Professional Documents
Culture Documents
CHALLENGES:
1.
2.
3.
4.
Our Goal
Better comprehension
about EFFECTIVE
PATIENT EDUCATION
and its application in
caring for the sick.
Patient Education
..intrinsic to any specialty of medicine
..constitutes considerable portion of the time a
physician spends in caring for patients
According to studies, 19-41% of all direct patient
care time was devoted to patient education and
counseling activities
Bergman et all.,1966; Parrish et al.,1967; Hessel & Haggerty,1968;
Donaldson & London,1971.
POOR COMPLIANCE or
NONADHERENCE
What must
be the
reasons?
POOR COMPLIANCE or
NONADHERENCE
experiences
behavioral strategies.
1. Hypertension (McKenny,1973;
Williamson et al.,1975;Inui,et al.,1976)
2. Asthma (Green,et
al.,1977; Maiman,et
al.,1979)
3. Streptococcal infections
(Linkewich,1974)
PATIENT EDUCATION
METHODS
.. The PHYSICIANS
TEACHING STRATEGIES
Patient Education
METHODS
A.Individual Instruction
B.Instructional Aids
C.Demonstration
D.Group Classes
E. Peer Group Discussions
F. Behavior Modification
A. INDIVIDUAL
INSTRUCTION
Providing information and explanations to
the patient is an intrinsic part of the office
visit.
The physician provides instruction during
these encounters _course of history,
actual PE performance, and the
discussion of the diagnosis/regimen.
INDIVIDUAL INSTRUCTION
In dealing with individual patients
these principles for effective patient
teaching is applied:
Use unambiguous and appropriate
terminology
Be specific as possible
Provide the correct amount of
information, neither too little nor too
much.
..the principles
Use unambiguous and appropriate
terminology
Here are some commonly employed terms
and phrases which may mean differently to
some patients: esophagus, pills, under
control, monitor, explore lap, etc.
Convert medical terms to laymans
language whenever feasible.
..the principles
Be specific as possible
Do not say: you cut down on smoking, you watch
the sweets, take these capsules 3x a day
..the principles
Provide the correct amount of information,
neither too little nor too much.
Some enthusiastic clinicians undertake patient
education activities as they would approach a
lecture to third year medical students,
describing to the patients various pathophysiologic mechanisms and biochemical
pathways.
Asking the patient, Is there anything you would
like to know about your health condition? will
ensure that you do not undershoot the mark.
INDIVIDUAL Patient
INSTRUCTION
In simple terms, individual instruction
must be fitted to the patients need for
information considering his
demographics, socio-cultural background
and spiritual beliefs.
Putting into practice the preceding three
principles can lead to effective patient
teaching, thus_ the stronger adherence to
the regimen.
B. INSTRUCTIONAL
AIDS
Handwritten notes by the
physician(post-it or a small pad)
Leaflets and Pamphlets (from
voluntary agencies, pharmaceutical
industries, etc)
Others (models, audio-video
presentations from u-tubes,
simulated cases and role-plays)
INSTRUCTIONAL AIDS
this category includes a variety of audio and
visual techniques, such as pamphlets
anatomic models, posters in the waiting
room, and slide tape productions;
By definition, instructional aids are to
supplement, not as a replacement of the
verbal instructions given by the nurse or
physician himself.
INSTRUCTIONAL AIDS
Jotting down the regimen is
indicated at the following times:
Any new drug is prescribed
Any change in the dosage or schedule
of any medicine
If the patient is confused with the
regimen for any reason
Shifting of physicians with previous
prescriptions from the former
INSTRUCTIONAL AIDS
Many physicians have used the printed
materials from the pharmaceutical
companies or health agencies in addition
to materials that they themselves have
developed.
In recent years, a number of firms have
developed slide-tape programs or the
video presentations (x-plain.com)
accessible in the web.
At any rate, these instructional aids must
not interfere with the patient-physician
relationship.
C. ACTUAL Skills
DEMONSTRATION
This method is used to teach psychomotor
skills to patients
Breast self-examination
Self injection of insulin
Use of inhalers
Wound dressings at home
Eyedrop or topical dermatologic
applications
The see one, do one, teach one dictum
applies here.
Simply handling out a pamphlet is not
sufficient
D. GROUP CLASSES
These have been employed widely for
prenatal education and more recently for
community-wide health promotion
activities in nutrition, exercise, and the
like.
The classes generally consist of a
didactic lecture followed by a question
and answer period.
It may be given by the physician, nurse,
health education specialist, or
nutritionist.
GROUP CLASSES
More work needs to go into the planning
and publicity for a class than into
individual teaching.
It is helpful to write out formal behavioral
objectives. Examples: participants must
be able to demonstrate conscious
breathing, do stretching exercises,
monitor their blood sugar with the use of
handy glucometers, specimen collection
for lab exams, etc.
Instructional aids are useful in
conjunction with group classes.
E. PEER GROUP
DISCUSSIONS
The health professional serves
F. BEHAVIOR
MODIFICATION
Behavior Modification particularly
refers to those methods developed
by behavioral psychology.
The techniques are utilized more
often in psychiatric care but have
considerable relevance to patient
education, particularly preventive
health education(Pomerleau,1975).
BEHAVIOR MODIFICATION
Before a care provider appropriately
assist a patient to transform health
behavior, he must first attempt to
understand and diagnose what
behavior needs to be changed_ the
Behavioral Diagnosis in
Practice
BEHAVIOR MODIFICATION
The most important consequences are
rewards or punishments.
People are more influenced by immediate
than long-term consequences
Techniques fall under 9 general categories
that pertain to one link in the A-B-C chain
BEHAVIOR MODIFICATION
Behavior Modification Specialists
attempt to understand and diagnose
behavior in terms of its A-B-Cs ..
the repetitive cycle of Antecedents,
Behaviors, and Consequences that
occur in a persons daily life.
BEHAVIOR MODIFICATION
Antecedents
Internal _craving for food or cigarette; boredom; tiredness;
depression and so on..
Problem Behaviors
Commonly are substance abuse; consumption of high
caloric foods; disruptive behavior patterns; phobias.
Consequences
People are more influenced by immediate than long-term
consequences.
Control
antecedents
(smoke only 5
cigarettes a day)
1.
2.
2.
Eliminate
antecedents
(throw away all
ashtrays)
3.
3.
Do incompatible
behaviors
(eat celery and
carrots)
Gradually
change over
time or the
shaping
method
(smoke 3
cigarettes less
each day)
Use modeling
and rehearsal of
desired behavior
Consequenc
es
1.
Use rewards
2.
Use extinction
(remove rewards for
undesired behavior)
3.
Use punishment
Case Scenario
Alex, a 28-year-old male, single,
electronics technician works at his own
shop after he graduated from a 2-year
vocational course.
He started smoking at the age of 18 after
finishing high school; consumes about
10-15 sticks a day depending upon his
work load and day to day stresses.
He habitually drinks coffee every time he
feels tense and claims to experience
difficulty in concentrating due to
frequent incoming phone-calls.
Antecedent
s
1.
2.
3.
Availability of
cigarettes.
Tense feeling,
associated
with coffee
drinking.
Frequent
incoming
telephone
calls.
Behavior
Consequen
ces (of
stopping)
Smokes 10-15
1.
sticks of cigarettes
a day, mostly at
2.
working time.
Feel less
nervous.
Better able to
concentrate
on work.
2.
3.
Cut down on
coffee
drinking.
Go to work
one hour
earlier when
the office is
quiet.
Do deep
breathing
exercises.
ces
1.
2.
3.
Chew gum.
Jog four
times a
week.
Practice
refusal
responses
to friend
who offers
cigarette.
Go to a trip to
your favorite
vacation place
or buy yourself
a new
gadget/motor
vehicle as a
reward for
quitting.
Simply
BEHAVIORALof
DIAGNOSIS
is..
the put,
assessment
the reasons
FINDINGS of
BEHAVIORAL
DIAGNOSIS
1.
Lack of awareness or understanding
INDIVIDUA
L
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
SOCIAL
12.
13.
ENVIRONMENTAL
14.
15.
16.
MEDICAL
REGIMEN
17.
18.
Side effects
Complex regimen
Other examples
Patient has not completed a course
of antibiotics for UTI
She did not realize that she had to
continue taking the pills even after the
pain went away
She wanted her bottle of pills to last for
a second attack of UTI because of
limited financial resources
Other examples
Housewife trying to lose weight
Identify the easy availability of high
calorie foods
Feelings of boredom and depression
relieved by eating cookies
Other examples
A teenager who has no interest in
managing her condition
Denial of the existence of the disease
because of the ardent desire to be
normal like the rest of her friends
Lack of confidence in her ability to
successfully manage the condition
Once the
behavioral
diagnosis is made,
the most
appropriate
educational-
EDUCATIONAL-BEHAVIORAL
STRATEGIES
INDIVIDUAL
Teaching, instructional aids, repetition
Reassurance, encouragement, attribution, peer-group discussions
Simplify regimen, cue pill-taking to other activities, weekly pill dispenser,
involve family
Supportive exploration of patients feelings and perceptions
Point out dangers of untreated condition and benefits of therapy
Try non-pharmacological treatment, reassure patient that drugs will be
used minimally
Demonstration and guided practice
Behavior modification techniques (contingency management, contracting,
etc.)
Give patient ample freedom and respect, explore patients feelings
Psychiatric referral, if necessary
SOCIAL
Telephone call, invite to accompany patient to next clinic follow-up, home
visit, etc.
Develop provider communication skills, improve accessibility and
continuity of care
ENVIRONMENTAL
Prescribe generics, provide free care and samples, referral to social
worker
Community organizing; practice management to reduce waiting time
knowing
is not enough
CASE STUDY
..The case illustrates the
interrelationships and
complexities that are likely
to be encountered by any
Family Physician. The
intended emphasis,
the patient
35-year-old, married, female fastfoodchain corporation branch manager
Remarkably overweight with multiple
somatic complaints
chest pains, difficulty of breathing, easy
fatigability, pain on weight bearing joints
PE and Labs are within normal limits, except
for the BMI of 40
the patient
Clinical Interventions
Diagnosis - Depression
Management - counseling (CSCP) and antidepressants
Notes:
The dynamics of her weight and sloppy appearance clarified as a
safe expression of rage at her abusive husband, she was then
able to participate successfully in a rational weight control
program supervised by a behaviorally oriented nutritionist.
The physicians therapeutic strategy was not an immediate
attack on her apparent problem of obesity, which was less a
problem of ignorance about nutrition than a defense against
anger and fear.
Clinical Notes
Diagnosis - Depression
Management - counseling (CSCP) and
antidepressants
Notes:
the decision to
institute a planned
program of patient
education in a
particular practice
is not governed so
much by financial
considerations as
it is by the
commitment of the
physician to the
value of such
services and
willingness to be
responsible for
their quality
PRACTICE MANAGEMENT
CONSIDERATIONS
Despite the superordinate importance of
considering patient education within the
context of patient-provider interaction, it is
also useful to view patient education from
the perspective of practice management
considerations.
It is mainly a decision to formalize and
improve the educational activities that are
already being done on an informal basis.
PRACTICE MANAGEMENT
CONSIDERATIONS
All physicians perform educational functions for their
patients in their course of their ordinary clinical work
when they_
Explain
Advise
Recommend
Warn
Reassure and
Persuade
However, they may not think about these actions as uniquely
educational. These are delivered impromptu or
extemporaneous, occurring as the need arises, and not usually
subjected to evaluation.
PRACTICE MANAGEMENT
CONSIDERATIONS
developing a plan
hiring new professionals to do
buying a package of audio-visual equipment
library of pamphlets
sets of up-to-date books, audio-cassettes or videotapes
internet access
PRACTICE MANAGEMENT
CONSIDERATIONS
The first step to patient education is to examine
the practice as a whole to determine what needs
to be done and among the staff can become more
involved.
Any practice can improve and grow its
educational services by utilizing existing
resources and personnel.
The location, as well as the size and maturity of
practice will determine where to begin and will
set initial limits on the scope of the plan and
resources available
Frequently
Encountered PATIENT
EDUCATION PROBLEMS:
DIET THERAPY
DIABETES MELLITUS
ESSENTIAL HYPERTENSION
CONTRACEPTIVE COUNSELING
ANXIETY and RELATED PROBLEMS
CHRONIC ARTHRITIS
HABITS
CHILDBIRTH EDUCATION
PARENTING PROBLEMS
WELL-CHILD PROTOCOLS
Frequently Encountered
Patient Education Problems:
1. DIET THERAPY
Weight Reduction
Fad diets
Controlled sodium
Potassium-enriched
Bulky, high fiber
Diets for pregnancy
Infant and child diets
Diets for eliminating common allergies
2. DIABETES MELLITUS
Type I, Type II
MODY, DM in pregnancy
Frequently Encountered
Patient Education Problems:
3.
ESSENTIAL HYPERTENSION
4.
CONTRACEPTIVE COUNSELING
5.
Weight control
Exercise
Antihypertensive drugs
Family planning
Barrier methods
Oral contraceptive pills
Sterilization procedures
Relaxation techniques
Exercise
Stress reduction techniques
Anti-anxiety drugs
Frequently Encountered
Patient Education Problems:
6.
HABITS
7.
CHRONIC ARTHRITIS
8.
Foods to avoid
Classification
CHILDBIRTH EDUCATION
9.
Leopolds
PARENTING PROBLEMS
Age-related issues
Immunization updates
Developmental milestones
2.
SALAMAT YA
BALBALEG
ed INDENGEL tan
INPIBIANG YO
..Thank you very much
for listening, and
more importantly, in