Using Digital Media to Counsel Patients

Advancements in our ability to care for patients have enabled us to control and sometimes cure many diseases. To manage more complex requirements of patient care, the education of health care professionals has become longer and more intense. Many pharmacy schools are now going to a 7-year program, and training for specialty areas may require 2 years of residency.

Although pharmacists have advanced to provide better care, there is not a corresponding advancement in patients’ health knowledge. Our ability to teach patients about how to manage their health is as important as managing treatment choices. A systematic review found that low health literacy leads to difficulty in understanding and following medical advice, poor health outcomes, higher use of emergency care, and more hospitalizations. The review also found that low health literacy leads to poor medication adherence and less ability of patients to recognize their medications.¹

The most common method of patient education is direct interaction with a patient, using written material for additional information. There are many good resources for improving counseling skills,^2,3 but one of the challenges is finding the time or staff to provide patient counseling in an era of tight budgets and staffing.⁴

One strategy for providing counseling to more patients is the use of video in a way that is convenient for patients. The US Department of Health and Human Services, Office of Disease Prevention and Health Promotion, recommends the use of technology to improve health literacy and avoid overreliance on written communication.⁵

A comparative analysis of multimedia and print material suggested that video might be better for low-literacy patients and that multimedia counseling is equivalent to or better than providing written material in most studies.⁶ A study of asthma patients found that video improved knowledge in low-literacy patients but was equivalent to print in patients with adequate literacy. The study also found that, in all patients, video was better than print for learning a skill such as inhaler technique.⁷

Improving patients’ understanding of how to manage their health has also become a focus of regulatory agencies. CMS implemented the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey nationally in 2006, with the first results reported in 2008. CMS applies a 2% penalty from Medicare reimbursement to hospitals that do not submit survey results. Beginning in 2012, CMS started using HCAHPS scores as part of the calculation in the Hospital Value-Based Purchasing (VBP) program as specified in the Patient Protection and Affordable Care Act of 2010. The most recently available 4 quarters of HCAHPS results are posted on the Hospital Compare website.⁸ In 2016 and 2017, 25% of the VBP calculation will be based on HCAHPS scores.⁹

Although required by CMS, the HCAHPS survey is not restricted to Medicare beneficiaries. Surveys are sent to a random sample of adult patients 2 to 42 days after discharge. Hospitals can collect their own surveys (by telephone or mail) or contract an outside firm to do it. This allows hospitals to use the survey results to monitor trends in patient responses.⁸

The HCAHPS survey contains 32 questions that cover 11 dimensions. A rating of 1 to 5 stars is calculated from the scores for each dimension. The Star Ratings are posted on the Hospital Compare website for consumers to use to compare hospitals. A 12-Star Rating is calculated as an overall summary of the patient’s experience of care at the hospital.¹⁰

A Web Tool to Improve Patient Education

According to Renato Cataldo, PharmD, CEO of MedSocket, Clinical Consult Portal (CCP) is a HIPAA-compliant video learning management platform that can be used in any clinical setting to aid in patient education and knowledge retention. Patients can view videos in the hospital or at home. Videos can be accessed through computers, tablets, or smartphones. CCP allows patients to access personalized clinical and instructional information. These videos can include medications, procedures, and preventive care. Patients can watch the instructional content as often as they like. Use of CCP videos can help hospitals cover domains in the HCAHPS survey, such as medication, transition of care, and health care provider communication. CCP allows providers to share user-generated patient-specific videos to remind patients and their caregivers of important information in managing a patient’s transition to home.

The CCP video library consists of patient information for hundreds of medications, as well as links to additional patient education resources. CCP allows users to upload health-system created patient education videos and personalized patient-specific videos. Because staffing and time constraints can make patient education difficult to satisfy, use of CCP videos can streamline the delivery of information, allowing more patients to be reached.

This is also true for transition of care to help patients understand why each discharge medication is being given. During the flurry of activities involved in patient discharge, it is difficult to review all information with a patient. Patients also need to understand what they will be responsible for managing when they leave the hospital. A patient-specific video can review and emphasize the information needed for home care. Many hospitals create specific videos for certain high-volume or complicated diagnoses or procedures, such as heart failure, asthma, and surgeries. In these cases, a short patient-specific video can review care specific to the patient, introduce other videos, and include reminders about follow-up appointments. Use of CCP can allow patients to watch important information in a less stressful environment.

A hospital stay is a stressful time for a patient, who may not remember everything that is communicated. Use of videos can help remind patients of information discussed with health care providers during a hospital stay. The CCP patient drug-counseling video library can be used for initial counseling during a hospital stay, discharge counseling at the end of a stay, or as an at-home reminder of important health care information.

This article is published in collaboration with the Directions in Pharmacy CE Conference program.

Scot Walker, PharmD, MS, BCPS, BCACP, is executive vice president, Clinical Operations, of MedSocket.

References

• Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155(2):97-107. doi: 10.7326/0003-4819-155-2-201107190-00005.
• Terrie YC. 10 behaviors of effective counselors. Pharmacy Times website. pharmacytimes.com/publications/issue/2008/2008-05/2008-05-8527#sthash.K2q7oFAb.dpuf. Published May 1, 2008. Accessed June 24, 2016.
• American Society of Health-System Pharmacists. ASHP guidelines on pharmacist-conducted patient education and counseling. Am J Health Syst Pharm. 1997;54(4):431-434.
• Guirguis LM, Chewning BA. Role theory: literature review and implications for patient-pharmacist interactions. Res Social Adm Pharm. 2005;1(4):483-507.
• US Department of Health and Human Services, Office of Disease Prevention and Health Promotion (2010). National Action Plan to Improve Health Literacy. Washington, DC. health.gov/communication/hlactionplan/pdf/Health_Literacy_Action_Plan.pdf. Accessed June 16, 2016.
• Wilsona EA, Makoul G, Bojarski EA, et al. Comparative analysis of print and multimedia health materials: a review of the literature. Patient Educ Couns. 2012;89(1):7-14. doi: 10.1016/j.pec.2012.06.007.
• Wilson E, Park DC, Curtis LM, et al. Media and memory: the efficacy of video and print materials for promoting patient education about asthma. Patient Educ Couns. 2010;80(3):393-398. doi: 10.1016/j.pec.2010.07.011.
• CMS. HCAHPS: Patients’ Perspectives of Care Survey. CMS website. cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-instruments/HospitalQualityInits/HospitalHCAHPS.html. Accessed June 26, 2016.
• CMS. Hospital value-based purchasing. CMS website. cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf. Published June 2015. Accessed June 26, 2016.
• CMS. HCAHPS fact sheet. CMS website. hcahpsonline.org/Files/HCAHPS_Fact_Sheet_June_2015.pdf. Published June 2015. Accessed June 26, 2016.