Continuing Ed
by Katherine Webster
April 2007
In the United States, clinical education programs can improve patient compliance and lead to better patient care.
For patients with chronic medical conditions, effective health care goes far beyond a visit to a physician’s office. An understanding of the condition and compliance with a prescribed course of treatment or therapy is critical for effective disease management and positive patient outcomes. Unfortunately, many patients fail to comply fully with ongoing treatment, and it often is difficult for health care practitioners to affect this behavior between clinic visits. The solutions to this problem vary between countries, due in part to different health care delivery systems.
In recognition of this problem, many pharmaceutical companies in the United States are providing clinical education programs. In general, these programs provide disease management education to clinical staff or patients, or sometimes both. Some programs are branded, offering information on specific medications that the patient’s physician has prescribed. Other programs are unbranded and focus on general disease education. The main goal of both, however, is to improve patient care through increased education and support.
“We know that people with chronic illness only take their medication 50 percent of the time,” says Gwen Carlton, assistant professor of nursing at Western Carolina University, in Asheville, N.C., USA, and former director of the Asthma Care Network, an unbranded program sponsored by GlaxoSmithKline and implemented by Innovex. The reason many patients are not compliant is that they’re not well educated about the importance of staying on their prescribed treatment regimen, Carlton says. “Communication is a huge issue,” she says. “If the [clinical] staff isn’t well educated, they can’t be expected to educate the patients.”
A Targeted Approach
The Asthma Care Network sent nurses and certified respiratory therapists into primary care offices to work with nurses and other staff in an effort to improve recognition of early-warning signs. “The staff spends a lot more time with patients than the doctor does,” Carlton says. “They’re the ones that take a lot of the phone calls and do a lot of the screening. We had a continuing education program for the nursing staff, and we told them all about asthma devices and about the Institute of Health guidelines for asthma management. We really helped them understand the illness.”
The program also provided clinical staff with an Office Visit Assessment form, aimed at securing detailed histories from patients in order to evaluate whether their condition was properly managed. Office staff could then fax the forms to a third party, which would report back with a summary of how well patients’ conditions were controlled. “Physicians are so busy—if they have a tool like this that asks the right questions of the patient, then the physician can see that [data] and they can make better informed decisions about how to treat the patient,” Carlton says.
Comprehensive Care
Spreading information and increasing understanding among staff and patients is the primary initiative of many clinical education programs. Keep Moving, a branded program for Tylenol implemented by McNeil Consumer Health Care, supplies clinical staff with comprehensive education kits to give to their patients with osteoarthritis. “We knew we needed to create something that would help patients in more ways than simply providing a pill,” says Bob Stirling, director of professional marketing at McNeil, in Fort Washington, Pa., USA. The kits include a DVD of exercises to strengthen joints, a resource guide created by health care experts, a sample of non-prescription Tylenol Arthritis and various other tips and tools for managing the condition.
Keep Moving also uses nurse educators to work with clinical staff. “We use the nurse educators because they have so much more connectivity to the entire office, and to the patients in particular,” Stirling says. “While physicians make diagnoses, it is often the nurses who field questions and become coaches and champions for the patients.”
Some clinical education programs in the United States even offer financial assistance to patients. MS Lifelines, a program sponsored by EMD Serono and Pfizer, offers treatment reimbursement support to patients with multiple sclerosis. “The goal is to alleviate barriers to affordable access to care,” says Scott Sherman, director of patient services, neurology, at EMD Serono, in Rockland, Mass., USA.
Nurses at MS Lifelines work directly with patients, either in a physician’s office or in the patients’ homes, to help them comply with multiple sclerosis therapy programs. Each nurse must complete an intensive certification program through the International Organization of MS Nurses. Educational materials are developed with help from MS Lifelines Ambassadors, who are people living with the disease. Additionally, all educational materials need to pass legal and regulatory muster, Sherman says.
This kind of rigorous internal review is normal. Since the success of a program depends on its adherence to sound medical practice, sponsoring organizations subject clinical education materials to review by their medical and legal departments. Most organizations build materials around national disease-specific guidelines, and some seek input from independent medical associations.
Win-Win Situation
“The Asthma Care Network was based on national guidelines,” Carlton says. “We developed the content, we refined it, Innovex provided the education service and [GlaxoSmithKline] funded it—what a wonderful deal.”
Because clinical education programs benefit all parties involved, especially patients and clinical staff, they will continue to grow in importance, Carlton says. “At every level, we provided information about appropriate guidelines—to the staff, to the physicians—and then they could give better care to their patients.”
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