Communication Key to Patient Education on Louisiana Medical News

Communication Key to Patient Education

By: TED GRIGGS

Posted: Monday, September 26, 2011 10:12 am

Communication Key to Patient Education | Melissa Stewart, eQHealth Solutions, patient literacy, Our Lady of the Lake College, Centers for Medicare & Medicaid Services, health literacy

Patient accountability is considered one of the keys to healthcare reform, but turning people into knowledgeable consumers who can care for themselves has been a difficult task for providers.

But Melissa Stewart, DNP, RN, CPE, a faculty member at Our Lady of the Lake College in Baton Rouge, believes her patient teaching method could help change that.

Stewart’s method applies time-tested education methods to a medical model, she said.

“It basically is a way to tap into what educators know … in how to frame information so that it’s best received and understood,” Stewart said. “Everybody learns in different ways.”

Some learn best by reading, others by hearing, still others by seeing a demonstration, she said. But in healthcare, everything is moving so fast and providers have so many things going on that they don’t have time to figure out the best approach for each individual patient.

Stewart’s work breaks up the information in a logical way so patients can better understand what’s required and why, she said. The approach also lets providers find out if the patients really know what they need to do.

“Right now in healthcare one of our common practices is for the patient to verbalize understanding. So in other words they say, ‘I understand.’”

But no one takes that approach when it comes to teaching algebra, Stewart said.

“‘I understand’ does nothing for us,” she said. “It’s the same thing when we ask them to repeat it (the instructions) back to us. I compare that to a parrot that asks for a cracker. Well, does Polly even know what a cracker really is?”

Stewart said a logical order must be followed in order for a person to understand the information.

“So if I’m telling you ‘fill this script, be sure to come back in three weeks, weigh yourself every day and pay at the window,’ please tell me how all of that is a logical order?” she said.

Providers can’t throw things out randomly without confusing the patient, Stewart said. It’s best to have the information flow from what the provider used to make the diagnosis, the rationale for treatment, and from there to what the patient needs to do at home.

“You came in with this. This is what’s happening. This is where we’re going and this is why,” Stewart said.

This approach helps the patient see from the provider’s viewpoint, she said. Changing someone’s behavior is the hardest thing a provider can do, and if the patient doesn’t understand the why, the task becomes even more difficult.

Take a congestive heart failure patient who is moving to provide self care. If that person doesn’t understand the why behind the instructions, the patient is going to go back to the doctor if anything changes, Stewart said. But suppose the patient knows the reason he must keep a daily diary of his weight is the doctor is watching for fluid retention, and even a 2-pound fluctuation may indicate the need for a change in medication?

Then the patient is empowered, and he doesn’t end up in the intensive care unit on diuretics, Stewart said.

A patient who comprehends his care plan can generate enormous savings. Low health literacy cost the United States’ economy an estimated $106 billion to $236 billion a year, according to a 2006 study by the University of Connecticut.

The savings achieved by improving health literacy would have been enough to insure everyone in the country without health coverage, more than 47 million people at the time, according to the report.

Stewart’s methods have already proven effective.

Baton Rouge-based eQHealth Solutions incorporated Stewart’s model in Care Transitions, a pilot project designed to reduce unnecessary hospitalizations among seniors. During the first year, participating hospitals reduced readmission rates from 18 percent to 4 percent.

In 2010, the Centers for Medicare & Medicaid Services cited the project as one of the nation's most innovative healthcare projects.

The model is laid out in Stewart’s book, “Practical Patient Literacy: the Medagogy Model,” which McGraw-Hill will release in December.

Stewart said the beauty of her model is that it takes less than 15 minutes for providers to implement, enough time to get across the needed information.

Providers and patients need to be on the same page, working from a base of shared knowledge.

“Everything is disease-oriented or it’s provider-oriented, but where healthcare is going is patient-oriented, and we’re not there,” Stewart said. “We’re on the outside trying to make the patient fit in our box. We’ve got to take a new approach and fit in that patient’s box.”

Stewart said her approach exposes the patient to providers’ thinking, and the reasoning behind instructions.

The patient can take in that information and decide whether this approach will work in his or her her life, Stewart said. If the original treatment plan doesn’t work, the patient can tell that to the provider, who can adjust the care plan so that it does fit.