Effective Patient Education for REMS Programs
Patient education and improved adherence to health care instructions is a topic of vast interest and research, yet conclusive evidence about the effectiveness of specific interventions remains elusive. Understanding and applying principles of effective adult education improves the likelihood of implementing programs that improve understanding and adherence.
In addition, it is clear that certain aspects of effective physician education can enable physicians to, in turn, become better educators of patients. Since physicians are an important influencer of patient behavior and because patient adherence is critical to achieving optimal risk management program outcomes, education of the physician becomes an important consideration for effective patient education.
Current State of Patient Adherence
One of the most challenging problems physicians encounter in their practice is patient non-adherence to recommended therapeutic regimens. Non-adherence occurs most frequently in patients suffering from chronic diseases. The rates of non-adherence range from 13% to 93% depending on the therapeutic regimen (Miaskowski, 2001).
With an increased emphasis on out-patient care and an overall decrease in the amount of time physicians have to spend with their patients during routine appointments, the need to identify effective means to improve patient adherence to therapy has become increasingly important.
What is Effective in Improving Patient Adherence?
A number of factors may contribute to improving patient adherence:
- A good physician-patient relationship, with both physician and patient setting treatment goals together
- Physician assessment of individual patient needs
- Patients involvement in the management of their disease, including development of a sense of responsibility for his or her disease
- Patient counseling and education sessions administered by the physician or office staff to the patient
- Supportive patient education materials written at a fifth to sixth grade reading level
- Patient follow-up (telephone) by the physician’s office
- Incentives and reminders such as calendars, pill boxes, and refrigerator magnets to increase patient motivation
It should be noted that a good interpersonal relationship, assessing individual needs, and setting goals are all elements of general adult learning.
A Model of Effective Patient Education: Enhancing the Physician-Patient Relationship
Designers of patient education programs can utilize the existing physician-patient relationship in order to improve program effectiveness. Although the physician is the nucleus of the patient’s health program (Falvo, 2004; Quill, 1996), he/she may not be an effective communicator or may not have the time needed to educate a patient. It is, therefore, important to involve so-called physician extenders such as nurses and office staff in the patient education process.
It is important for patients to perceive that their physician endorses all aspects of their care. Patient follow-up by other healthcare providers who communicate on behalf of the physician via telephone, web, and/or email can help reinforce the physician-patient relationship and improve adherence if patients are confident that their physician supports the educational messages.
Physicians may delegate many follow-up activities to different staff members, but interactions with the patient through nurses, physician assistants, and office staff should reinforce the patient’s perception of consistency of messaging among the people interacting with them.
Pharmaceutical companies that seek greater patient adherence need to provide effective educational materials and tools. These materials need to be consistent with the concept of enhancing the patient-physician relationship, helping to communicate to the patient that health care providers such as nurses, physician assistants, and pharmacists are all extensions of their physician. Examples of effective language, such as “your doctor may recommend” or “according to your doctor”, should be used consistently throughout all messages and interventions.
Program Design Considerations
Program designers should consider the following during program design:
- A blended learning approach should be used, including live interactive sessions with physician and staff, supported by exercises and/or storytelling along with printed materials
- All educational pieces should be consistent and create the sense that health care providers are an extension of the physician. Use verbiage such as, “Your doctor may recommend” or “it is possible your doctor may want you to…”
- Content should be written at a fifth to sixth grade reading level
- Printed information should take into account any special needs of the targeted patient audience; for example, a larger font size should be used for the elderly and materials should be written in multiple languages for diverse patient populations
- Develop an action plan to be completed between the patient and physician or office staff to help assess patient comprehension levels. The action plan should also specify follow-up office visits and lab tests
Effective Office Implementation
In order to effectively implement patient education, an in-service turnkey kit can be provided by pharmaceutical companies to help the physician and/or their staff educate the patient. Suggestions for physician or office staff implementation of an effective educational session include:
- A “live” initial learning session between the health care professional and patient, supported by a PowerPoint, flip chart, and/or video
- Parse complex information out at intermittent intervals and summarize frequently
- Include enabling materials, such as brochures or tools, as part of interactive sessions
- Distribute reminders and content to reinforce adherence (videotapes, DVD, CD-ROMs, online education, e-mail, printed materials)
- Online education should be highly interactive and include voice, animation, text, and a testing component in a game format
- Follow-up should include materials distributed to patients and caregivers, live interactive sessions between healthcare providers and patients, and videos, online education, and support group meetings
References
Falvo D. 2004. Effective Patient Education: A Guide to Increased Compliance. Third Edition, Sudbury, MD: Jones and Bartlett Publishers, Inc.
Miaskowski C, et al. Lack of Adherence with the Analgesic Regimen: A Significant barrier to Effective Cancer Pain Management. Journal of Clinical Oncology. 2001;19(23):4275-4279.
Quill TE and H Brody. Physician Recommendations and Patient Autonomy: Finding a Balance between Physician Power and Patient Choice. Annals of Internal Medicine.1996;125(9):763-768.
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