Health reform promises improved access, more patients to educate

What might patient education managers do to prepare?

Although no one is sure what the new health care legislation will look like when fully implemented, all agree it will give more people access to preventive and medical care.

As a result, many health care professionals agree that reform will impact patient education.

Fran London, MS, RN, a health education specialist at the The Emily Center at Phoenix (AZ) Children's Hospital, expects that more patients will get screened, get care for chronic illnesses, get diagnosed with illnesses new to them, and get regular care.

"Each one of these will increase the need for effective and efficient patient education," says London.

It will be more important than ever for health care providers to evaluate understanding, because people who have not used the health care system for a while may not have the basic knowledge to understand instructions or an accurate view of how much self-care is required, she adds.

Health care reform will impact patient education because millions of currently uninsured people will be able to access health care when they fall ill and will need information about self-care and follow-up care, says Louise Villejo, MPH, CHES, executive director of the patient education office at the University of Texas M. D. Anderson Cancer Center in Houston.

"There will be an increased need for patient education in all areas, because people will be accessing the health care system throughout the continuum of care," says Villejo.

Many hospital systems have focused on acute care; however, health care reforms will require systems to expand their inventory of resources to cover the preventive side of care and early disease management aspects, predicts Diane Moyer, BSN, MS, RN, program director of patient education for The Ohio State University Medical Center in Columbus.

Providing resources to physicians' offices and clinics will be essential, and helping those providers know how to select quality, easy-to-read and understand materials for use in educating patients will be very important, adds Moyer.

Mary Szczepanik, RN, BSN, MS, a breast health specialist at the OhioHealth Breast Health Institute in Columbus, says that because health care is a process, not a moment in time, needs will change as the person moves through the continuum of care. However, if more individuals are able to seek preventive care, such as well-child care and screenings, then there will be an increase in the diagnosis of disease, which suggests an increased need for education about the treatment.

What do patient education managers need to be doing in order to prepare for the changes in health care delivery?

"Become more involved in the preventive side of care by making sure that learning opportunities are provided by easy access to information," advises Sandra Cornett, RN, PhD, director of AHEC Clear Health Communication Program Office of Outreach & Engagement, The Ohio State University College of Medicine in Columbus.

We need to communicate in such a way that preventive care is seen as meaningful to people with low health literacy, she explains.

According to Szczepanik, there are social and cultural norms associated with low health literacy that cannot be changed simply by providing better access to health care or improving health literacy. "We have to find a way to convince people that finding a health problem earlier, rather than later, is a good thing," she says.

To reach a variety of people, education needs to be delivered in many different modalities, says Cornett. Social networking formats, such as Facebook, Twitter, texting, and podcasts, may help the younger population.

Patient education managers should explore ways to get their messages out to vulnerable populations, such as those with low health literacy. Also, they should explore settings where the message will be received, says Cornett. She encourages taking lessons on disease prevention into churches, beauty salons, barber shops, grocery stores, recreational areas, schools, adult education classes, and retail shops, as well as distributing information through ads and public service announcements. Patient education managers will need to do a thorough assessment of the patient population they serve, says Szczepanik. This assessment should include the socioeconomic status of the population, as well as existing comorbidities, health history, and health literacy level.

Villejo says there are already a lot of materials available through government agencies, disease-specific organizations, wellness organizations, health education vendors, and health care institutions that cover preventive services, such as diabetes screening. Processes are needed to provide preventive health information in the community, in schools, and in the workplace, as well as clinics, physician offices, and health care systems. "Simple print materials and multimedia materials should be available," says Villejo.

Thinking outside the box

Cezanne C. Garcia, MPH, adjunct faculty, School of Public Health and Senior Program and Resource Specialist at the Institute for Family Centered Care in Bethesda, MD, says, "Be wary of defining preventive care solely as those services that are provided/scripted by health care-based services."

She advises support of community-based services, such as the delivery of fruits and vegetables to libraries in neighborhoods that historically have had no access to non-processed foods; participation in fitness activities in communities; construction of walkways and bike paths to encourage fitness in everyday life; support of fitness in schools for children; and meditation and exercise to tackle depression.

"We have been a sick-care system, rather than a health care system model, for so long, we need to help people understand how to stay healthy. It could be a big shift for providers and patients, but I think PEMs are positioned to help both parties be successful in the transition by helping to message content in a way that is easily understood by patients," says Moyer.

To gain the greatest benefit from the recently passed health care legislation, which would be to improve health outcomes and hold down costs, patient education toward the goal of increasing health literacy is absolutely necessary, says Jennifer Rho, MD, MPH, co-founder, medical director, and volunteer physician at Hawthorne Health Services at Hawthorne Education Center in Rochester, MN.

A lot of emphasis within the health care system has focused on creating easy-to-understand written materials and improving patient-provider communication; however, improving the health literacy of patients is equally important, says Rho.

"What I have found as a physician practicing in a health service for adult literacy students is that while they want health materials easier to understand, they are equally...eager to improve their knowledge of the health care system, healthy living, and common health issues," she explains.

Assess what areas of health education are most important to the local patient population, then work directly with patients and community members to develop materials that meet the local needs, she advises.

Consumers will need information and education within their community about how to be an empowered consumer of health care, says Cornett. This might include information on how to prepare for a doctor's/clinic visit; asking questions; understanding services available; appropriate use of the emergency department; knowing where to go to get resources and care; personal responsibility for getting care; and what to expect in the American system of health care, she explains.

According to Rho, people with very low health literacy, who have had limited access to health care in the past, may not understand what it means to have health insurance. Because this population is not currently reached by traditional patient education methods, which tend to be hospital-based, it is important that patient education managers step outside of the hospital and go into the community with their efforts, she says.

A patient education system where one person assists the patient in obtaining the care they need and deserve is an effective model, says Szczepanik. The assistant would help those inexperienced with the medical system make appointments, read schedules, and understand the steps and timelines for care, she explains.

In addition to teaching patients how to utilize the health care system, changes need to be made to make the system easier to navigate, says Cornett. Every health care system should do a health literacy environmental assessment on matters such as how well people can physically navigate the system. This would include an evaluation of the telephone system, entrance, lobby, maps, signs, information desk, staff assistance, color codes, and services and specialties, she says.

In addition, print communication and oral communication would be reviewed, as well as technology, staff orientation, and skill building in communication, says Cornett.

Although it is not yet clear how the legislative changes will impact the health care system, patient education, or individuals, Szczepanik says she is optimistic. She hopes that cost barriers will no longer be an obstacle to preventive screenings and care — or compliance with the care recommended by health care professionals once a diagnosis is made. She is also hopeful that more people will understand the advantages of leading healthier lifestyles.


For more information or discussion on the impact of health care reform on patient education, contact:

• Sandra Cornett, RN, Ph.D., Director, AHEC Clear Health Communication Program, Office of Outreach & Engagement, The Ohio State University College of Medicine, 052 Meiling Hall, 370 W. 9th Avenue, Columbus, OH 43210. Telephone: (614)688-3327 (Tues/Thurs) E-mail:

• Cezanne C. Garcia, MPH, Adjunct Faculty, School of Public Health, Senior Program and Resource Specialist, Institute for Family Centered Care, 7900 Wisconsin Avenue Suite 405, Bethesda MD 20814. E-mail:

• Fran London, MS, RN, Health Education Specialist, The Emily Center, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016-7710. Telephone: (602) 546-1408. E-mail:

• Diane Moyer, BSN, MS, RN, Program Director, Patient Education, The Ohio State University Medical Center, 660 Ackerman Road, Room 667, P.O. Box 183110, Columbus, OH 43218-3110. Telephone: 614-293-3191. E-mail:

• Jennifer Rho, Md, MPH, Co-founder, Medical Director, Volunteer Physician, Hawthorne Health Services at Hawthorne Education Center, Rochester, MN. E-mail:

• Mary Szczepanik, RN, BSN,MS, Breast Health Specialist, OhioHealth Breast Health Institute, 376 Blenheim Road, Columbus' Ohio 43214. Telephone: (614) 268-3547. E-mail:

• Louise Villejo, MPH, CHES, Executive Director, UT M. D. Anderson Cancer Center, Patient Education Office, 1515 Holcombe – 21, Houston, TX 77030. Telephone: (713) 792-7128. E-mail: