Maintaining Patient Health Is About Education
The Groves Medical Centre in New Malden, Surrey – a finalist for the Medical Defence Union (MDU) risk management award – holds patient education evenings to encourage self-management and make contact with patients with undiagnosed conditions.
Rupert Lee, one of the MDU’s clinical risk managers, says: ‘This project is important because patients who have not seen their GP in a long time have been diagnosed.’
The judges were particularly impressed by the practice’s contribution to patient safety and their quality of care.
Six meetings are held each year and a variety of topics are covered.
‘We want to benefit as many patients in the practice as possible,’ says Dr Jeremy Harris, a GP at the practice.
‘We try to have at least one topic each for the elderly, women, men and children, and we also take on a clinical topic like hypertension or asthma.’
Topics are suggested by the practice’s patient participation group as well as the health professionals. Several of last year’s sessions addressed health promotion issues such as reducing obesity and smoking. For example, a party was held for children with asthma to test their inhaler technique.
Each event targets a specific group. The practice is fully computerised and each patient’s record has codes attached. To choose a mailing list, a code is entered and the computer provides names and addresses.
For an evening on obesity, the practice targeted patients with a BMI greater than 30. They identified and invited 290 patients, of whom more than 200 attended.
‘Uptake is about 40-50 per cent,’ says Dr Harris. ‘We sometimes write to between 400 and 600 patients, and expect to see about 250 people on the night.’
Due to the large numbers, the sessions are held in the church hall opposite the surgery. The costs of postage and hiring the hall are covered by pharmaceutical companies.
Dr Harris came up with the idea four years ago to save time and reach a large audience.
‘GPs need about two hours with each patient to explain the importance of lifestyle and how to help the management of their own conditions.
‘The evenings enable us to see a lot of people at once. We don’t have to keep repeating ourselves and patients realise that they are not alone.’
Presentations are given by experts, including hospital consultants, dietitians and GPs.
Dr Harris says it is important to discuss lifestyle issues before talking about disease management. Sometimes patients speak about their experience of the condition and how to manage and treat it.
‘We have had a patient speak at the past three sessions,’ says Dr Harris.
‘We know our patients well and choose people who will do a good job. The woman who spoke about her experience with breast cancer was particularly moving.’
Despite the amount of work required to put an evening together, the entire practice staff have supported the project from the outset and gained from the experience.
Some have improved their understanding of health conditions or improved their own health. They have also developed new computer skills that are beneficial on a daily basis.
Recently the patient participation group has contributed more to the preparation and practical tasks. They also make an audio recording of each session.
‘Some of the staff may have felt resentful of their involvement at first, but they now appreciate the amount of time saved,’ says Dr Harris.
The evenings have even improved patient care. ‘Patients are more interested in their own health and are more positive,’ says Dr Harris.
‘They understand their conditions, comply with treatment and come for check-ups.’
He adds: ‘Consultations are more productive because of patients’ increased understanding and awareness.’
Following an education evening on asthma, patients record their own peak flow before a consultation, saving valuable surgery time. Patient compliance is measured by how well the practice hits their targets – such as identifying all diabetics in the patient list.
New diabetics were detected following a diabetes’ awareness evening.
Dr Harris says: ‘We are constantly achieving our targets more closely.’
Patient awareness has certainly improved. An evening on breast care led several women to identify breast lumps, and some of them were cancerous.
The session also helped to decrease the participants’ fears about cancer.
Patients give feedback at their GP consultations, on questionnaires at the end of each session, and at patient group meetings.
Their comments have been positive in general, and some patients have suggested topics for future evenings.
The average attendance is 250 people, but 350 attended an evening on depression and a session on the prostate attracted more than 300.
‘We were surprised at the high numbers at the depression evening,’ says Dr Harris. ‘Patients found it helpful. They met others with similar problems and felt reassured.’
The lowest attendance was 50 people at a stop-smoking evening. Dr Harris says: ‘We expected low numbers but half of those who came eventually quit smoking so it was still a huge success.’
Some of the sessions are followed up with support groups. A nurse-led weight-loss group began after a session on obesity, and an exercise class to prevent falls in over-65s came out of a falls prevention evening.
The patient group is setting up self-help groups for other conditions, such as depression, asthma and skin conditions.
The sessions will involve a professional, such as a GP partner with a special interest, a nurse or dietitian.
In the future, GPs will have increasing involvement in the discussions because patients feel comfortable with them and participate more.
‘This year each and every session will involve a GP partner,’ says Dr Harris.
Dr Harris says that unfortunately the sessions have not decreased patients’ demands.
‘The government is making more promises so patients’ expectations remain high,’ he says. ‘However following the education evenings, their demands are linked with greater understanding.’
– Improved self-management and patient compliance to treatment.
– More effective use of consultation time.
– Improved relationships between patients and GPs. Patients find it easier to visit their GP about conditions that are embarrassing.
– Undiagnosed conditions are identified and treated, including prostate problems and diabetes.
– Improved flu vaccine uptake in over-65s and at-risk groups.
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