Implementing an integrated information prescription model in family medicine Francesca Frati, MLIS...
-
Upload
luke-burgess -
Category
Documents
-
view
219 -
download
3
Transcript of Implementing an integrated information prescription model in family medicine Francesca Frati, MLIS...
Implementing an integrated information prescription model in family medicineFrancesca Frati, MLIS
In collaboration with
Roland Grad, MDCM, MSc, CCFP
Herzl Family Practise Centre, Montreal QC
STFM Conference for Practise improvement: health education and patient education
Newport Beach, CA, November 10, 2007
Agenda
This session reviews
1. Background
How the information needs of the community were determined
Existing health information models with a focus on the Information Rx model
2. Implementation
3. Challenges
4. Lessons learned several months after implementation.
Empowerment 1
It is increasingly believed that an informed patient is an empowered patient, better able to act as partner with his or her health professional (HP) with the goal of achieving improved health outcomes.
“This type of partnership approach is known variously as shared or informed decision making, evidence based patient choice, or concordance.”
1. Coulter A, Ellins J. Effectiveness of strategies for informing, educating, and involving patients. BMJ 2007;335:24-27. Available from www.bmj.com
The setting: summer /fall 2007
Needs assessment: summer 2006 It was perceived that the health information
needs of the community were being met with room for improvement.
Health consumers and HPs surveyed
Confirms that both consumers and HPs want better access to consumer health information, and information literacy instruction.
We felt that the addition of a librarian to the health care team on site could help meet this need.
Review of existing models
1. Patient and family resource centres in the library setting Consumer health information provided by librarians
2.a. Patient and family resource centres within the hospital community Patient education provided by nurses
2.b. Patient and family resource centres within the larger community (clinics, malls etc.) Patient education provided by nurses
Continued review reveals a third model 3. A review of existing resources revealed a
service model with a librarian acting on-site as a member of the health care team with the support of the affiliated hospital library.
Based on an innovative InformationRx model first implemented at the Monkfield Medical Centre in UK (see Information Prescription section of article available from: www.cilip.org.uk/publications/updatemagazine/archive/archive2004/december/grimwood ).
Innovative how? Consumer is referred to a service
InformationRxs are usually filled by a medical or public library a participating bookstore or by the patient him or herself with the use of
recommended online resources
MedlinePlus InfoRx (http://nnlm.gov/hip/infoRx/summary.html)
Our solution
The in-house InformationRx service
Health information needs addressed for consumers and for HPs
by a librarian on site as a new member of the health care team.
supported by the adjacent hospital library
Where does Rx come in?
HPs are encouraged to refer their patients to the Patient Information Coordinator (librarian)
HPs can write a prescription for informationi.e. the question
Rx is filled by librarian In person By phone/email/fax
Why on site?
Avoid out of sight out of mind(we have a library?)
Librarian is better placed to understand the needs of the community
HP needs are addressed, not just consumers’
Integrated into practise Documented in charts Trust
The InfoRx pad
Pads were created to make prescribing easier
Family health topics were chosen with the help of the Patient Education Committee
Pads are in each consultation room and in the observation rooms
Consults All consults are documented
Question Recommended resources
Websites Books Pamphlets etc.
1 copy given to referring HP with Rx attached who then puts in the chart
Treated as clinical encounter- schedule in appointment scheduling software
Support for HPs
Giving patients the information & instruction (“teach them to fish”)
Assist with the creation of patient level materials
Provide guidance and instruction to HPs on the topic of consumer health resources & literacy issues
Provide updates on new consumer resources
Operation Librarian on-site 7 hours per week
Library provides support by Handling overflow Print collection PFRC website to include family medicine topics
Patient Education Committee provides support for decision making- predated service
Drop in encouraged
Pamphlet collection in room
Use of service to date
Opened 4 months ago
Seeing patients for 1 month
13 consults
Compare to library: 6-7 per month, mainly divided between 2 people
Challenges
Meeting the health information needs of consumers and HPs in a timely manner can be difficult.
Meeting these needs in a family practice setting presents unique challenges.
Meeting these needs at point of care means changing the way the team works.
Big challenge #1- change(based on my experience) Support staff
May not understand the need May not recognise the authority of unfamiliar professional
Nurses May not see how service is different from Patient Education May not recognise the skills a librarian brings to position Concern that librarian might provide inappropriate info or advice
Physicians May have trouble developing new habits (writing Rx)
Librarian May need to adapt communication style Learning curve specific to clinical setting
Big challenge # 2: time Coordinator only on site 7 hrs per week
All administrative aspects included in 7 hours
Start up issues Support staff
Learning about service Booking appointments Ordering materials (signs, pads, furniture, computer etc.)
Nurses Learning about service Assisting with the evaluation of print materials
Physicians Learning about service Writing InfoRx Promoting service to Residents, consumers
Librarian Doing it all in 7 hrs
Support from on high
Clinic chief meets with librarian on weekly basis Brings cases to librarian Assesses needs Problem solves
Creative solutions InfoRx cases blog Cases & challenges documented Opportunity for discussion Eventual wider audience
Evaluation
The chief of the unit is evaluating the service as part of his patient perspective initiative
The library will include evaluation of the service as part of its patient satisfaction survey
It was initially thought that a user post-consultation mini-survey would be administered as part of day-to-day operation of the service- it was decided that this is not practical
Lessons learned
“talk is cheap” – clinic chief
Residents use service more than FP Teachers- thought it would be opposite
Nurses don’t use the service
Patience!
Too soon to tell
Thank you!