Heart Disease and Stroke: Provider Education

Background on Provider Education

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expandWhat are provider education strategies?

collapseWhat are provider education strategies?

  • Intervention strategies used to train providers and practitioners to counsel or provide advice to individuals in order to encourage them to improve prevention, management and rehabilitation behaviors for heart disease and stroke (e.g., lifestyle changes to reduce weight or increase healthy behaviors, monitoring, taking medications to regulate blood pressure and cholesterol).
  • These strategies provide information (e.g., training sessions, training materials) and reminders (e.g., checklists, prompts) to encourage providers and practitioners to address a range of different health behaviors and lifestyle changes with their patients or clients. Professional Association conferences such annual meetings of the Missouri State Medical Association, Missouri Association of Osteopathic Physicians and Surgeons, the Missouri Chapter of the American College of Cardiology, Missouri Nurses Association etc. are excellent venues for introducing new information for consideration by the governing of each of the aforementioned associations. 
  • By enhancing providers’ and practitioners’ knowledge and skills related to counseling their patients or clients, provider education can:
    • increase providers’ and practitioners’ awareness of signs and symptoms of heart disease, heart attack and stroke;
    • enhance providers’ and practitioners’ awareness of behavior change strategies to prevent, manage and rehabilitate heart disease and stroke (e.g., increasing physical activity and healthy eating, quitting smoking, monitoring and taking medications to regulate blood pressure or cholesterol);
    • improve communication strategies and methods for providers and practitioners to support patients’ or clients’ heart disease- and stroke-related behavioral patterns (e.g., physician recommendations, follow-up);
    • increase provider and practitioner referrals to resources in the community to support patients’ or clients’ heart disease- and stroke-related behavioral patterns (e.g., referrals to programs and services) and minimize barriers (e.g., referrals to places to access to lower cost medications);
    • improve culturally competent communication of providers and practitioners with their patients and clients;
    • increase provider and practitioner role modeling of appropriate heart disease and stroke related behaviors (e.g., speaking in community forums, participating in heart disease and stroke campaigns) and support for related environmental and policy interventions (e.g., advocating increased access to healthy foods and places to exercise in the community).

expandHow can I use provider education strategies in heart disease and stroke interventions?

collapseHow can I use provider education strategies in heart disease and stroke interventions?

  • Health care providers and practitioners are a primary and respected source of health information. Many individuals and families seek out the advice of health care providers and practitioners to maintain their health and quality of life on a regular basis. Therefore, health care providers and practitioners are ideally suited to have an ongoing influence on individuals’ decisions to adopt certain behaviors. Traditionally, health care providers and practitioners include those professionally trained to work in clinical settings (e.g., physicians, nurses, dentists, and dietitians). For community-based interventions, providers and practitioners may also include individuals working in schools (e.g., school nurses, health education teachers, physical education teachers and coaches), worksites (e.g., worksite wellness professionals), faith-based organizations (e.g., health ministers) and other private or public community settings (e.g., exercise instructors, pharmacists).
  • Provider education, when used alone, can help to increase heart disease and stroke prevention, management and rehabilitation behaviors among those individuals seeking or receiving health care services. Providers and practitioners can provide recommendations and support to patients and clients for behavior change (e.g., eating health foods, being physically active, monitoring blood pressure or cholesterol, taking medication regularly). Therefore, provider education may be particularly useful in helping individuals become ready to change their behavior. 
  • Previous work has suggested that those interventions that incorporate provider education as well as strategies that act to create changes in policies, environments, knowledge/awareness, or skills are more effective than the use of provider education strategies alone. For example, provider education may be connected to efforts to increase access to monitoring devices and medications for regulating blood pressure and cholesterol, community-wide campaigns to reach a large population or enhance individual self-management skills.

expandWhat are the different types of heart disease and stroke provider education strategies?

collapseWhat are the different types of heart disease and stroke provider education strategies?

  • Provider education refers to the training of providers and practitioners to enhance their interaction with patients and clients. The information given to patients or clients may be provided face-to-face or over the phone, during a single session or over multiple sessions or through informational materials including brochures or videos created for this purpose. During the interactions with patients or clients, providers and practitioners typically provide the following:
    • An assessment of an individual’s behaviors related to heart disease and stroke and readiness to make behavior changes. This assessment enables the provider to give personally relevant information to the individual about their needs. This information may be intended to increase knowledge or awareness, change attitudes, teach skills or provide social support.
    • An opportunity for the individual to ask questions or clarify what they have been told. This exchange with the provider can help to ensure that the individual understands the information and recommendations that they have been provided. For example:  It is important when giving the patient the results of their labs or blood pressure, to write them down and give them to the client. It gives them ownership and helps them remember the results. When changing medications, educate the client on how to monitor results and underscore the need to bring their results on the next visit with their provider.
    • Referrals and resources within the community to assist the individual in following recommendations regarding heart disease and stroke. For example, the provider or practitioner may recommend alternatives to access reduced cost medications, programs to enhance individual knowledge and skills or support groups.
    • Subsequent interactions between the provider/practitioner and individual, including a reassessment of the individual’s behaviors as well as a discussion of challenges, benefits and advice for maintaining behaviors over time.
  • Provider reminder interventions can be developed as part of provider education. Provider reminder interventions give cues or prompts to providers to increase the likelihood that they will discuss heart disease and stroke information with individuals. Provider reminder interventions utilize various strategies to prompt providers to discuss heart disease and stroke with individuals, including changes to the individual’s chart (e.g., stickers, colored folders), changes in the physical environment (e.g., posters in exam rooms) or personal prompts (e.g., laminated pocket-sized information sheets, computerized reminder systems).

expandWhat should I consider when developing provider education strategies for my heart disease and stroke intervention?

collapseWhat should I consider when developing provider education strategies for my heart disease and stroke intervention?

  • Provider education works best if it is hands-on and practical. This may include discussions among health care providers about how to counsel or provide advice to specific individuals (e.g., pregnant women, people with multiple risk factors, people with a family history of heart disease), how to respond to individual barriers to prevention, management and rehabilitation (e.g., unemployed or uninsured individuals, people with disabilities), how to reach high-risk populations, how to work in different settings and how to integrate effective practice strategies into different practice styles.
  • Previous studies suggest that it is important to consider longer-term education strategies, tailor provider education about heart disease and stroke to specific behaviors and train providers on community and environmental influences on these behaviors in addition to the more traditional focus on the individual. It is also useful to share methods for patient tracking, repeat counseling and referrals as appropriate. Because providers and practitioners prefer to receive training in a quick and succinct manner, some have found it useful to provide a series of workshops or sessions at times convenient to the providers rather than one single, but longer, session.
  • It is difficult to understand the effectiveness of these interventions because the interaction between the provider/practitioner and the patient/client is unique for each individual, short in duration (often less than 5 minutes), may involve recommendations for multiple behaviors at once (e.g., eat more fruits and vegetables, get more exercise, quit smoking) or may lack institutional support for sharing this type of information during a visit (e.g., policies, procedures, training, or incentives).

expandWith whom should I work to create provider education strategies for heart disease and stroke interventions?

collapseWith whom should I work to create provider education strategies for heart disease and stroke interventions?

  • To develop your provider education intervention or to determine the most appropriate training strategies and methods, it is sometimes advisable that you work through professional associations and subsequently with different community partners. Examples of professional associations are:
  • Missouri State Medical Association
  • Missouri Association of Osteopathic Surgeons
  • Missouri Nurses Association
  • Missouri Group Practice Management Association
  • Missouri Rural Health Association
  • Missouri Association of Rural Health Clinics
  • Examples of potential partners include:
    • Local health departments
    • health care services (e.g., clinics, hospitals)
    • schools
    • worksites
    • civic organizations/ community organizations (e.g., Head Start, Boy/ Girl Scouts, YMCA, 4H Club, American Heart Association)
    • senior/ independent living facilities
    • faith-based organizations
    • neighborhood organizations and community members
    • coalitions
    • researchers and evaluators
    • government agencies (e.g., transportation, planning, WIC, food stamps, social services, parks and recreation, community development, economic development)
    • advocacy organizations (e.g., clean air, green space preservation)
    • elected officials/ policy-makers/ decision-makers/ community leaders
    • metropolitan centers
    • media (e.g., newspaper, billboards, television, radio)
    • communications or advertising agencies
    • consumer organizations (e.g., supermarkets, restaurants, gyms)
    • producers, distributors, and manufacturers (e.g., food, tobacco, active/sedentary recreation)

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