6 Optimization Strategies for Client Education, Engagement, and Self-Management

Section6.4 Optimize

Section 6 Optimize—Optimization Strategies for Client Education, Engagement, and Self-Management- 1

Optimization Strategies for Client Education, Engagement, and Self-Management

When local public health (LPH) care includes visits to clients’ homes there is an opportunity to enhance patient education, engagement, and access to information about self-care and how their health status compares to norms for improvement. This tool demonstrates how electronic health records (EHR), health information exchange (HIE), and other health information technology (HIT) can support these goals.

Time needed: 4 hours
Suggested other tools: NA

Introduction

A number of studies[1] have demonstrated that when chronically ill patients have access to their vital data—by whatever means—they are in a much better position to monitor their environment, behavior, diet, and compliance with medication.

How to Use

1.Distinguish usefulness between public reporting and generic reference material, as well as personalized report cards, tailored education, and self-management tools.

2.Acquire and utilize strategies to optimize adoption of EHR, HIE, and HIT to support all forms of patient engagement and self-management.

3.Evaluate the impact of HIT on patient self-management and plan for continuous improvement.

Comparison of Patient Support Materials and Usability within EHR, HIE, and other HIT

Form of Patient Support / Advantages and disadvantages
Generic reference material – home health agencies and many other providers subscribe to services that provide health education content suitable for:
-Brochures, pamphlets, or other handout material
-Adopting as content for the organization’s Web site / Advantages: Generic reference material acquired from a company that specializes in its development and acquisition is an important first step in making health education available to your patients. The material is generally written specifically for the target audience, in “lay language,” with suitable illustrations and generic advice.
Disadvantages: Generic reference material may not have been written with public health in mind.
Generic reference material does not directly enable comparison with the educational content and specific patient’s condition.
Generic reference material—when distributed by a public health nurse—may require more explanation than customizable material.
Customizable educational material is available as a utility in some EHR systems.
-Some systems enable the public health nurse to select specific educational material and have it print with the patient’s name, photo, language spoken, and even large font.
-Some systems enable the public health nurse to combine educational material on multiple conditions for a single client or family so one unique packet of information can be provided to the patient.
-Some systems pre-populate educational material selected by the public health nurse with patient-specific information, further customizing the material to the specific patient. / Advantages: Educational materials customizable through the EHR provide a closer bond between the material and the client, as well as specific guidance. To the extent that the client’s own information can be incorporated, the materials are more beneficial. The public health nurse can spend time focusing on specific messages rather than filling in client-specific information.
Client-specific report cards and diaries (sometimes referred to as “participatory medicine”) are intended to motivate the client to partner with the public health nurse in improving his or her health, take an active role in self-management, participate in decision-making, and assume responsibility for making agreed-upon changes in behavior. / Advantages: Client-specific diaries provide very specific, clear messages about the client’s health status and can be generated by some EHRs, especially when linked to an HIE organization (HIO) where multiple providers can contribute data (e.g., medications from pharmacy, lab results from commercial or public health lab, vital signs from public health nurse).
Disadvantages: Client diaries may not include specific instructions for improvement. They must be explained to the client and/or family in a supportive, partnering manner. These should not be introduced as “grades” in school. The public health nurse using the diaries must be skilled in using them.
See also:
Motivational interviewing is a non-judgmental approach to increasing a patient’s awareness of the potential problems caused, consequences experienced, and risks faced as a result of a health-related behavior – especially those that contribute to chronic disease (e.g., diet, exercise) and behavioral disorders (e.g., drinking, isolation). Steps include involving client in talking about issues and establishing rapport, focusing on specific things the client wants to change, and allowing client to plan the specific steps to implement the desired change so that the client feels empowered to actuate the change.
See also:
Shared decision making tools involve a collaborative process that allows clients and providers to make health care decisions together, taking into account the best scientific evidence available as well as the patient’s values and preferences. This honors both the provider’s expert knowledge and the client’s right to be fully informed of all care options and potential harms and benefits. It is most applicable to major clinical decisions, such as whether to have a particular surgery, but is also effective for lifestyle changes. See also:
Patient self-management/patient engagement tools
Patient self-management/patient engagement tools often refer to technology used by a client or informal caregiver to manage health problems outside formal institutions. These tools can be accessed independently by a client, and can be provided by a public health nurse who also uses motivational interviewing and shared decision making to help clients address barriers to achieving their health goals (e.g., lose weight, stop smoking). Some EHRs offer templates to build a client’s self-management plan of care. Patient education, diaries, and report cards are also helpful adjuncts. Increasingly, patient self-management is being linked to the broader scope of care coordination in the chronic care model.
See also:

Adoption and Evaluation of Patient Self-Management Results

1.Consider using a tool to plan and track how you aid client education and self-management.

2.At a minimum, list self-management techniques that your LPH department has or can readily acquire/develop. Provide training and encourage staff members to use these techniques.

3.Ideally, document for each patient what self-management technique was applied when. (Techniques may need to be reinforced with discussions, and some techniques may need to be repeated.)

4.Although it is unlikely that only one technique will be effective when there is a specific opportunity for improvement, it can be helpful to focus on a specific goal and document results.

5.Two examples—for different patients—are provided below. Add your own focus areas and techniques.

Self-Management Technique / Date Initiated / Baseline Data / Results after __ Time / Specific Instructions to Patient / Results after __ Time
Report Card
Diabetic diary
PHR to receive lab results / May 2 / Uncontrolled diabetes; goal: Hg A1c = 8 in 3 months / Aug 5:
Hg A1c = 8.2 / -Use structured diabetic diary to record diet and blood sugars
-Track Hg A1c values through PHR / Nov 3:
Hg A1c = 7.4
Depression Self-Care Action Plan / May 8 / PHQ = 9
(Has fluctuated between 7 and 9) / Jun 12
PHQ = 8 / -Have client develop a self-care plan / Aug 14
PHQ = 7

Section 6 Optimize—Optimization Strategies for Client Education, Engagement, and Self-Management - 1

[1] Richardson, J. et al. 2012 Monitoring Physical Functioning as the Sixth Vital Sign, BMC Family Practice,