research is necessary to identify ways of helping patients with RA transition to—and maintain—more intensive forms of PA which are more likely to improve disease activity and functional status.

Implementation of an Order Set to Adhere to National Patient Safety Goals for Warfarin Therapy

In 2009, The Joint Commission mandated full compliance with National Patient Safety Goal (NPSG) 03.05.01 to reduce the likelihood of patient harm associated with anticoagulant therapy. We conducted a retrospective chart review of inpatients receiving warfarin at Methodist Hospital pre and post implementation of a warfarin order set between January 2008 and July 2011. The primary endpoint of this study was overall adherence to laboratory monitoring. Secondary endpoints included compliance with individual laboratory parameters, percentage of patient educational sessions completed prior to discharge, and percentage of appropriate follow-up arrangements documented on discharge. A total of 707 patients were assessed. Overall adherence to laboratory monitoring parameters significantly improved from 71.8% to 87.5% (odds ratio [OR], 2.76; 95% CI, 1.87- 4.07; P < .001). Additional improvements were seen in patient education prior to discharge, and appropriate follow-up arrangements were documented at discharge. This analysis demonstrates that implementation of an order set assists in adherence to policies and procedures designed to address the NPSG 03.05.01. Additionally, pharmacy involvement in monitoring, educating, and arranging for follow-up may lead to successful completion of these parameters.

SP0106 Motivational interviewing and self-regulation to increase physical activity in patients with rheumatoid arthritis

So far, a number of studies have shown that interventions which are specifically aimed at promoting daily physical activity in patients with rheumatoid arthritis (RA) have positive effects on patients’...

AB0432 Vaccination in rheumatoid arthritis: Are your vaccinations up to date?

BackgroundInfection is one of the main causes of increased mortality in rheumatoid arthritis (RA). This may be due to disease itself or drug therapies commonly used.ObjectivesTo assess the uptake of...

Adults with sickle cell anaemia: specific patient competencies required for day-to-day management of hydroxyurea treatment

Introduction: Sickle cell disease (SCD) is a genetic haemoglobin abnormality responsible for various complications including chronic haemolytic anaemia and vaso-occlusive crises. Hydroxyurea (HU) therapy is used in patients with severe symptoms to improve the clinical course. To be effective and safe, hydroxyurea therapy must be monitored and patients must acquire specific competencies. Objectives: To establish competency standards relative to HU treatment for adults with SCD. Methods: A group of professionals experienced with SCD and trained in therapeutic patient education (TPE) held three day-long meetings to discuss HU-related competencies. Results: The competencies were listed in a single document. An assessment grid and a knowledge questionnaire for individual patient education sessions were also created. Discussion: HU is a chemotherapy agent whose use requires careful monitoring and specific patient competencies, which can be acquired via TPE. Furthermore, TPE can address the concerns and misconceptions associated with HU. Competency standards have proved helpful for designing TPE programmes. The competency standards reported here are unique, as they focus on a specific treatment used in a specific disease, instead of on the full range of issues related to a disease. Conclusion: This work is a first step towards harmonising TPE programmes for adults taking HU for SCD.

Abstract TP327: Are We Really That Noncompliant? Identifying Barriers to Documenting Patient Education

Background/Purpose: Patient education impacts stroke recovery and prevention. Certification as a Joint Commission Primary Stroke Center (JC PSC) requires consistent performance in patient education. Prior to instituting a new electronic medical record (EMR) in March 2011 our hospital maintained compliance with this measure at or above 93%. We have experienced difficulty returning to this level for unclear reasons. We sought to identify factors contributing to a decrease in performance. Methods: The institution’s Get with the Guidelines Stroke database was reviewed from July 2010 to June 2012. Institutional and departmental changes occurring during months of low compliance were explored. A Project RN was hired to focus on data abstraction and patient education. Results: Prior to March 2011 compliance was 93-100%, at which time it dropped to 68%. April 2011 to June 2012 the range was 76-100% with 9 months less than 90%. Only three months during that time were 93% or better. The initial decrease in compliance was clearly attributable to the EMR which lacks previously available “hard stops” for education. Continued compliance of less than 90% was multifactorial. An average census increase of 16.8% per month from 2010 to 2012 was identified. In addition, there were staffing changes within the stroke center during months of low performance. Absence of a nurse practitioner on the inpatient unit had a negative impact. Patients in the stroke unit had better documentation of education than those on other units. Improved compliance coincided with preparation for a JC PSC site visit and completion of the Project RN’s orientation. Conclusions: Consistent achievement of stroke education at 93% or better can be reached, but is challenging in a frequently changing environment. We believe our patients are getting stroke-specific education, but documentation has declined due to the EMR, changes in staff, and growing census. Identifying these barriers has allowed the development of a PI plan with a goal of consistent compliance of 93% or better. This plan includes revision of the Project RN responsibilities and scheduling patient education sessions more frequently. Another NP is being recruited, and investigation into better use of the available features of the EMR is underway.

The effect of education and supervised exercise vs. education alone on the time to total hip replacement in patients with severe hip osteoarthritis. A randomized clinical trial protocol

BackgroundThe age- and gender-specific incidence of total hip replacement surgery has increased over the last two decades in all age groups. Recent studies indicate that non-surgical interventions are effective in reducing pain and disability, even at later stages of the disease when joint replacement is considered. We hypothesize that the time to hip replacement can be postponed in patients with severe hip osteoarthritis following participation in a patient education and supervised exercise program when compared to patients receiving patient education alone.Methods/designA prospective, blinded, parallel-group multi-center trial (2 sites), with balanced randomization [1:1]. Patients with hip osteoarthritis and an indication for hip replacement surgery, aged 40 years and above, will be consecutively recruited and randomized into two treatment groups. The active treatment group will receive 3 months of supervised exercise consisting of 12 sessions of individualized, goal-based neuromuscular training, and 12 sessions of intensive resistance training plus patient education (3 sessions). The control group will receive only patient education (3 sessions). The primary end-point for assessing the effectiveness of the intervention is 12 months after baseline. However, follow-ups will also be performed once a year for at least 5 years. The primary outcome measure is the time to hip replacement surgery measured on a Kaplain-Meier survival curve from time of inclusion. Secondary outcome measures are the five subscales of the Hip disability and Osteoarthritis Outcome Score, physical activity level (UCLA activity score), and patient’s global perceived effect. Other measures include pain after exercise, joint-specific adverse events, exercise adherence, general health status (EQ-5D-5L), mechanical muscle strength and performance in physical tests. A cost-effectiveness analysis will also be performed.DiscussionTo our knowledge, this is the first randomized clinical trial comparing a patient education plus supervised exercise program to patient education alone in hip osteoarthritis patients with an indication for surgery on the time to total hip replacement.Trial registrationNCT01697241

Diabetes Specialty Clinic

People with diabetes who have chronically higher than normal blood glucose levels are at risk for a variety of health conditions, such as kidney failure, blindness, amputation, and a shortened life expectancy. At a Veterans Health Administration Medical Center (White River Junction, Vermont), a team of providers, diabetes educators, and psychologist noticed that patient education and therapy sessions were not effective for some patients and in addition the center had above the benchmark percentage of veterans who had higher than normal blood glucose levels. The team thought a new approach might work better and through feedback from staff and primary care providers developed the Diabetes Specialty Clinic (DSC). Our working theory was that veterans would make changes in diabetes self-management and improve their levels of blood glucose by sharing their experiences with other veterans in a supportive environment. Both quantitative and qualitative methods were used to evaluate whether the DSC had a positive impact with the veterans. Hemoglobin A1c was obtained at the first group meeting and at 6 weeks, 6 months, and 1 year, along with 5 patient-reported outcomes obtained using 4 questionnaires. Thirty-nine veterans participated in the DSC. For the veterans who participated in the DSC for more than a year, 42% of the measures showed improvement, and they shared positive feedback on how the DSC influenced their behaviors by helping them engage in self-care activities. The DSC seemed to be effective in creating a space for establishing relationships, resolving issues, and understanding the management of diabetes for veterans and health care professionals.

Pulmonary rehabilitation in clinical routine: A follow-up study

The effect of rehabilitation for chronic obstructive pulmonary disease has been well-documented in randomized controlled trials. Evidence-based guidelines support rehabilitation programmes for chronic obstructive pulmonary disease, but knowledge of their outcome in clinical practice is limited. The aim of this study was to assess the outcome of a clinical routine rehabilitation programme for chronic obstructive pulmonary disease implemented by a Danish regional hospital. Changes in walk-distance (6-min walk-distance test; 6MWD), dyspnoea (Medical Research Council dyspnoea scale; MRC) and health-related quality of life (Short-Form 36; SF-36) were compared between and within completers and non-completers from baseline to the end of clinical routine rehabilitation, and at 6 and 12 months. The 8-week clinical routine rehabilitation comprised bi-weekly 90-min sessions of patient education and physical training. The hospital treated 521 patients during the study period. Of these, 175 were invited to join the study, 148 participated at baseline, and 98 at the 12-month follow-up. Completers' 6MWD was sustained from baseline to the end of clinical routine rehabilitation, but had declined by 12 months. Dyspnoea and health-related quality of life did not change. Seventy-five percent of completers felt better or much better after rehabilitation. The failure of completers to achieve expected outcomes shows a need for a stronger implementation effort and continuous quality control. Successful implementation in clinical routine requires targeted recruitment and overall programme improvement in general, and a stronger focus on physical training and staff competences.

Perceptions of patient education during hospital visit – described by school‐age children with a chronic illness and their parents

Families having a child with a chronic disease face changes in their everyday lives, and the whole family is involved in patient education. Nurses bear a great responsibility for patient education, but their school-age patients' and their parents' perceptions of patient education have only been studied to a limited extent. The current study aimed to explore the elements of significant patient education events during a hospital visit described by school-age children with a chronic illness and their parents. The design was qualitative and descriptive. A total of nineteen Finnish parents and their 12 children aged 5-12, suffering from chronic diseases, were interviewed using a critical incident technique. The data were analysed by deductive content analysis. The descriptions of patient education comprised cases with parents' shock at the outset of the patient education sessions and cases with the outcome of these sessions, including an experience of empowerment or lack of it. The patient education practices were examined by determining nursing, didactic and interpersonal competences. Nursing competence involved illustrations of knowledge and the ability to care for children and families as well as knowledge of the disease and its management. Didactic competence comprised practical examples of knowledge of teaching and the ability to implement the education process. Interpersonal competence manifested itself in the ability to have a dialogue. The findings show the importance of comprehensive patient education competence required of nurses giving education to families having children with chronic illnesses. This knowledge can be applied to promote nurses' professional training and to develop patient education.

Feasibility and changes in symptoms and functioning following inpatient cancer rehabilitation

Aim. The aim was to assess feasibility of a 3 + 1 week inpatient rehabilitation program for cancer survivors, to explore characteristics of the attending participants and examine changes in work status, symptoms and functioning, level of fatigue, exercise and physical performance following rehabilitation. Methods. This was an open intervention study involving cancer survivors having completed primary cancer treatment. The multidisiplinary program consisted of physical training, patient education and group sessions. Participant were assessed at primary stay (T0), at follow-up stay 8–12 weeks later (T1), and six months after T1 (T2). Symptoms and functioning were assessed by the European Organization for Research and Treatment Core Quality-of-Life Questionnaire, physical fatigue by Fatigue Questionnaire, physical exercise by The Nord- Trøndelag Health Study Physical Activity Questionnaire and physical performance by aerobic capacity (VO2max), 30 second Sit-to-stand (STS) and Maximum Step Length (MSL). Linear mixed models were used in analyses. Results. One hundred and thirty-four of 163 included participants (82%) completed both rehabilitation stays and returned questionaires at T2. The majority of completers were females (81%), breast cancer survivors (60%), highly educated and with mean age of 52.8 years (SD of 8.1). Participants had higher level of symptoms and fatigue and lower functioning at admission compared to a Norwegian reference population. However, they reported higher physical exercise level and 47% reported improved work status from T0 to T2. Symptoms and functioning, fatigue, physical exercise and physical performance improved significantly from T0 to T1 and were maintained at T2. Conclusions. The rehabilitation program was feasible and symptoms and functioning normalized following rehabilitation. The program mainly recruited well-educated breast cancer survivors, reporting relative high level of physical exercise. More focus should be put on recruiting and selecting those who need comprehensive inpatient rehabilitation and also compare the effects of inpatient with outpatient rehabilitation programs.

Diversity of patient preparation activities before initiation of antiretroviral therapy in Cape Town, South Africa

To investigate patient education and counseling activities prior to the initiation of antiretroviral therapy (ART) at public sector services across Cape Town, South Africa. Key informant interviews and programme reviews were conducted with government bodies and non-governmental organisations involved in patient preparation activities. All 11 organisations in Cape Town involved in training and managing personnel to prepare patients for ART during 2010 participated. Each organisation reported a different approach to patient preparation within public sector clinics and in each aspect of patient preparation activities. The number of patient education sessions ranged from 3 to 7, and the delays to ART initiation introduced by patient preparation ranged from 3 to 6 weeks. Different patient education materials (pamphlets, posters and flipcharts) were used by various programmes, and all programmes reported that shortages in materials meant that patient preparation often took place without any educational materials. Each programme also reported attention to mental illness and alcohol/substance use disorders, but none employed formal screening tools consistently, and the handling of patients with potential mental health- or substance-related problems varied. Approaches to prepare patients before ART initiation are wide ranging in one part of South Africa. Their relative value requires investigation, as there is little evidence for the impact of varying approaches. Moreover, the risks associated with delayed ART initiation may outweigh any benefits of patient education before the start of treatment.

Online and face-to-face orthopaedic surgery education methods

The recent study by Heikkinen et al. (2012) concluded that symptoms related to surgery were not impacted by whether internet-based or face-toface patient education was used. However, this conclusion is not actually supported by the findings in their study because of missing statistical information and very low measurement validity for pain and disability, possibly due to questionnaire miswording. First, the low validity of the measurements is obvious by viewing their Table 1. For example, the percentage of patients reporting a high disability level nearly quadruples from 5.6% to 20% after the internet-based education session compared to before the session. This difference is statistically significant by the chi squared test at p < 0.001. If the disability measurement is taken as valid, then the conclusion would be an internet education session quadruples a patient’s disability level. Even in the face-to-face patient education session the percentage of patients reporting high levels of disability doubled from 1.4% to 2.9%. There are dozens of other examples which indicate that the pain and disabilities measurements were not consistent or accurate and consequently had little or no validity. A possible explanation for the validity problems is found in the VAS questionnaire wording and procedures. One of the most important determinants

The Influence of Distress on Knowledge Transfer for Men Newly Diagnosed with Prostate Cancer

The purpose of this inquiry was to evaluate the efficacy of prostate cancer education sessions. Implementation of 3-h patient educational sessions was intended to provide men newly diagnosed with localized prostate cancer, who face difficult and complex decisions, information about potential treatment options. Fifty-seven men completed the distress thermometer assessment before the education session to assess baseline levels of distress. Seven of the men were interviewed post-educational session to determine the degree of knowledge transfer from the session. This study explored the efficacy of the patients' learning experience using an interpretive phenomenological research approach. Resulting data revealed that these patients, as adult learners, were distressed and that, despite the availability of pertinent medical content, the subject material was not learned as intended or readily understood. The conclusion drawn from this preliminary applied educational research study was that the education model used was less than efficacious at ensuring that sufficient knowledge transfer was achieved for medical treatment decision-making processes. These findings suggest a need for future research to explore the application of adult learning theories and approaches that may offer enhanced knowledge translation and transfer for prostate cancer education programs.

An Introductory Pharmacy Practice Experience on Improving Medication Adherence

To evaluate the impact of a medication adherence activity on introductory pharmacy practice experience students' perceptions of patient adherence as well as student development of empathy and confidence in patient counseling. Students participated in a personal medication simulation using an automated medication dispenser. Students then identified a patient with nonadherence and provided counseling on use of the dispenser. After 4 to 6 weeks, students interviewed the patient about their experience with the dispenser and assessed changes in adherence. One hundred fifty-three students completed the assignment and 3 surveys instruments. Following the experience, the majority of students agreed or strongly agreed that they developed more empathy for patients with multiple medications and felt confident counseling a patient in the use of a dispenser (92.0% and 88.2%, respectively). Most students (91.4%) reported feeling that their patient education session was successful. An introductory pharmacy practice experience involving an automated medication dispenser and patient counseling to improve medication adherence resulted in the development of empathy and improved student confidence.