Patient education for better managed care

By Rebecca Anwar, Ph.D.

Managed care causes changes in the way we think about patient education and the responsibility we assume in the medical office. Sure, it has always been your job to give patients medical instructions at the time of their office visit and when they were discharged from the hospital. The next time they came in for an office visit you would ask if they followed your advice. Like most practices, you may keep a few instruction sheets or brochures about certain medical conditions. Pharmaceutical representatives have traditionally provided these printed materials. Enter managed care! It is time to get serious about expanding your patient education program. Patient education is the golden egg of managed care.

Assuming more responsibility for patient education in the ambulatory setting keeps patients healthier and keeps medical conditions from worsening. It can reduce the need for hospitalization. Patients can be taught the importance of prevention, early treatment and overall health maintenance. They will partner with you for a healthier life style. Your patients can learn ways to reduce the chance of serious health problems and complications. They will recognize lifestyle factors that may be contributing to their health problems. They will know when to seek medical attention, rather than delay medical care and risk the chance their health could deteriorate. In the end, they will “get better, quicker.”

It is always discouraging when patients ignore your advice to change their dietary habits, take off 30 pounds, stop smoking or get into a regular exercise program. Patients don’t like to change something they enjoy. You have to get them to buy into your concepts and see the benefits. Here are a few suggestions to fine tune your patient education efforts and gain your patients’ cooperation.

An Effective Recall System. Your computer can help with this. You need to be able to recall patients by mail for check ups and be able to pull up a list for those that didn’t respond. This can include patients due for an annual exam, mammogram, prostrate check or a host of other situations including medications check, skin growths and postoperative re-examinations. Patients need to be reminded. In addition perform an occasional random chart audit to see if your recall system really is working! Simply pull every tenth chart and see if the patient was instructed to return for a visit. Check to see if the time has lapsed and the patient has not returned. Are there any notations of attempts to schedule or patient communication? Can you explain why the patient has not been in or how it slipped through your recall system? In the managed care environment you can expect to be monitored. Your recall system will be far more successful if you have effective procedures in place and your entire staff understands their importance. Your success will be enhanced if you are effectively communicating and educating your patients of the significance of the recall. They will assume more responsibility when the first reminder arrives at their home.

Patient Education Center. Designate a space in your office for a patient education center. This should be a separate alcove or room and should be equipped with several chairs, so a clinical staff person and a patient’s family member can accompany them. Dedicate some time to meet with your pharmaceutical representatives. They can give you suggestions and provide additional patient information materials for your patient education center. In addition to a comprehensive assortment of patient education materials related to your specialty, you might want to consider having a video monitor with an appropriate selection of video health care presentations. They are well worth the investment. Some specialty practices and large groups have even invested in interactive video programs—an excellent learning tool! Having a patient education center sends the patient a wonderful message. It says you care and it reinforces your treatment recommendations.

Audio Tapes. There are several ways to make audio tapes a cost-effective component of your patient education program. You can record consultations on hand-held tape players so patients can review your instructions in the comfort of their own home and with family. Or, develop a series of audiotapes on topics that are most often discussed with patients. Use a professional to script the audiotape message to ensure quality and clarity. You can then record the tapes yourself to hold costs down.

Lending Library. Invest in books that are written for the lay person—books that give your patients solid, practical advice about their condition in language they understand. You will be reinforcing your message. Patients will start to understand how important it is to make the changes you suggest and follow your advice.

Support Group Endorsement. When your patients or their family members have a serious condition and need outside support you can be their best resource. Make an effort to become familiar with and gain a better understanding of the support groups in your geographic area. This information can easily be obtained through your county social services and your local Chamber of Commerce. You or your staff should attend a meeting and get to know more about the person conducting the sessions. Endorse these support groups with vigor! In fact, someone in your office could arrange the patient’s first session. This way, you have a better chance of the patient attending and you signal to the patient that you think it is important.

Advice Nurse. Many hospitals and larger medical groups have already added the advice nurse to their portfolio of services. They have protocols in place and market the service to their patients. In the past, patients would wait for a condition to worsen, in an attempt to avoid a trip to the doctor—the “maybe it will go away” syndrome. Now these same patients will call and talk to a nurse. In a small practice it may not be affordable to have an advice nurse all day long. But you can still consider implementing the concept. Start by dedicating nurse time for specific time slots, one hour in the a.m. and one hour in the p.m. Delegate a specific phone line that has an answer machine to take the calls the rest of the time. The recorded message will tell the patients when the nurse will be responding to the call. They can elect to leave a message for the nurse, or call into the regular line if it is something that needs immediate attention. This way you can test the waters to see how your patients adjust, how it impacts your staff and what benefits you and your patients reap.

Every tool you use to reinforce the changes you are asking patients to make gets you closer to patient acceptance. You will see many of your patients buy into your concepts and understand the importance of following your advice. They will start assuming more responsibility for their health. Your patient care team will include doctor, staff and patient.

In the managed care arena, patient cooperation, life style issues and patient education will be more important than ever before. Health care expenditures are constantly being scrutinized for appropriateness and quality of care. Patient education plays a vital role. Your patient will “get better, quicker” and maintain overall better health.

Rebecca Anwar, Ph.D., is a senior consultant with The Sage Group, Inc., a national health care consulting firm specializing in strategic planning, integrated healthcare development, managed care training, operations and marketing. She is based in Philadelphia.