Notes & Links: August 16, 2013

The Adopt One! Challenge

Changing how physicians are being motivated to improve their communications skills look at Adopt One! It’s a simple challenge to physicians to adopt techniques and tools to engage and satisfy their patients. The program offers participating physicians a baseline assessment of their communications skills with patients and benchmarks it against best practices and their peers. It will then offer online access to assessment, recommendations, and tools to develop and improves patient-centic communications skills.

Here are the benefits:

  • More productive visits
  • More engaged and activated patients
  • Higher level of patient trust, information sharing, and adherence
  • Fewer patient request ion for unnecessary tests
  • Fewer medical errors and malpractice claims
  • Exceptional patient experiences

I buy each benefit but do busy stressed and hard pressed HCP have the time to do this? If these benefits are accomplished even in a few practices it will support and expand the changes we are seeing with online patient learning and the desire for more and better engagement. Take look and let me know what you think?

Metaphor in Video: Simple Ways to Improve Patient Education and Boost ROI

 Now that is a promise. I mean a whopper of a promise. 

Andrew Angus writing on HealthWorks offers pharmaceutical marketers a way to eliminate the use of jargon to help patients become better involved in their healthcare. Already the hair on my neck is standing up thinking about pharma improving communications to patients. 

The way to do this is to replace jargon with metaphor. Let’s take a look at the example:

“Insulin is a hormone that treats diabetes by controlling the amount of sugar (glucose) in the blood…It’s important to space your insulin doses throughout the day to keep your blood sugar levels within the normal range despite eating habits and activity patterns.”
Prepare to watch as your patient’s eyes glaze over as first confusion, then boredom, set in. Or you could put it in terms he already understands:

“Okay, Jimmy. Think of your pancreas as a refrigerator. Refrigerators keep food cool so it doesn’t spoil, right? A chemical called Freon is what helps fridges stay cool. Think of that Freon as insulin. If a fridge runs out of Freon, the food will go bad. Your body needs a consistent stream of Humalog so its food doesn’t go bad.”

What you need to realize is that your story has to solve someone else’s problem, so you need a way to express it concisely. The trick is to know what your consumers will understand. Everyone has used a fridge, but there are as many metaphors as there are drugs, so don’t be afraid to get creative.

I think I get the Freon metaphor but the money shot is that last paragraph. I agree in learning if you speak about someone else that the learner can relate to they will improve their uptake of knowledge. “Know what you consumers will understand’ is the issue to learn what they know what they don’t is a Herculean task for a busy HCP. 

Now how do you put this in practice. Well of course with a 60 second video. Find a metaphor that covers all your patients and do a video for everything from hemorrhoids to hematoma is no mean feat. Let me know if I’m being mean. 

Staging Dementia From Symptoms Profiles on a Care Partner Website

Rockwood, Richard, et. al from Dalhousie University published a paper in JMIR looking at how symptoms of dementia tracked on by a partner/caregiver online relate to dementia stage. They used the Artificial Neural Network to find relationships between the dementia stages and individualized profiles of people.

The results were:

The ANN model was trained in 66% of the 320 Memory Clinic patients, with the remaining 34% used to test its accuracy in classification. Training and testing staging distributions were not significantly different. In the 1930 Web-based profiles, 309 people (16%) were classified as having mild cognitive impairment, 36% as mild dementia, 29% as moderate, and 19% as severe. In both the clinical and Web-based symptom profiles, most symptoms became more common as the stage of dementia worsened (eg, mean 5.6 SD 5.9 symptoms in the MCI group versus 11.9 SD 11.3 in the severe). Overall, Web profiles recorded more symptoms (mean 7.1 SD 8.0) than did clinic ones (mean 5.5 SD 1.8). Even so, symptom profiles were relatively similar between the Web-based and clinical datasets.

This is where the authors end and it speaks to the need and benefit of using the Internet to drive healthcare knowledge and improve patient care. 

Finally, especially as disease-modifying drugs are developed that modify the course of dementia (and thereby its stages), it could lead to the creation of a more robust clinical staging methodology that considers symptom profile composition as important to understanding dementia severity and potential treatment effects.

Efficacy of a Text Message-Based Smoking Cessation Intervention for Young People: A Cluster Randomized Controlled Trial

Haug, Schaub, et. al from the Swiss Research Institute Public Health and Addiction publishing in JMIR show how texting can do more then take down a politician it can impact smoking in adolescents. 

A 2-arm cluster randomized controlled trial, using school class as the randomization unit, was conducted to test the efficacy of the SMS text messaging intervention compared to an assessment-only control group. Students who smoked were proactively recruited via online screening in vocational school classes. Text messages, tailored to demographic and smoking-related variables, were sent to the participants of the intervention group at least 3 times per week over a period of 3 months. A follow-up assessment was performed 6 months after study inclusion. The primary outcome measure was 7-day smoking abstinence. Secondary outcomes were 4-week smoking abstinence, cigarette consumption, stage of change, and attempts to quit smoking. We used regression models controlling for baseline differences between the study groups to test the efficacy of the intervention. Both complete-case analyses (CCA) and intention-to-treat analyses (ITT) were performed. Subgroup analyses were conducted for occasional and daily smokers.

This study demonstrated the potential of an SMS text message–based intervention to reach a high proportion of young smokers with low education levels. The intervention did not have statistically significant short-term effects on smoking cessation; however, it resulted in statistically significant lower cigarette consumption. Additionally, it resulted in statistically significant more attempts to quit smoking in occasional smokers.

Text messaging reaches adolescents very well it speaks directly to where they participate but more importantly it speaks to lower socioeconomic groups more effectively. And remember the more one trys to quit the greater the chance of success.

Teaching Medicine Requires Teaching Thinking

I couldn’t resist this one just for the doh factor. But with due respect this is a well considered piece that looks at how do we assess diagnosis accuracy but db looks at how to teach a thought process. What can be done to help medical students learn how to critically appraise learn how to approach a medical problem 

This works for me:

Great medicine does not come from following scripts.  Great medicine occurs when the clinician knows enough to either proceed or know that they need another physician to help.  Algorithms are not the answer.  Excellent thought processes are the answer.