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How to help patients make informed decisions
'Information prescription' should be part of care
Case managers should always remember that giving patients the right information about their condition is a form of care, Molly Mettler, MSW, says.
"It's more than semantics. We are saying that having good information is as important as any medical test. Any care that happens without information being part of the process is incomplete care," adds Mettler, past chair of the National Council on Aging and senior vice president of Healthwise Incorporated, a Boise, ID, organization with a mission to help people make better health care decisions.
She and her company promote a concept called "information therapy," which means getting the right information to the right patient at the right time.
Patients typically forget a critical amount of information they receive during a physician visit, Mettler says.
Not only are physician visits of short duration but often patients are stressed about their condition, not feeling well, and are given far more oral information than they can absorb.
Prevent information erosion
Dutch researchers discovered that patients forget between half and 80% of all medical information delivered during the average consultation. Their study, published in the May 2003 issue of the Journal of the Royal Society of Medicine, showed that if the patients were given 10 facts, they forgot five of them and remembered half of the rest incorrectly, she says.
"There is a terrible erosion of medical information in the hands of the patient. Preventing this information erosion is a significant issue for case managers," Mettler says.
She advocates "information therapy" or putting the right facts in the hands of patients and their family in a way that helps them make a decision that's right for them.
"One of the great laments of case managers and other providers is that patients get a plan of care, but they don't adhere to it or fully participate in it," she adds.
Giving a patient the right information won't necessarily assure adherence, but patients who do not get good information routinely during the health care process have a harder time complying, Mettler explains.
"The average physician consultation is seven minutes long. People who are enrolled in a case management programs often have multiple health problems, behavioral health problems, multiple prescriptions, and need to make lifestyle changes. You can take everything an average patient experiences and multiply it for patients who are in a case management situation," she says.
One of the most important things for case managers to remember is how they communicate the medical information their clients need.
"They should be making it available for their client as part of the process of care," Mettler says.
Building on the foundation of information a patient has also is part of the process of care, she says.
Case managers should find out what kind of information the patient already has in his or her hands, make sure it is the kind of information the patient needs, and supplement it with better or more detailed information if necessary.
"When the dawn of the Internet happened, everybody thought how wonderful it is that the vast medical libraries of the world were available. But it's more like a fire hose. Consumers are inundated with too much information with no quality control about it. Some of the information is OK, some is just dumb, and some is downright dangerous," Mettler says.
The best way to help your clients get the proper medical information is to give them an information prescription as part of the process of care.
"It's almost like patient safety for information. If they don't have the correct information, they may not be safe," she says.
"Information prescriptions need to be built into the process of case management in a way that doesn't add to the workload," Mettler says.
When a patient has access to a computer, the case manager and patient or caregiver go through a real-time coaching and counseling session on-line.
Mettler's company, Healthwise Incorporated, has developed an electronic tool for "information prescriptions." The Healthwise Knowledgebase is used by a number of hospitals, health insurers, and other providers.
Healthwise Incorporated offers a model of information therapy that allows case managers, physicians, and others to "prescribe" visits to a web site that includes decision guides and other information targeted to the member's particular diagnoses.
"This helps case managers save time because they have a credentialed information source they can go back to again and again," she says.
"We think that information therapy could result in better outcomes across the board. I can see it becoming a practice enhancement," she says.
The right moment
Ultimately, Mettler believes, a health plan or case management service that offers prescribed targeted information to patients will have an advantage.
"Any care that doesn't include information therapy is incomplete care," she says.
Newsletters and other printed materials may fall short because members don't get the information when they need it, Mettler points out.
"The moment they need it is when they have a decision to make or a health behavior to change, or when their illness is getting worse or getting better. The right moment when information is needed is determined by the patient who is at a crossroads and has to change something, make a decision, or face a change in health status," she says.
Healthwise Incorporated updates its database quarterly with the latest information from medical journals, puts it in language the consumer can understand, and lays it out so it can be used in decision making.
"There are a lot of databases available, but what people want most is information that helps them make a decision about what they need to do next to help manage their health problems," she says.