Prescribing Information for Better Patient Engagement in Indiana

As part of the current paradigm shift away from the traditional model of medicine — deferring all responsibility to the physician — to more active participation by the patient and ownership of his or her health, the right information is the key to the right behavior. But what is the right information? Are some methods for its delivery better than others?

With these and related questions in mind, Raymond E. Dusman, MD, FACC, is leading a research project at Parkview Physicians Group Cardiology in Fort Wayne, IN, to assess how his practice can use the ACC’s CardioSmart.org website to enhance communication, health literacy and care planning.

“The practical application is how to re-engineer the workflow of a large cardiology practice to focus on patient-centered care through patient activation and enhanced patient education,” Dusman says. “What can be learned from this that could lead to improved patient outcomes?”

The study is a randomized prospective trial consisting of a control group and a study group both using the CardioSmart website as the information source. The control group received only a one-page information prescription, while the study group received both the information prescription and a one-on-one scripted training session introducing the resources available on CardioSmart.org. All patients were assigned a username and password so the frequency of visits and level of engagement with the site could be tracked. Follow-up surveys assessing self-reported knowledge, self-management skills and perceived quality of CardioSmart.org were disseminated at one and six months post-intervention, with a final survey to follow at 12 months.

The objectives of the study are to evaluate impact of the information prescription, to develop the proper intervention technique, to determine the need for training patients in the use of the information prescription, and to determine patient satisfaction with the website.

In the future, the research team will be correlating website use with method of instruction and demographics, etc. The findings from the study could be used to recommend efficient workflows to maximize patient engagement, education and activation.

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Lynchburg’s Lesson in Practice Integration

Centra Medical Group’s Stroobants Cardiovascular Center in Lynchburg, VA, was one of the first facilities to integrate resources and materials from the ACC’s CardioSmart program into their practice.

Patients at the practice’s Farmville, VA, location are shown cardiovascular-specific content from CardioSmart on waiting room TVs while those in Lynchburg are provided with CardioSmart fact sheets in the exam rooms. In addition, many of the exam room consultations are enhanced with the use of CardioSmart’s Heart Explorer iPad app, which features interactive and high-resolution cardiac graphics and animations.

Among the 21 cardiologists and three cardiothoracic surgeons at Stroobants, C. Michael Valentine, MD, FACC, has played a leading role in making CardioSmart a priority for the practice and its patients. Valentine gives every patient he sees a CardioSmart “prescription,” a referral for the patient to start using CardioSmart.org to learn more about their conditions, treatment options and lifestyle changes they may need to make. More recently, Valentine took this referral process a step further by working with members of his team — Natalie Caldwell, RN, BSN, Analyst, Robbie Price, Nurse Practitioner, and Sheila Salmons, Systems Analyst — to come up with a brilliant solution: linking to CardioSmart.org in patients’ electronic health record (EHR) discharge instructions. This “one-click EHR” directs patients to CardioSmart, and Valentine thinks it could be a game-changer for every practice.

“Embedding CardioSmart into EHR instructions in a seamless fashion will do more for patient-doctor engagement than any other method,” says Valentine. “I really believe that.”

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On the Road in Pueblo, CO

It’s 4:00 a.m. in Pueblo, CO – a city known for some of the highest rates of teen pregnancy, obesity, diabetes and poverty in the state. The Parkview Mobile Nurses, an on-the-go preventative health care team made up of registered nurses and health educators, pack up their van with bone density machines, blood pressure cuffs and other medical supplies. Today they will conduct a health fair at one of their 50+ business partners’ sites and CardioSmart will be front and center.

Through health screenings like these, the Parkview Mobile Nurses are able to help identify health risks and empower individuals to make positive change. To date, numerous members of the Pueblo community have dropped countless pounds, gone off their blood pressure and diabetes medications, and had life-saving follow-up appointments with doctors after receiving coaching from the team.

“The community trusts the Parkview Mobile Nurses because they take the time to listen,” said one community member in a recent letter to the Parkview Medical Center Chief Executive Officer.

The team has a routine. They set up multiple screening stations to prepare for the company workers who will begin arriving at 5:00 a.m. They hang informative posters about blood pressure, BMI, cholesterol and diabetes. Each poster is branded CardioSmart and has links to the website.

Each health fair participant will meet one-on-one with the nurses who are equipped with CardioSmart resources. They may use the CardioSmart Heart Explorer iPad app to educate participants on atrial fibrillation. They may encourage the use of specific online tools, such as the medication reminder app. One of the nurses’ future goals is to have an entire screening station dedicated to CardioSmart where they can help individuals register on CardioSmart.org and show them how to navigate the site.

“When we tell people we have access to an incredible resource, they trust us. And being backed by the ACC makes the resource all the more reputable,” says Kim Dodds, RN.

Because of their close ties to the community, the mobile nurses are also able to spread the CardioSmart message beyond their mobile screening sites. The team recently partnered with Pueblo’s first donation-based yoga studio by giving each member a card with a link to the CardioSmart website. Most people did not have their own yoga mat, so the team urged them to sign up for CardioSmart Challenges, track their fitness activities and earn points toward a CardioSmart yoga mat.

Terri Tibbs, coordination director for the Parkview Mobile Nurses, says, “There’s not a day that goes by that we don’t promote CardioSmart. We tell people that when the Parkview Mobile Nurses can’t be there, that’s when CardioSmart can.”

Keywords: Electronic Health Records, Cholesterol, Follow-Up Studies, Body Mass Index, Health Literacy, Patient Satisfaction, Blood Pressure, Communication, Diabetes Mellitus, Patient-Centered Care, Cardiology Magazine, ACC Publications

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