DIMENSIONS OF CARE

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Other Topics Worth Consideration:

Locating free healthcare for those without insurance;

Allergies & Asthma;

Diet & Nutrition;

Sleep Disorders & Sleep Health;

Parenting & Work Demands;

Obesity;

Cancer, particularly cancers that are most preva lent in your community or region;

Stress & Stress Management;

Substance Abuse;

Back Pain & Problems;

Dental & Eye Health, Safety & Prevention;

Domestic Violence & Abuse;

Elder Care & Aging Issues.

Anyone who has been through a Joint Commission Survey knows the importance and priority that the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has increasingly placed on Patient Education. Furthermore, the American Hospital Association (AHA), based on joint research efforts with the Picker Institute into patients’ needs, has identified Patient Education as one of the eight dimensions of care warranting priority attention and focus from providers and health systems. In fact, surveyed patients indicated "more information" and "involvement with their care" as two of their principal needs. Roughly one in every five clinic or office patients (21%) said that they were not as involved in decisions about their care as they wanted to be. Furthermore, 28% reported that they did not get as much information as they wanted and 20-36% found it hard to get information or to be involved in decisions.1 

As a preventive medicine specialty, occupational medicine is extremely well suited to the fulfillment of this JCAHO and AHA objective. For many practices, however, there are probably many opportunities to improve or enhance their patient education activities. In most occupational practices, Patient Education is limited to patient instructions regarding the care of their work-related injury, e.g., wound care or crutch walking. However, many other opportunities exist to educate patients about general health and safety as well as specific health issues such as heart disease or diabetes.

Below is a list of possible opportunities for Patient Education within a typical occupational medicine practice:

Pre-Placement/Physical Exams
Hypertension, Heart Disease, Diabetes,Physical Fitness & Exercise, Prevention of Work Injuries, Cancer, Back Care & Health (for patients with abnormal results or risk factors)

DOT Exams
Hypertension, Heart Disease, Diabetes, Physical Fitness & Exercise, Vision & Hearing, Cancer, Prostate, Back Care/Problems, Smoking Cessation, Stress Management, Road Rage/Safe Driving, Sleep Disorders/Sleep Information

Audio & PFT Testing
Hearing & Lung Safety, Prevention, General Hearing/Pulmonary Health

Vision Screens
Eye Protection, Safety & Health

Drug Screens & BATs
Substance Abuse in the Workplace, Substance Abuse & Children/Teens, EAP or Assistance Information

Respirator Exams
Toxicology Information for specific exposure(s), Respirator Safety/Use, Lung/Heart Health, OSHA or other relevant health & safety information specific to work exposure or environment

Work Injuries
Future Prevention, Safety or Ergonomics information specific to injury/job, Anticipated Recovery Time & Patient Responsibilities to expedite recovery

To facilitate this process and make sure you are providing the right information as well as the same information consistently, particularly if you are a multi-site practice, form a team of physicians, RNs, and supervisors. This team is expected to review patient education materials and reach consensus on what will be distributed and under what circumstances. For example, all patients with hypertension should get the same information about hypertension, heart disease, and basic prevention/health guidelines. To expedite the process, assign topics to individuals to do the research and bring back suggestions to the larger team for review and approval.

Generally, this should not take a tremendous amount of time or effort—there is a wealth of health, safety, and prevention information already available, and often for free. Your local hospital council should be able to provide you with statistics on the diseases or health problems that are most prevalent in the community you serve. By targeting these issues, you can be assured that you are working toward the larger public health good of the community that your program and health system serve. In addition, check within your own health system to see what publications and resources are already being used by the various departments or specialty areas on the topics you have decided to target. Family practice physicians and organizations also routinely make this information available to Primary Care Practices (PCPs) and their patients, so don’t forget to touch base with some of the PCPs within your system, too.

Other good resources are non-profit organizations such as the American Cancer Society, American Heart Association, American Lung Association, and the like. Often they have pamphlets and materials available for little or no cost and will happily work with your organization to help get their message and information distributed. Finally, the Internet has numerous web pages where information can be accessed quickly and for free. Be sure to use Internet sources you trust, however, as the accuracy of Internet content varies widely. A few appropriate and trustworthy sites, to get you started, are listed in the Resources section at the end of this article.

Whatever materials you decide to provide, make sure they are standardized across all sites and are basic, understandable, and at an 8th grade reading level. They need to meet the fundamental needs of your patient populations; they do not need to be highly technical or clinical. Your health system may even have a patient education committee that can assist in reviewing your materials for JCAHO compliance or help guide you to the best resources. Also, you need to make sure that the information you are providing is reproducible—you don’t want to be in violation of any copyright laws.

Besides being an important issue for accreditation, Patient Education is an important public health initiative that occupational practices can use to better support the health and wellness of their clients’ employees. Many of the patients entering an occupational practice have not been seen or evaluated by a physician in years and often have no health insurance coverage. In many cases, the occupational practice is the ONLY point of medical contact these patients have. Consequently, we may be their only hope of catching a non-work related health condition early enough to prevent the onset of disease and minimize a negative outcome and, at the very least, of educating them about their own general health, safety, well being, and risk factors. Since many occupational practices are part of much larger health delivery systems, Patient Education in the occupational setting can support both the programmatic and larger health system goals of "improving the health status of the populations they serve." .