saudi diploma in family medicine center of post graduate studies i n f amily m edicine

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Saudi Diploma in Family Medicine Center of Post Graduate Studies in Family Medicine

Patient EducationPatient Education

Dr. Zekeriya Aktürkzekeriya.akturk@gmail.com

www.aile.net

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Objectives

• At the end of this session, the trainees should be able to:– Define the principles of patient education– Explain the integrated health behavior model– Explain the health behavior change model– Design and apply a health education

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• Tobacco use• Exercise• Nutrition • Traffic accidents• Home accidents and environmental injuries• Sexually transmitted diseases• Unwanted pregnancies• Oral health• …

USPSTF Recommendations

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• Doctor-patient relationship always includes patient education.

• A good doctor HAS to be a good educator.• Patient education spreads throughout all

levels of the consultation.

Timing

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• Encourage patients to take responsibility of their health behaviors

• Establish doctor-patient partnership– Doctor: health counselor– “First information then choice”

Aims

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• Feed-back• Reinforcement• Individualization• Facilitation• Relevance• Using multiple channels of education

Principles

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1. Establish a therapeutic relationship2. Provide counseling to all patients3. Ascertain that patient understands the

relationship between behavior and health4. Work with the patient to eliminate barriers

to behavioral change5. Include patients in the decision of which

risk factor to change

Suggestions from the USPSTF

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6. Use combined strategies7. Prepare a behavioral change plan8. Track the changes by follow-up visits9. Include all your personnel

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The Integrated Health Behavior Model

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Health Behavior Change1. Precontemplation: Not intending to take action in the

foreseeable future, usually measured as the next 6 months.2. Contemplation: Intending to change in the next 6 months;

aware of the pros and cons of changing, leading to procrastination.

3. Preparation: Intending to take action in the immediate future, usually measured as the next month; have a plan.

4. Action: Have made specific overt modifications to behavior within the last 6 months.

5. Maintenance: Working to prevent relapse, increasing confidence; typically lasts 6 months to 5 years.

6. Termination: Zero temptation to relapse and 100% confidence in ability to maintain new behavior.

From Prochaska JO, Velicer WF: The transtheoretical model of health behavior change. Am J Health Promot 12:38, 1997.

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• Motivation is critical– “What would you like to do?”– “How about making a change?”

• Giving information to a patient ready to change will motivate him/her for positive change.

• For simple behaviours just simple reminders may be enough. Difficult changes such as diet may need special discussion sessions.

Good News!

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• Providing information and clues to patients without motivation is not useful– Health belief– Social support– Activity – MOTIVATION

Bad News!

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• Leave open door• Give time• Determine aims and expectations of the patient• Determine wrong informaiton and beliefs and

substitute with correct ones• Supports and barriers

– family, social environment, occupation, income, working hours

• Low personal benefit

If Patient not Motivated

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• Don’t blame,• Reward successes (even if small),• Be encouraging,

• Some will never change; whatever your efforts..

Education

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• Individualize:– Assess the present knowledge.– Use material relevant to patients understanding.

• Team work.

Education

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• Most commonly neglected part.• Don’t just give information and go!,• Determine personal needs,• Update the needs after evaluation,• Make a new planning..... Establish

continuity.

Evaluate

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• Who will participate?• Using verbal education• Using printed materials• Doing what is comfortable to ones self• Other materials and methods• Office design

Planning of Patient Education

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• Involve all team members:– Makes the education stronger,– Gives more time to the doctor.

• Doctor:– Determines objectives of education,– Gives broad information on the importance of the

objectives,– Determines which educational process to use,– Evaluateds the process.

Who will participate?

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• According to the need, the doctor himself may provide the education or assign somebody else.– Education nurse,– The receptionist may provide relevant documents,

• Other resources of the public may be utilized,– Public education centers,– Social services,– Voluntary organizations.

• Patient education teams may be established in bigger organizations.

Who will participate?

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• Patients should be evaluated with their families.– Family support will affect the success of

educaitons.– In many occasions the partner should be involved

as well.• Diet education needs the contribution of the one who

cooks.– Caregivers of children and elderlies are direct

targets of the education.

Who will participate?

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• The basis of education is established during the consultation.– Information should be approppriate.– The structure should be based on mutual

expectations of the patient and educator.

Verbal education

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• Should be non-judgmental and non-accusive,

• Make clear that patient views are respected,– Be a team with the patient for a mutual aim.

• Understand the beliefs, skills, readiness to change, and anxieties,– Low to medium anxiety will increase

motivation; excessive anxiety may cause denial.

Verbal education

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• Avoid medical jargon.– Use together with synonyms or avoid totally.

• Use clear and understandable statements.– “decrease fat consumption”, “make more exercise”,

“don't lift heavy objects”, “take your medicine three times a day” are inappropriate.

• Ascertain the patient has understood you.– Encourage to ask questions.– Politely ask to repeat what was told.– Take over the fault of misunderstanding.

Verbal education

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• Used very frequently.• Wnated by patients.• Should be supported with verbal

education in advance.

Printed material

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• Before used;– Is the content appropriate?,– Understandability,– Easiness to onbtain and keep

• Should be prepared according to the average level of the population.– Should be preferred in patients with well known

edcucational level.

Printed material

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• You may control the content– Focus on maximum 3-4 points– Avoid medical terminology, statistics or scary

expressions– Use short sentences, understandable words– Give open messages

Doing what is comfortable to yourself

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• Models• Maquettes, manikins• Tapes • Video• Computer• …

Other methods

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• Look to the office as a patient training center.– Educational materials in the waiting and

examination rooms.– Posters on the walls.– Educational video in the waiting room.– Change the themes with some period.

Office design