A basic overview of the Indian Health Service patient education program and description of patient education protocols and codes, documentation, and associate HIT tools.
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IHS Patient Education overview
1. Overview of Indian Health Service
Patient Education
CDR Christopher Lamer, PharmD, MHS, BCPS, CDE
2. Indian Health Service
• Provides a comprehensive health service
delivery system for approximately 1.9
million American Indians and Alaska
Natives.
• Serves members of 562 federally
recognized Tribes.
• FY 2009 appropriation is approximately
$3.58 billion.
• Indian Health Service total staff consists of
about 15,700 employees, which includes
4. Ask Advise Assess Assist
1. Ask the patient if he or
she uses tobacco products
(cigarettes, snuff, dip,
etc.).
2. Ask the patient if he or
she uses tobacco products
for cultural or religious
purposes.
3. Ask the patient if he or
she is exposed to tobacco
smoke at work.
4. Ask the patient if anyone
uses tobacco products at
home.
5. Document the health
factor screening results
using the values in the
table.
5. Ask Advise Assess Assist
• Health Factors
– Non-Tobacco User
– Current Smoker
– Current Smokeless
– Current Smoker & Smokeless
– Cessation Smoker
– Cessation Smokeless
– Previous Smoker
– Pervious Smokeless
– Ceremonial Use Only
– Smoker in the Home
– Smoke Free Home
– Exposure to Environmental Tobacco Smoke
9. PEPC Has Two Components
1. Code – This is the code used
to document the education
provided to the patient or
family.
1. Mnemonic
10. PEPC Has Two Components
HTN-C COMPLICATIONS
1. Code – This is the code used Outcome: The patient will verbally
summarize the complications of
to document the education uncontrolled hypertension.
provided to the patient or
Standards:
family.
1. The patient will verbally summarize
1. Mnemonic the complications of uncontrolled
hypertension.
2. Explain that heart attacks may result
2. Protocols - Protocols are from the heart having to work harder
written guidelines for to pump blood through congested and
hardened arteries.
education. 3. Explain that blindness may result
1. Guidelines from injured blood vessels in the eye.
4. Explain that strokes may result from
ruptures of injured blood vessels in
the brain.
5. Explain that circulatory
complications eventually impair the
ability of the kidneys to filter out
toxins.
13. Ask Advise Assess Assist
Readines Level of
Sub-
Topic s to Understandi Provider Time
Topic
Learn ng
14. Ask Advise Assess Assist
Readines Level of
Sub-
Topic s to Understandi Provider Time
Topic
Learn ng
-Mnemonic (TO, HTN)
-ICD9 Code
-CPT Code
15. Ask Advise Assess Assist
Readines Level of
Sub-
Topic s to Understandi Provider Time
Topic
Learn ng
-Mnemonic (TO, HTN)
-ICD9 Code
-CPT Code
AP - Anatomy & Physiology HM - Home Management N - Nutrition
C - Complications HY - Hygiene P - Prevention
DP - Disease Process LA - Lifestyle Adaptations PRO - Procedures
EQ - Equipment L – Literature S - Safety
EX - Exercise M – Medications TE - Tests
FU - Follow-up MNT – Med Nutrition Tx TX - Treatment
16. Ask Advise Assess Assist
Readines Level of
Sub-
Topic s to Understandi Provider Time
Topic
Learn ng
Education Code
-Mnemonic (TO, HTN)
-ICD9 Code
-CPT Code
AP - Anatomy & Physiology HM - Home Management N - Nutrition
C - Complications HY - Hygiene P - Prevention
DP - Disease Process LA - Lifestyle Adaptations PRO - Procedures
EQ - Equipment L – Literature S - Safety
EX - Exercise M – Medications TE - Tests
FU - Follow-up MNT – Med Nutrition Tx TX - Treatment
17. Ask Advise Assess Assist
Readines Level of
Sub-
Topic s to Understandi Provider Time
Topic
Learn ng
Education Code -Receptive
-Eager
-Mnemonic (TO, HTN) -Unreceptive
-ICD9 Code -Distraction
-CPT Code -Intoxication
-Severity of illness
AP - Anatomy & Physiology HM - Home Management N - Nutrition
C - Complications HY - Hygiene P - Prevention
DP - Disease Process LA - Lifestyle Adaptations PRO - Procedures
EQ - Equipment L – Literature S - Safety
EX - Exercise M – Medications TE - Tests
FU - Follow-up MNT – Med Nutrition Tx TX - Treatment
18. Ask Advise Assess Assist
Readines Level of
Sub-
Topic s to Understandi Provider Time
Topic
Learn ng
Education Code -Receptive -Good
-Eager -Fair
-Mnemonic (TO, HTN) -Unreceptive -Poor
-ICD9 Code -Distraction -Refused
-CPT Code -Intoxication -Group
-Severity of illness
AP - Anatomy & Physiology HM - Home Management N - Nutrition
C - Complications HY - Hygiene P - Prevention
DP - Disease Process LA - Lifestyle Adaptations PRO - Procedures
EQ - Equipment L – Literature S - Safety
EX - Exercise M – Medications TE - Tests
FU - Follow-up MNT – Med Nutrition Tx TX - Treatment
19. Ask Advise Assess Assist
Readines Level of
Sub-
Topic s to Understandi Provider Time
Topic
Learn ng
20. Ask Advise Assess Assist
Readines Level of
Sub-
Topic s to Understandi Provider Time
Topic
Learn ng
TO - QT- EAGR - G - ABC - 5min
26. Ask Advise Assess Assist
– The patient uses tobacco and wants to quit
• Provide resources and assistance
– Quit line information TO-HELP
– Tobacco handouts TO-L
– Refer to tobacco cessation specialist TO-IR
– The patient uses tobacco and does not want to
quit
• Provide and review tobacco treatment literature
– TO-L-RECPT-G-CL-3min-GNS
• Provide feedback on why they should consider quitting
– The patient has used tobacco and has quit
– The patient has never used tobacco
• Commend and promote abstinence
27. Ask Advise Assess Assist
• Set a goal and a quit date
• TO-QT-G-CL-5min – GS – will
quit on 6/25
29. Ask Advise Assess Assist
• TO-IR INFORMATION AND REFERRAL
– OUTCOME: The patient/family will understand the process of referral and treatment
for nicotine dependence.
– STANDARDS:
• Discuss sources for tobacco cessation treatment
• Refer to nicotine treatment program or other resource as available.
• TO-QL QUIT LINE
– OUTCOME: The patient/family will understand how to access and benefit from a
tobacco quit line.
– STANDARDS:
• Explain to the patient/family that a quit line will enable to the patient to talk
with a specialist who can helpthem plan an individualized quit method and
may some times be used in coordination with other types of tobacco use
treatment such as group or individual programs and/or medications.
• Explain that people who use telephone counseling stop smoking at twice the
rate of those who don’t get this type of help.
• Provide the patient with the quite line phone number and hours of operation
or assist the patient in calling the quit line during the patient encounter.
• Explain how the quit line works and what the patient can expect from calling.
33. Barriers to Learning
• No barriers
• Fine motor skills
deficit
• Doesn’t read English
• Hard of hearing
• Interpreter
needed
• Deaf
• Social stressors
• Visually
impaired
• Values/beliefs
• Blind
• Cognitive
impairment
• Distraction
Ask about tobacco use at every visit and document responses using the Tobacco health factors
RPMS codes not up to date
RPMS codes not up to date
RPMS codes not up to date
RPMS codes not up to date
RPMS codes not up to date
RPMS codes not up to date
Advise the patient to quit tobacco abuse using a personalized, positive and motivating statement
“quitting tobacco is the most important thing you can do to protect your health”
Chris will show the information that can be added to the education code – mention free text comments
Chris will show the information that can be added to the education code – mention free text comments
Chris will show the information that can be added to the education code – mention free text comments
Chris will show the information that can be added to the education code – mention free text comments
Chris will show the information that can be added to the education code – mention free text comments
Chris will show the information that can be added to the education code – mention free text comments
Chris will show the information that can be added to the education code – mention free text comments
Chris will show the information that can be added to the education code – mention free text comments
Chris will show the information that can be added to the education code – mention free text comments
Chris will show the information that can be added to the education code – mention free text comments
Chris will show the information that can be added to the education code – mention free text comments
Chris will show the information that can be added to the education code – mention free text comments
Chris will show the information that can be added to the education code – mention free text comments
Chris will show the information that can be added to the education code – mention free text comments
Chris will show the information that can be added to the education code – mention free text comments
Assess how willing someone is to quit –
If they are ready to quit, in which case you can add a goal to the patient education code
If they are not ready to quit, you can document that a goal was not set
Patients who do not use tobacco or have already quit should receive positive feedback and continued motivation to not start
If wiling to quit, set a quit date, remove tobacco products from the environment, get support for the patient (identify family and friends). Discuss past quit attempts and the things that helped as well as the things that led to relapse. Review the benefits of quitting tobacco.
Add a goal to the patient education code
Schedule follow-up visits to review progress toward quitting.
Refer patients as appropriate using consults in EHR or other mechanisms and patient education
Provide guidance on what to do if there is a relapse
Review medications and other treatments
Refer to quit lines for additional support and document using patient education – this is a new code that will be released with the next PEPC manual