Compliance improves with peer education

Osteoarthritis affects roughly 16 million Americans annually. The estimated annual costs, including medical treatment, diminished productivity, and absenteeism from the workplace, compound to a staggering $40 billion.1

Studies show that arthritis symptoms can be reduced by as much as 30% through patient education and up to 50% with the appropriate medications.2 That good news, along with the recent release of the first practice guidelines for osteoarthritis by the American College of Rheumatology (ACR) in Atlanta, makes the disease a natural target for disease management efforts.3 (See "Resources," p. 71, for information on ordering the practice guidelines.)

And who better to teach people how to cope with this painful and disabling disease than the experts: arthritis patients themselves. A peer education program called Patient Partners in Arthritis, sponsored by Searle Pharmaceutical in Skokie, IL, features a series of six, two-hour seminars led by trained patient volunteers. Participants include both managed care providers and patients.

Patient volunteers are trained at the University of Texas Southwestern Medical Center in Dallas, and they team up with local health care professionals to present the educational series, says Jennifer Finch, RN, a nurse and arthritis patient from Weedsport, NY, who helped develop the series. "We train volunteers to keep the information presented consistent. The training goes beyond the basics. We even teach them the technical anatomy of the hand and wrist. We want them to be a credible source of information," she stresses.

In addition to leading programs for other patients, patient volunteers learn medical terminology so they can go to medical schools and professional groups and talk to residents, therapists, physicians, and nurses about the treatment of arthritis patients, Finch says. "The volunteer training is a very large commitment. It means weekends away from home. It requires studying books and other materials for months before they come to Texas. But patients who are motivated and have presentation skills are an invaluable educational resource," she says.

"Patient volunteers are an excellent resource for training clinicians in the sensitive handling of arthritis patients," Finch says. "Physicians many times don’t understand how frustrating this disease can be to a person who can’t get themselves dressed or get on the road to work without an exhausting process. Because the patient volunteers are trained to discuss this disease, they are able to express these issues clearly. They also give physicians practice in the sensitive examination of an arthritic body."

The biggest payoff is in showing arthritis patients that people just like them are coping with the disease in a positive, successful manner, she says. The seminars deal with all aspects of arthritis and how patients can manage their disease. Topics include:

• exercise;

• pharmacology;

• nutrition;

• activities of daily living;

• anatomy and physiology;

• adaptive devices;

• communicating with physicians.

Each topic includes discussion by patients, a presentation by health care professionals, and hands-on demonstrations. Here’s an example of how the seminars work:

• A pharmacist discusses various arthritis medications: how they work, how long it takes them to become effective, and what their side effects may be.

• The patient volunteer gives practical tips such as how to chart medications to make sure patients take them properly. The volunteer also may share personal experiences about drug side effects or the consequences of failing to follow medication instructions.

Each seminar is designed to give patients practical tools to get the most out of the health care system. Patients need to understand their disease and learn to discuss it in meaningful terms with their health care professionals, Finch says. "We teach patients how to talk to their doctors, to get the most of each visit, and to put their symptoms in a framework that helps doctors clearly understand the impact of the disease on the patient," she says.

For example, patients are taught not to say, "My hands don’t work as well as they used to," but rather, "I can’t open the top of the milk carton anymore," she explains. "We don’t teach patients to be obsessed with their disease but to be specific so that they can get the help they really need."

Program participants also receive handouts to take home, Finch adds. "We try to give them all sorts of written materials to help support the learning. If we’re talking about nutrition, we’ll hand out a copy of the food pyramid and some information about where to find adaptive devices that make cooking a good meal easier," she says.

Searle also supplies a total patient management book. "The book was written and approved by health care professionals. It doesn’t contain anything that would harm anyone. It just gives good information about nutrition, exercise, etc. It’s very simplified but gives excellent information," Finch says.

Managed care organizations that have implemented the Patient Partners in Arthritis program say it works. "The patient volunteers relate to our patients. They have been through a lot of issues in dealing with their disease, and they really set the momentum for each session," says Joyce E. Graham, RN, BSN, rheumatology case manager with Kaiser Permanente Mid-Atlantic Region West End Medical Center in Washington, DC.

"The patient volunteers have a big impact. They also encourage other patients to get up and give testimony. They become a support group. It helps patients to hear what medications worked for someone else. We have patients fill out evaluations after each session, and the responses have been very positive," Graham says. The West End Medical Center uses the Patient Partner volunteers to help facilitate other programs at its arthritis clinics. (For more information about the arthritis clinics, see story, above.)

"Each session also included hands-on demonstrations. If the program talks about exercise, the therapist runs through a program that everyone can participate in — simple exercises they can do every day at home," Graham says.

Patients who attend Patient Partners seem to have a more positive outlook, she says. "We haven’t really tabulated the data from all the evaluations, but patients seem more positive and are certainly more compliant with their doctors’ orders. They also feel more free to call me for more information. It’s really helped," she says.

References

1. Greenberg P, Finkelstein S, Berndt E. Economic consequences of illness in the workplace. Sloan Management Review 1995; Summer:26-34.

2. Hirano P, Laurent D, Lorig K. Arthritis patient education studies, 1987-1991: A review of the literature. Patient Education and Counseling, 1994; 24:9-54.

3. Hochberg MC, Altman RD, Brandt KD, et al. Guidelines for the medical management of osteoarthritis, Arthritis & Rheumatism, 1995; 38(11):1,535-1,546.