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Overview of Indian Health Service
 Patient Education
      CDR Christopher Lamer, PharmD, MHS, BCPS, CDE
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
Resource and Patient Management



                         11 000101
                        001 0110 000
                     011 01110101 10
                     11001010 010 00 1
                      01 11100 0000111
                       10000111 10100
                       1100 0 0101 1
                          00 11110
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.
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
Tobacco Health Factors
Ask               Advise                     Assess                      Assist




http://www.ihs.gov/NonMedicalPrograms/HealthEd/index.cfm?
module=initiative&option=protocols&newquery=dsp_NatlPatientEd_Protocols.cfm
PEPC Has Two Components
PEPC Has Two Components

1.   Code – This is the code used
     to document the education
     provided to the patient or
     family.
     1.   Mnemonic
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.
Ask   Advise   Assess   Assist
Ask   Advise   Assess   Assist
Ask      Advise            Assess          Assist
                Readines     Level of
        Sub-
Topic             s to     Understandi   Provider   Time
        Topic
                 Learn         ng
Ask          Advise               Assess          Assist
                       Readines     Level of
           Sub-
Topic                    s to     Understandi   Provider   Time
           Topic
                        Learn         ng



 -Mnemonic (TO, HTN)
 -ICD9 Code
 -CPT Code
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
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
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
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
Ask      Advise            Assess          Assist


                Readines     Level of
        Sub-
Topic             s to     Understandi   Provider   Time
        Topic
                 Learn         ng
Ask      Advise            Assess          Assist


                Readines     Level of
        Sub-
Topic             s to     Understandi   Provider   Time
        Topic
                 Learn         ng



TO - QT- EAGR - G - ABC - 5min
Adding Patient Education
Outcome and Standards
Select the code you want
Document Education
Pick Lists
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
Ask    Advise    Assess    Assist

• Set a goal and a quit date
     • TO-QT-G-CL-5min – GS – will
       quit on 6/25
Ask   Advise   Assess   Assist
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.
Clinical Reporting System
Table 6.25 IHS Clients Served by Location
    Location          2001      2002       2004        2006        2008
Total Clients      696,060    812,301    1,214,646     1,696,881   2,202,279
Hospital           445,842    534,891     740,077       968,008    1,284,632
Health Center      225,617    253,526      430,931      596,006     715,628

Health Station       17,515     16,271      23,140       64,206     65,521

Location (Home)       6,339      6,719      15,505       32,741     21,701
School                 189        157          879        5,278     12,004
Village Clinic         510        700        4,113       14,386     226,679

Administration/          35        37             58     11,513      39,724
Other
Learning Preference

  •   Talk
  •   Video
 
 
 
 
  •   Small group
 
 
  •   Read
 
 
           
  •   Do/practice
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
Healthcare Communications




        http://www.ihs.gov/healthcommunications/
Patient Education Handouts
RPMS Patient Wellness Handout
•   Demographics
•   Blood Pressure
•   Cholesterol
•   Allergies
•   Vital Signs
•   Diabetes Care
•   Preventive Screening
•   Medications
•   Immunizations
•   Patient Goals
•   Physical Activity

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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
  • 3. Resource and Patient Management 11 000101 001 0110 000 011 01110101 10 11001010 010 00 1 01 11100 0000111 10000111 10100 1100 0 0101 1 00 11110
  • 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
  • 7. Ask Advise Assess Assist http://www.ihs.gov/NonMedicalPrograms/HealthEd/index.cfm? module=initiative&option=protocols&newquery=dsp_NatlPatientEd_Protocols.cfm
  • 8. PEPC Has Two Components
  • 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.
  • 11. Ask Advise Assess Assist
  • 12. Ask Advise Assess Assist
  • 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
  • 23. Select the code you want
  • 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
  • 28. Ask Advise Assess Assist
  • 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.
  • 31. Table 6.25 IHS Clients Served by Location Location 2001 2002 2004 2006 2008 Total Clients 696,060 812,301 1,214,646 1,696,881 2,202,279 Hospital 445,842 534,891 740,077 968,008 1,284,632 Health Center 225,617 253,526 430,931 596,006 715,628 Health Station 17,515 16,271 23,140 64,206 65,521 Location (Home) 6,339 6,719 15,505 32,741 21,701 School 189 157 879 5,278 12,004 Village Clinic 510 700 4,113 14,386 226,679 Administration/ 35 37 58 11,513 39,724 Other
  • 32. Learning Preference • Talk • Video • Small group • Read • Do/practice
  • 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
  • 34. Healthcare Communications http://www.ihs.gov/healthcommunications/
  • 36. RPMS Patient Wellness Handout • Demographics • Blood Pressure • Cholesterol • Allergies • Vital Signs • Diabetes Care • Preventive Screening • Medications • Immunizations • Patient Goals • Physical Activity

Editor's Notes

  1. Ask about tobacco use at every visit and document responses using the Tobacco health factors
  2. RPMS codes not up to date
  3. RPMS codes not up to date
  4. RPMS codes not up to date
  5. RPMS codes not up to date
  6. RPMS codes not up to date
  7. RPMS codes not up to date
  8. 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”
  9. Chris will show the information that can be added to the education code – mention free text comments
  10. Chris will show the information that can be added to the education code – mention free text comments
  11. Chris will show the information that can be added to the education code – mention free text comments
  12. Chris will show the information that can be added to the education code – mention free text comments
  13. Chris will show the information that can be added to the education code – mention free text comments
  14. Chris will show the information that can be added to the education code – mention free text comments
  15. Chris will show the information that can be added to the education code – mention free text comments
  16. Chris will show the information that can be added to the education code – mention free text comments
  17. Chris will show the information that can be added to the education code – mention free text comments
  18. Chris will show the information that can be added to the education code – mention free text comments
  19. Chris will show the information that can be added to the education code – mention free text comments
  20. Chris will show the information that can be added to the education code – mention free text comments
  21. Chris will show the information that can be added to the education code – mention free text comments
  22. Chris will show the information that can be added to the education code – mention free text comments
  23. Chris will show the information that can be added to the education code – mention free text comments
  24. 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
  25. 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
  26. 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