BEHAVIORAL PRESCRIPTION PRESCRIPTION STEPS AS AN EFFECTIVE TOOL
BEHAVIORAL PRESCRIPTION & PRESCRIPTION STEPS AS AN EFFECTIVE TOOL IN THE OFFICE Family Medicine Residency Program - West Suburban Medical Center – River Forest, IL Michelle Domanchuk, MSN, APN/CNP Kenneth Blair, MD Z. Harry Piotrowski, MS Katherine Walsh, MD WORKSHOP TEACHING EXERCISE AND EVALUATION METHODS BACKGROUND 60 Minute Workshop: Residents PURPOSE Develop an effective curriculum for Family Medicine Residents on motivational interviewing techniques during a routine office visit with a patient - centered approach to guide patients towards healthy behavioral changes using Behavioral Prescription Steps. 1 Workshop: Case Study – Readability Standard 1. Background: Self-Efficacy Theory Chronic Care Model Disease Management Model 2. Practice reading dialogues aloud Flesch Reading Ease (FRE) 0 -100 >= 70 Flesch-Kincaid Grade Level (FKGL) 7 3. Motivational Interviewing Techniques Patient Practitioner Facilitator/Recorder 1. What would you like to change? 2. What are some things you can do to make that change? 4. What can you do to overcome these barriers? 5. Is there any other help you need to accomplish this goal? • Group discussion 4 6. How confident are you that you can achieve this step at the present time on a scale of 1 -10? (<7, redefine step) 7. At follow-up visit, review the steps and document on previous prescription, what % of the time they were able to comply 8. Redefine long-term goal and revise steps accordingly 2 EVALUATION of Resident Learning BEHAVIORAL PRESCRIPTION □ AIM (Not at all Confident) STEPS 5 6 7 8 9 (Totally Assessment of 18 resident BPPS’susing 7 criteria yielded a 77. 0% average score (97/[7 criteria x 18 BPPS]) 2. 3. 4. Learning Sequence Activity 7 Criteria Results 1. Read the Case Study AA 59 male, HTN diabetes 2. Write a. BPPS 24 residents write a BPPS that includes 69 Prescription Steps 85. 7% Average Score 3. Guided Self-Assessment of Prescription Steps Using 7 Criteria 18 of 24 residents made corrections in several Prescription Steps 93. 5% Average Score 11 5. Used short simple language (action verbs and complete sentence) NUMBER ___ 10 4. Avoided spelling errors Confident) 1. 5 3. Avoided symbols or signs 10 Chart Review: 7 Criteria (81. 8 % Average) Computerized Self-Learning Exercise : Case Study, Preparing & Revising a BBPS 2. Avoided the use of abbreviations On a scale of 1 -10, how confident are you that you can do each step? 4 9 8 1. Used active voice/first person (I will) PRESCRIPTION STEPS 3 23/40 BPPS (57. 5%) did not record a long term goal 17. 3% 30. 6% 15. 3% 36. 7% Using abbreviations (Criteria 1) Confidence level missing (Criteria 6) 7 Assessment Criteria For BPPS FOR: ______________ DATE: ______ 2 Long Term Goal 7 8 9 10 new case study and prepares a BPPS 3. Computerized Self–Learning Exercise: Case Study and BPPS 1 3. 9 were % Most commonly missed elements were: 2. Chart Review: BPPS used with patients □ PCCS Average steps 2. 5 per BPPS CL 18 residents completed a BPPS 1. Workshop: Resident presented with □ PCCL 98 steps 86. 3 Workshop: Case Study – 7 Criteria 6. From a Case Study, each 3 -resident group 1. develop s a BPPS 3. What might get in the way of accomplishing this goal? □ PCCA Confidence Levels (CL) 5. Divide into groups of 3: Start with Prescription Steps: □ FMC Chart Review: BPPS and Steps 40 BPPS Observed Conclusion: The BPPS simplifies language with action verbs and complete sentences leading to patientcentered behavioral change 7 4. How to establish Prescription Steps How to Do a Behavioral Prescription RESULTS: WORKSHOP CASE STUDY, CHART REVIEW, COMPUTER EXERCISE CONCLUSIONS ___ 6. Written to be achievable at a 7. confidence level of 7 or higher A one-hour workshop is sufficient to learn to appropriately write BPPS ___ 7. Written to be frequency-specific A Chart Review indicated adoption of BPPS in resident’s patient panel *Long Term Goal: 6 Residents are able to self-assess the appropriateness of Prescription Steps & make necessary adjustments in the BPPS Patient readability, which is essential, is enhanced with a BPPS Patient Signature: __________________ BPPS encourages realistic goal-setting with the patient in the office Practitioner Signature: _______________ ©Behavioral PSX/Prescription Steps (BPPS)- developed at West Suburban Medical Center 3 Future research to focus on reviewing patient charts to assess patient behavioral changes and health outcomes attributed to the BPPS STFM, San Francisco 2006. Supported by HRSA Residency Training Grant, D 58 HP 00249, CFDA 93. 884. For further information contact Domanchuk Michelle, michelle. domanchuk@reshealthcare. org (708) 763 -2193 12
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