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Connecting Patients and Physicians: A role in encouraging communication Contributed Paper Session October 14 th 2012 2012 MLA Quad Chapter Meeting Baltimore, MD
Introduction This project embedded a medical librarian in an university outpatient clinic to assist patients in finding health information and clarifying questions for their doctors. Hypothesis Patients provided with quality consumer health information at an appropriate literacy level and assisted with preparing questions before their clinic visit will have more productive interactions with their health care providers.
Methods Internal Medicine and Medical Specialties (IMMS) Clinic for 4 hours a week over 9 weeks from May July 2012. A laptop with WIFI connections and mobile printer were set up in a corner of the waiting room for the librarian to provide individual patient consultations.
Study Populations Population 1: Physicians 7 3 Residents and 4 Attendings Pre intervention survey Post intervention survey Population 2: Patients 12 Survey on computer access and preferred learning styles
Results Patients 12 patients identified 25 questions for their doctors. Questions related to: medications symptoms disease treatment
Sample Questions Identified with Patients What is pancrealipase used for? Why do I need to take it? It is very expensive! What are the treatments for pulmonary fibrosis (PF)? Are there clinical trials ? Is PF linked to occupational exposure -working in shipyards or chemical plants ? My heart is racing and the doctor wants to put me on a 30 day heart monitor. Is there the doctor more concerned?
Resources Used MedlinePlus.gov Health Topics and Drug Topics PubMed for journal articles Clinical Trials.gov Shands Mychart electronic patient record Needy Meds Prescription formularies ( WalMart Target) Association websites Pulmonary Fibrosis Association Neurofibromatosis Foundation
Sample Patient Encounter What are my options for treating external hemorrhoids? Information identified: MedlinePlus.gov -anatomical drawings, patient handouts patient interactive tutorials 1. PubMed -American Family Physician article on treatment of hemorrhoids Cochrane Systematic Review suggested one procedure was better than another in reducing recurrence of hemorrhoids.
Sample Patient Encounter I have fibromyalgia. Lyrica is not helping the pain. In another state I had used TENS and physical therapy which did help. Questions identified for the doctor : When might I begin to feel better using the Lyrica ? Is physical therapy an option for me now? If not, why not ? Information identified: Medlineplus about Lyrica PubMed an article on the use of physical therapy for fibromyalgia.
Sample Physician E ncounter I need information on diabetes in Arabic. My patient is returning to Saudi Arabia where he needs to educate his family about his condition, its management and the lifestyle changes he needs to make. Information identified : MedlinePlus Multiple languages 20 bilingual booklets in English and Arabic RHIN.org 116 items including audios, videos and documents
Results Physicians 4 of 7 physicians saw patients who had met with the librarian. 3 of the 4 physicians reported that the patients benefited from the interaction. 3 of the 4 physicians reported that the interaction with the librarian did not increase their patient visit time. 1 physician reported that the interaction did increase their patient visit time.
Requests for Health Information 6 of 7 physicians want information to share with patients. Topics requested: Asthma High blood pressure Diabetes Weight loss Medication use High cholesterol
Conclusions Responses to the intervention have been positive Patients like to receive new information in multiple ways. They reported using 2 or more methods. Hearing was the most reported single method. Although patients use computers, their access to the internet is more limited Physicians were open to our intervention promoting better informed patients. Most physicians most found this added value without prolonging the visit time
Lessons Learned Choose the right partners Active outreach is essential. Clinic staff participation is key. IRB process is an education for librarians and for the people who are reading proposals Patients, providers and IRB reviewers are unsure of librarians and abilities, and the resources librarians can provide.
More Lessons Learned Patient recruitment takes energy and is an art. Patients respond more to verbal invitations to participate than they do printed flyers. Multiple sources and formats of health information are needed to meet different learning styles Document everything.
Future Plans Continue the project for 8 hours per week through Spring 2013 with funding from Gatorade Research Fund. Expand client base to all IMMS specialties. Involve clinic staff more. Consider scheduling appointments for patients to meet with librarian.
Acknowledgements This project has been funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract No. HHS N 276 2011 00004 C with the University of Maryland Baltimore Thank you
Authors Linda C. Butson MLn MPH, AHIP, Consumer Health and Community Outreach Rebecca R. Pauly, MD FACP, Associate Vice President for Health Affairs, Equity and Diversity, Professor of Medicine, Jennifer A. Lyon MS, MLIS, AHIP Clinical Research Librarian Michele R. Tennant, PhD, MLIS, Assistant Director, Biomedical and Health Information Services, Health Science Center Libraries and Bioinformatics Librarian Cecilia Botero MLS, Associate Dean of the George A. Smathers Libraries and Fackler Director of the Health Science Center Libraries Neal Singh Undergraduate Student