My HealtheVet

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My HealtheVet 126 Optimizing Patient Education

• Kathleen Charters, PhD, RN, CPHIMS, CNE
• Kathleen Painter, RN, MSN, CHM

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Objectives

• Demonstrate how to find specific health patient
  education information on My HealtheVet
• Assess patient needs in a time-limited clinical
  encounter
• Use My HealtheVet to leverage existing
  educational resources programs
• Identify strategies to optimize patient education
  by focusing on specific health needs of an
  individual patient
• State how to request content development
  modifications to clinical information patient
  education

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Housekeeping

• Questions
• Use 3x5 cards
• Hold until end of presentation
• Responses will be discussed posted on-line

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Needs Assessment

• Show of hands
• Are you using My HealtheVet in your clinical
  practice?
• How many of you think your patients are using My
  HealtheVet?
• Written responses
• What health information topics would you most
  frequently refer your patients to?
• Would you find self-entered information helpful
  in your clinical practice?
• Send to Kathleen.Painter2_at_va.gov

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Overview

• What Can My HealtheVetDo for Me?

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Introduction

• Introduction to My HealtheVet
• Who uses My HealtheVet
• Research Health
• Healthy Living
• Conditions
• Mental Health
• Medical Library
• Track Health
• Value of My HealtheVet in Clinical Practice

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What Is My HealtheVet?

• My HealtheVet is a web-based application designed
  for veterans, their families, their friends
  with the goal of optimizing veterans healthcare
• Holistic
• Supporting body, mind, spirit
• VA benefits, programs, services
• Personal Health Record
• Self-entered personal health-related
  information (patient participation)
• Extracts from the VA electronic medical record

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Who Uses My HealtheVet?
2006 06 n 253,869 2007 06 n 430,784
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General Health Issues

• Co-morbidities
• Diabetes
• Hypertension
• COPD
• Activities of Daily Living
• Social Isolation
• Sedentary life style
• Malnutrition (excess weight gain/loss)
• Diminished sexual function

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Using My HealtheVet

• To use My HealtheVet go to
• www.myhealth.va.gov

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Splash Page
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Home Page
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Research Health
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Healthy Living
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Diseases Conditions
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Medical Library
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Mental Health
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Track Health
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e-Rx
http//vaww1.va.gov/MyHealtheVet/
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Patient Action Plan
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What My HealtheVetCan Do For You

• A tool for patient education
• Provides information for shared decision making
• Activities that involve the patient in own care
• Material has been vetted by the VA
• Collaborative information sharing
• Efficient use of your time with patient
• Comprehensive view of patients health
• Blended view of patients medications

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• Patient Educational Needs

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Quick Ways to AssessPatient Education Needs

• Salient belief model
• Experiences of patients family friends
• Self-efficacy theory

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Salient Belief Model

• Based on the work of Miller
• Limited number 7 plus or minus 2 strong beliefs
  about any topic
• Salire to jumpobvious, significant
• When you think of , what do you think of?
• How to use this info
• To identify the patients concerns
• To tailor what you want to teach about to the
  patients concerns

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Experiences of Patients Family Friends

• Have you had a family member or friend who
  ?
• What was their experience?
• Confirm the positive
• Correct misconceptions
• Offer hope

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Self-efficacy Theory

• Based on the work of Alfred Bandura
• Ability to perform a given action
• Not concerned with the skills needed but the
  belief
• There are no self-efficacious people
• Its behavior situation specific

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Self-efficacy Theory

• Self-efficacy effects
• Behavior choices
• Activities to be attempted avoided
• Effort people will expend how long theyll
  persist
• Stay with a task longer make renewed efforts
  after problems

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Using Self-efficacy Theory

• Ask patients how confident they are on a scale
  from 1 (totally uncertain) to 10 (totally
  certain) about following treatment
  recommendations
• If they respond less than 7, its unlikely
  theyll be willing to take the recommended action
• Your cue to find out why
• Ask what would have to happen to get them to
  raise their score
• Problem solve with the patient
• Dont dictate your solution to the patients
  problem

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Ways to Enhance Self-efficacy

• Short-term goal setting
• Stage tasks
• Provide crutches
• Practice
• Use models (mastery coping)
• Help patients manage anxiety
• Provide feedback (self-monitoring)
• Help patients recall past successes

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Case Study Diabetes
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Findings

• 5 feet 3 inches
• Weight 180 lbs
• Body Mass Index 31.88
• BP is elevated (150/94)
• Mother died due to diabetic complications
• Father treated for hypertension

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Needs AssessmentExperience of Family Friends

• Both her parents were overweight
• Her mother developed diabetes when she was 55
  years old
• Concerned weight gain may lead to diabetes
• Heard about dangers for overweight children

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Concerns

• Concerned about the weight she has gained
• Afraid of getting Diabetes ending up like her
  mother
• Not as physically active
• Concerned about the health of her children

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Healthcare Team

• Obesity
• Elevated blood pressure r/o hypertension
• Altered self-identity
• Lowered self-esteem
• Possible PTSD

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Local Point of Contact
vaww1.va.gov/MyHealtheVet
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e-Rx
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e-Rx
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Case Study Elevated PSA(Prostate-Specific
Antigen)
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Medical Library Resources

• Medline Plus Related Topics
• Prostate Diseases (text)
• Tests Diagnostic Procedures
• Ultrasound (Interactive Tutorial)
• HealthWise
• Prostate Ultrasound - Medical Test Medical Test
• Prostate-Specific Antigen (PSA) - Medical Test
  Medical Test

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e-Rx Pad
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Local Point of Contact
vaww1.va.gov/MyHealtheVet
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Follow-up Visit
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Building Content onMy HealtheVet
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Overview

• How we build content
• Clinical Advisory Board
• Policy
• Submission Form
• Review Process
• Subject Matter Experts
• Clinical Focus Groups

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Need Content
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SUBMI S S I ON
F O R M
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Subject Matter Experts

• Veterans
• Physicians/Physician Assistants
• Psychologist
• Nurses
• Educators/Librarians
• Pharmacist
• Social Workers
• Others with vested interest
• Kathleen Charters Kathleen Painter support

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Focus Groups

• Mental Health Ken Weingardt
• Spirituality Jeni Cook
• Operation Iraqi Freedom / Operation Enduring
  Freedom Oyweda Moorer
• Clinical Adoption (VISN 8)
• Several additional focus groups
• Life cycle development
• Health conditions
• Caregivers

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The Power of the Web
Kathleen.Charters_at_va.gov
Kathleen.Painter2_at_va.gov
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Summary

• Find specific health patient education
  information on My HealtheVet
• Assess patient needs in a time-limited clinical
  encounter
• Use My HealtheVet to optimize existing
  educational resources programs
• Identify strategies to optimize patient education
  by focusing on the specific health needs of the
  individual patient
• Request content development modifications to
  the clinical information patient education

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Check It Out . . .

• My HealtheVet National Site
• www.myhealth.va.gov
• MHV Demo Account
• Username mhvuser
• Password mhvdemo1
• My HealtheVet Product Site vaww.va.gov/MyHealtheV
  et/
• My HealtheVet Training Site
• vaww.vistau.med.va.gov/vistau/mhv/

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Questions Answers

• Suggestions?

Kathleen Charters, PhD, RN, CPHIMS, CNE Clinical
Information Systems Specialist My HealtheVet
Program Management Office Silver Spring, MD (301)
734-0580 Kathleen.Charters_at_va.gov Kathleen
Painter, RN, MSN Lead, Patient Education My
HealtheVet VIRO Martinsburg, VA (304)
262-7342 Kathleen.Painter2_at_va.gov