New year, new program: Now’s the time for you to re-evaluate opportunities
January 1, 2000 8 minutes read
New year, new program: Now’s the time for you to re-evaluate opportunities
New information, educational gaps, misconceptions, and noncompliance all need to be addressed
In an age of information, it seems as if people would have all the facts they need to prevent and manage health problems. Yet, that presumption is false, according to the experts. Misinformation and misunderstanding of facts still occur too frequently.
Therefore, the dawn of this new millennium is a good time for patient education managers to make note of areas that are in need of educational campaigns or programs. For example, cancer — certainly one of the most dreaded diseases — wouldn’t be nearly the foe it is if people would embrace the lifestyle changes needed to reduce risk.
"Many people seriously underestimate the impact of modifiable risk factors for cancer as well as the beneficial effects of cancer screening," says Ted Gansler, MD, MBA, medical director for Health Content Products for the Atlanta-based American Cancer Society.
About one-third of the cancer deaths that occur in the United States each year are due to dietary and physical activity factors. Another third are due to cigarette smoking. Certain types of cancers that can be diagnosed through screening examinations account for approximately half of all new cancer cases. If Americans participated in regular cancer screenings, the five-year relative survival rate for cancers of the breast, colon, rectum, cervix, prostate, testis, oral cavity, and skin could increase to more than 95%, up from the current rate of 81%.
Another killer is obesity, yet unhealthy weight has increased in America over the past decade — up from 25% of adults in 1980 to 34% today. According to Shape Up America!, an organization founded by former U.S. Surgeon General C. Everett Koop, weight-related conditions are the second leading cause of death in the United States, resulting in about 300,000 preventable deaths each year. In a survey conducted by the Bethesda, MD-based organization, 60% of obese respondents did not believe that their weight posed health risks.
Diseases such as hypertension, diabetes, heart disease, certain types of cancers, and osteoarthritis all can be linked to obesity. All these chronic disease problems are going to grow in prevalence as the obesity epidemic grows. In addition, the longer people remain obese, the more likely they are to develop one or more of these comorbidities, says Barbara J. Moore, president of Shape Up America! Currently, 50% to 70% of all type two diabetics are obese.
There are many misconceptions about arthritis that need to be dispelled. Although many people think of arthritis as a disease that afflicts the elderly, it is the leading cause of disability in the United States among people over age 15, according to the Atlanta-based Arthritis Foundation. People tend to minimize the seriousness of the disease, but it is more than just minor aches and pains. If left undiagnosed and untreated, arthritis could become a major health problem.
The majority of arthritis-related joint damage occurs within the first two years of disease onset, so an early diagnosis is critical to minimizing the effect of arthritis.
"Myths are pervasive and very difficult to overcome, even among the professional health community," says Johanna Hinman, MPH, director of public health for the Arthritis Foundation. "People have the idea that arthritis is something you can’t prevent, and that you just have to live with once you get it. Education is a huge part of increasing awareness."
What can patient education managers do? According to the experts, they can help dispel myths about health problems, get new information into the hands of patients, and target patient groups that have a high incidence of the disease.
Although many education programs aimed at reducing infant mortality by focusing on prenatal care have been created — especially among the underserved population — there is still a great need for education. "Infant mortality is related to other problems in addition to prenatal care, like making sure babies have a safe place to sleep," says Francis Strodtdeck, DNS, RNC, NMP, president of the National Association of Neonatal Nurses in Des Plaines, IL.
Parents must understand that when babies sleep with adults, they are at increased risk for suffocation, she says. Educators should find innovative solutions to such problems. For example, Strodtdeck suggests parents remove a drawer from the dresser and pad it appropriately to provide a bed for the baby.
Media provide clues for education
Headlines in the newspaper often point toward common misconceptions. For example, the popularity of therapeutic use of herbs is growing, and many pregnant and nursing women see no harm in these remedies. Yet, herbal remedies are not regulated by the U.S. Food and Drug Admini stra tion (FDA) and there are not enough data available to know what side effects they may have, says Carole Kenner, DNS, RNC, FAAN, director of education and programs for the National Association of Neonatal Nurses. These remedies are especially popular with middle-class and upper-middle-class women.
Expectant parents or those contemplating having a baby need to be taught to review their health insurance policies so they are aware of any limitations in care for high-risk pregnancies. Such cases used to be directed to hospitals that had the technology and level of care to improve the life expectancy of high-risk babies. Under managed care, however, many women are no longer sent to such health care facilities. "These days, women must find out what kind of coverage they have in their insurance and what kind of services the facility they are covered under provides," says Kenner.
Although the topic of weight control is prevalent in the media, many Americans think in terms of height and weight. The old way of thinking must be replaced with information on body mass index (BMI), which is a much more accurate way of determining obesity, says Moore. BMI is a ratio between weight and height that correlates with body fat. A recent study determined that the higher the BMI, the higher the likelihood of dying prematurely. "A person with a BMI of 27 simply does not face the same risk as a person with a BMI of 35," she explains.
To aid health care professionals in the treatment of obesity, Shape Up America! has a BMI center on its Web site that helps people calculate body mass index. There is also a book available in the site’s professional center called Guidance for Treatment of Adult Obesity that can be downloaded free of charge at www.shapeup.org.
Commercials often tell Americans to manage their minor arthritis pain with over-the-counter medication, but t is important for people to get a correct diagnosis before assuming it is something they have to live with or treating the symptoms without knowing exactly what they are treating, says Hinman.
People need to be kept abreast of the advances in medications for arthritis, but they also need to be taught that medication is not the only way to manage the disease. There are other strategies that can reduce both pain and the need for a physician’s services. The Arthritis Self-Help Course teaches self-management and coping skills and is offered to the public through local chapters of the Arthritis Foundation.
Filling educational gaps
Gaps in education are clearly the reason for many instances of noncompliance, says Patti Finerty, RN, patient care resource manager for Emergency Medicine at The Ohio State Univers ity Medical Center in Columbus. Staff soon realized that many of the asthma patients coming into the emergency department (ED) for treatment did not understand their disease, what triggered episodes, or how to use medications to manage it effectively. For example, many did not know how to determine when to take special medication to ward off a bad episode because they either did not have a peak flow meter or they did not know how to use it.
To remedy the situation, an educational intervention was designed for the ED. It includes an educational packet with material on asthma, its triggers, and medications. Patients also are given a peak flow meter, a meter dose inhaler, and a spacer, crucial equipment for self-management of asthma. Following a 15- to 20-minute one-on-one educational intervention, ED staff schedule patients for an appointment at the asthma clinic and also make sure patients have a primary care physician.
"We have developed a learning flow sheet that we pass on to the next level of care, so each step is a continuation of what we began in the emergency department," says Finerty. She follows up on every asthma patient two to three days after their visit to the ED to see what their status is, and she makes a second call about four weeks following the visit to ask about functional outcomes such as days of missed work or school.
Educational guidelines need to be in place and followed by health care practitioners in order to control certain chronic diseases, says Martha Hill, RN, PhD, past president of the Dallas-based American Heart Association and a professor at Johns Hopkins University in Baltimore.
"When people talk about the compliance problem, they tend to blame the patient for not following the doctors’ orders. Before the patient is blamed, it’s important to find out whether or not the patient knows and understands what they are supposed to do, if they believe the treatment will help, do they know what to do if they suffer any adverse effects, and did they agree to the treatment in the first place," says Hill.
To improve compliance among heart disease patients in 1999, the American Heart Association launched a multifaceted Compliance Action Pro gram aimed at physicians, allied health care provi ders, health care organizations, and patients. A crucial educational component of the program is the Phy si cian’s Compliance Tool Kit, which includes materials that can be used to teach patients how to follow a health regimen. The program also includes the association’s Primary and Secondary Prevention Guidelines and a compliance booklet for patients titled "Knock Out America’s Hidden Health Threat."
Many organizations offer creative programs and educational materials that patient education managers can take advantage of. For example, Shape Up America! is launching a weight loss and physical fitness program on its Web site on Jan. 6, 2000. The program will give enrollees individualized instructions. People will receive guidance on menu plans, physical activity, and psychological tutorials for a small weekly fee, the amount of which is still undetermined.
The effort put into planning new patient education strategies for 2000 and beyond is worth the effort. Evidence of this can be seen in the decline in the number of new cancer cases and cancer deaths that began in this decade, says Gansler. "While advances in research and treatment are undoubtedly a key part of these declines, changes in behavior, particularly regarding tobacco use, are extremely important," he says.
For more information about areas of educational need and innovative ways to deliver education, contact:
• American Cancer Society, 1599 Clifton Road, NE, Atlanta, GA 30329. Telephone: (800) 227-2345 or (404) 320-3333. Web site: www.cancer.org.
• American Heart Association, National Center, 7272 Greenville Ave., Dallas, TX 75231-4596. Telephone: (800) 242-8721. Web site: www.americanheart.org.
• Arthritis Foundation, 1330 West Peachtree St., Atlanta, GA 30309. Telephone: (404) 872-7100. Fax: (404) 872-8694. For local chapter information, call toll-free: (800) 283-7800. Web site: www.arthritis.org.
• National Association of Neonatal Nurses, 701 Lee St., Suite 450, Des Plaines, IL 60016. Telephone: (847) 299-6266.
• Shape Up America!, 6707 Democracy Blvd., Suite 306, Bethesda, MD 20817. Telephone: (301) 493-5368. Web site: www.shapeup.org.
• The Ohio State University Medical Center, Patti Finerty, RN, Patient Care Resource Manager for Emergency Medicine, 6108 Meanz Hall, 1654 Upham Dr., Columbus, OH 43210-1228. Telephone: (614) 293-6913. Fax: (614) 293-4838. E-mail: finerty-1@ medctr.osu.edu.
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