Implementing an integrated information prescription model in family medicine
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Implementing an integrated information prescription model in family medicine. Francesca 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

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Implementing an integrated information prescription model in family medicine

Implementing an integrated information prescription model in family medicine

Francesca 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

Agenda

This session reviews

  • Background

    • How the information needs of the community were determined

    • Existing health information models with a focus on the Information Rx model

  • Implementation

  • Challenges

  • Lessons learned several months after implementation.


Empowerment 1

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

The setting: summer /fall 2007


Needs assessment summer 2006

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

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

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

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

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

Where does Rx come in?

  • HPs are encouraged to refer their patients to the Patient Information Coordinator (librarian)

  • HPs can write a prescription for information

    i.e. the question

  • Rx is filled by librarian

    • In person

    • By phone/email/fax


Why on site

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

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

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

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

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

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

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

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

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

Support from on high

  • Clinic chief meets with librarian on weekly basis

    • Brings cases to librarian

    • Assesses needs

    • Problem solves


Creative solutions

Creative solutions

  • InfoRx cases blog

  • Cases & challenges documented

  • Opportunity for discussion

  • Eventual wider audience


Evaluation

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

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


Implementing an integrated information prescription model in family medicine

Thank you!


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