IHS Patient Education overview

1. Overview of Indian Health Service Patient Education CDR Christopher Lamer, PharmD, MHS, BCPS, CDE

2. Indian Health Service • Provides a comprehensive health service delivery system for approximately 1.9 million American Indians and Alaska Natives. • Serves members of 562 federally recognized Tribes. • FY 2009 appropriation is approximately $3.58 billion. • Indian Health Service total staff consists of about 15,700 employees, which includes

3. Resource and Patient Management 11 000101 001 0110 000 011 01110101 10 11001010 010 00 1 01 11100 0000111 10000111 10100 1100 0 0101 1 00 11110

4. Ask Advise Assess Assist 1. Ask the patient if he or she uses tobacco products (cigarettes, snuff, dip, etc.). 2. Ask the patient if he or she uses tobacco products for cultural or religious purposes. 3. Ask the patient if he or she is exposed to tobacco smoke at work. 4. Ask the patient if anyone uses tobacco products at home. 5. Document the health factor screening results using the values in the table.

5. Ask Advise Assess Assist • Health Factors – Non-Tobacco User – Current Smoker – Current Smokeless – Current Smoker & Smokeless – Cessation Smoker – Cessation Smokeless – Previous Smoker – Pervious Smokeless – Ceremonial Use Only – Smoker in the Home – Smoke Free Home – Exposure to Environmental Tobacco Smoke

6. Tobacco Health Factors

7. Ask Advise Assess Assist http://www.ihs.gov/NonMedicalPrograms/HealthEd/index.cfm? module=initiative&option=protocols&newquery=dsp_NatlPatientEd_Protocols.cfm

8. PEPC Has Two Components

9. PEPC Has Two Components 1. Code – This is the code used to document the education provided to the patient or family. 1. Mnemonic

10. PEPC Has Two Components HTN-C COMPLICATIONS 1. Code – This is the code used Outcome: The patient will verbally summarize the complications of to document the education uncontrolled hypertension. provided to the patient or Standards: family. 1. The patient will verbally summarize 1. Mnemonic the complications of uncontrolled hypertension. 2. Explain that heart attacks may result 2. Protocols - Protocols are from the heart having to work harder written guidelines for to pump blood through congested and hardened arteries. education. 3. Explain that blindness may result 1. Guidelines from injured blood vessels in the eye. 4. Explain that strokes may result from ruptures of injured blood vessels in the brain. 5. Explain that circulatory complications eventually impair the ability of the kidneys to ﬁlter out toxins.

11. Ask Advise Assess Assist

13. Ask Advise Assess Assist Readines Level of Sub- Topic s to Understandi Provider Time Topic Learn ng

14. Ask Advise Assess Assist Readines Level of Sub- Topic s to Understandi Provider Time Topic Learn ng -Mnemonic (TO, HTN) -ICD9 Code -CPT Code

15. Ask Advise Assess Assist Readines Level of Sub- Topic s to Understandi Provider Time Topic Learn ng -Mnemonic (TO, HTN) -ICD9 Code -CPT Code AP - Anatomy & Physiology HM - Home Management N - Nutrition C - Complications HY - Hygiene P - Prevention DP - Disease Process LA - Lifestyle Adaptations PRO - Procedures EQ - Equipment L – Literature S - Safety EX - Exercise M – Medications TE - Tests FU - Follow-up MNT – Med Nutrition Tx TX - Treatment

16. Ask Advise Assess Assist Readines Level of Sub- Topic s to Understandi Provider Time Topic Learn ng Education Code -Mnemonic (TO, HTN) -ICD9 Code -CPT Code AP - Anatomy & Physiology HM - Home Management N - Nutrition C - Complications HY - Hygiene P - Prevention DP - Disease Process LA - Lifestyle Adaptations PRO - Procedures EQ - Equipment L – Literature S - Safety EX - Exercise M – Medications TE - Tests FU - Follow-up MNT – Med Nutrition Tx TX - Treatment

17. Ask Advise Assess Assist Readines Level of Sub- Topic s to Understandi Provider Time Topic Learn ng Education Code -Receptive -Eager -Mnemonic (TO, HTN) -Unreceptive -ICD9 Code -Distraction -CPT Code -Intoxication -Severity of illness AP - Anatomy & Physiology HM - Home Management N - Nutrition C - Complications HY - Hygiene P - Prevention DP - Disease Process LA - Lifestyle Adaptations PRO - Procedures EQ - Equipment L – Literature S - Safety EX - Exercise M – Medications TE - Tests FU - Follow-up MNT – Med Nutrition Tx TX - Treatment

18. Ask Advise Assess Assist Readines Level of Sub- Topic s to Understandi Provider Time Topic Learn ng Education Code -Receptive -Good -Eager -Fair -Mnemonic (TO, HTN) -Unreceptive -Poor -ICD9 Code -Distraction -Refused -CPT Code -Intoxication -Group -Severity of illness AP - Anatomy & Physiology HM - Home Management N - Nutrition C - Complications HY - Hygiene P - Prevention DP - Disease Process LA - Lifestyle Adaptations PRO - Procedures EQ - Equipment L – Literature S - Safety EX - Exercise M – Medications TE - Tests FU - Follow-up MNT – Med Nutrition Tx TX - Treatment

19. Ask Advise Assess Assist Readines Level of Sub- Topic s to Understandi Provider Time Topic Learn ng

20. Ask Advise Assess Assist Readines Level of Sub- Topic s to Understandi Provider Time Topic Learn ng TO - QT- EAGR - G - ABC - 5min

21. Adding Patient Education

22. Outcome and Standards

23. Select the code you want

24. Document Education

25. Pick Lists

26. Ask Advise Assess Assist – The patient uses tobacco and wants to quit • Provide resources and assistance – Quit line information TO-HELP – Tobacco handouts TO-L – Refer to tobacco cessation specialist TO-IR – The patient uses tobacco and does not want to quit • Provide and review tobacco treatment literature – TO-L-RECPT-G-CL-3min-GNS • Provide feedback on why they should consider quitting – The patient has used tobacco and has quit – The patient has never used tobacco • Commend and promote abstinence

27. Ask Advise Assess Assist • Set a goal and a quit date • TO-QT-G-CL-5min – GS – will quit on 6/25

29. Ask Advise Assess Assist • TO-IR INFORMATION AND REFERRAL – OUTCOME: The patient/family will understand the process of referral and treatment for nicotine dependence. – STANDARDS: • Discuss sources for tobacco cessation treatment • Refer to nicotine treatment program or other resource as available. • TO-QL QUIT LINE – OUTCOME: The patient/family will understand how to access and beneﬁt from a tobacco quit line. – STANDARDS: • Explain to the patient/family that a quit line will enable to the patient to talk with a specialist who can helpthem plan an individualized quit method and may some times be used in coordination with other types of tobacco use treatment such as group or individual programs and/or medications. • Explain that people who use telephone counseling stop smoking at twice the rate of those who don’t get this type of help. • Provide the patient with the quite line phone number and hours of operation or assist the patient in calling the quit line during the patient encounter. • Explain how the quit line works and what the patient can expect from calling.

30. Clinical Reporting System

31. Table 6.25 IHS Clients Served by Location Location 2001 2002 2004 2006 2008 Total Clients 696,060 812,301 1,214,646 1,696,881 2,202,279 Hospital 445,842 534,891 740,077 968,008 1,284,632 Health Center 225,617 253,526 430,931 596,006 715,628 Health Station 17,515 16,271 23,140 64,206 65,521 Location (Home) 6,339 6,719 15,505 32,741 21,701 School 189 157 879 5,278 12,004 Village Clinic 510 700 4,113 14,386 226,679 Administration/ 35 37 58 11,513 39,724 Other

32. Learning Preference • Talk • Video • Small group • Read • Do/practice

33. Barriers to Learning • No barriers • Fine motor skills deﬁcit • Doesn’t read English • Hard of hearing • Interpreter needed • Deaf • Social stressors • Visually impaired • Values/beliefs • Blind • Cognitive impairment • Distraction

34. Healthcare Communications http://www.ihs.gov/healthcommunications/

35. Patient Education Handouts

36. RPMS Patient Wellness Handout • Demographics • Blood Pressure • Cholesterol • Allergies • Vital Signs • Diabetes Care • Preventive Screening • Medications • Immunizations • Patient Goals • Physical Activity