A basic overview of the Indian Health Service patient education program and description of patient education protocols and codes, documentation, and associate HIT tools.

1. Overview of Indian Health Service
Patient Education
CDR Christopher Lamer, PharmD, MHS, BCPS, CDE

2. Indian Health Service
• Provides a comprehensive health service
delivery system for approximately 1.9
million American Indians and Alaska
Natives.
• Serves members of 562 federally
recognized Tribes.
• FY 2009 appropriation is approximately
$3.58 billion.
• Indian Health Service total staff consists of
about 15,700 employees, which includes

3. Resource and Patient Management
11 000101
001 0110 000
011 01110101 10
11001010 010 00 1
01 11100 0000111
10000111 10100
1100 0 0101 1
00 11110

4. Ask Advise Assess Assist
1. Ask the patient if he or
she uses tobacco products
(cigarettes, snuff, dip,
etc.).
2. Ask the patient if he or
she uses tobacco products
for cultural or religious
purposes.
3. Ask the patient if he or
she is exposed to tobacco
smoke at work.
4. Ask the patient if anyone
uses tobacco products at
home.
5. Document the health
factor screening results
using the values in the
table.

5. Ask Advise Assess Assist
• Health Factors
– Non-Tobacco User
– Current Smoker
– Current Smokeless
– Current Smoker & Smokeless
– Cessation Smoker
– Cessation Smokeless
– Previous Smoker
– Pervious Smokeless
– Ceremonial Use Only
– Smoker in the Home
– Smoke Free Home
– Exposure to Environmental Tobacco Smoke

6. Tobacco Health Factors

7. Ask Advise Assess Assist
http://www.ihs.gov/NonMedicalPrograms/HealthEd/index.cfm?
module=initiative&option=protocols&newquery=dsp_NatlPatientEd_Protocols.cfm

8. PEPC Has Two Components

9. PEPC Has Two Components
1. Code – This is the code used
to document the education
provided to the patient or
family.
1. Mnemonic

10. PEPC Has Two Components
HTN-C COMPLICATIONS
1. Code – This is the code used Outcome: The patient will verbally
summarize the complications of
to document the education uncontrolled hypertension.
provided to the patient or
Standards:
family.
1. The patient will verbally summarize
1. Mnemonic the complications of uncontrolled
hypertension.
2. Explain that heart attacks may result
2. Protocols - Protocols are from the heart having to work harder
written guidelines for to pump blood through congested and
hardened arteries.
education. 3. Explain that blindness may result
1. Guidelines from injured blood vessels in the eye.
4. Explain that strokes may result from
ruptures of injured blood vessels in
the brain.
5. Explain that circulatory
complications eventually impair the
ability of the kidneys to filter out
toxins.

11. Ask Advise Assess Assist

12. Ask Advise Assess Assist

13. Ask Advise Assess Assist
Readines Level of
Sub-
Topic s to Understandi Provider Time
Topic
Learn ng

14. Ask Advise Assess Assist
Readines Level of
Sub-
Topic s to Understandi Provider Time
Topic
Learn ng
-Mnemonic (TO, HTN)
-ICD9 Code
-CPT Code

15. Ask Advise Assess Assist
Readines Level of
Sub-
Topic s to Understandi Provider Time
Topic
Learn ng
-Mnemonic (TO, HTN)
-ICD9 Code
-CPT Code
AP - Anatomy & Physiology HM - Home Management N - Nutrition
C - Complications HY - Hygiene P - Prevention
DP - Disease Process LA - Lifestyle Adaptations PRO - Procedures
EQ - Equipment L – Literature S - Safety
EX - Exercise M – Medications TE - Tests
FU - Follow-up MNT – Med Nutrition Tx TX - Treatment

16. Ask Advise Assess Assist
Readines Level of
Sub-
Topic s to Understandi Provider Time
Topic
Learn ng
Education Code
-Mnemonic (TO, HTN)
-ICD9 Code
-CPT Code
AP - Anatomy & Physiology HM - Home Management N - Nutrition
C - Complications HY - Hygiene P - Prevention
DP - Disease Process LA - Lifestyle Adaptations PRO - Procedures
EQ - Equipment L – Literature S - Safety
EX - Exercise M – Medications TE - Tests
FU - Follow-up MNT – Med Nutrition Tx TX - Treatment

17. Ask Advise Assess Assist
Readines Level of
Sub-
Topic s to Understandi Provider Time
Topic
Learn ng
Education Code -Receptive
-Eager
-Mnemonic (TO, HTN) -Unreceptive
-ICD9 Code -Distraction
-CPT Code -Intoxication
-Severity of illness
AP - Anatomy & Physiology HM - Home Management N - Nutrition
C - Complications HY - Hygiene P - Prevention
DP - Disease Process LA - Lifestyle Adaptations PRO - Procedures
EQ - Equipment L – Literature S - Safety
EX - Exercise M – Medications TE - Tests
FU - Follow-up MNT – Med Nutrition Tx TX - Treatment

18. Ask Advise Assess Assist
Readines Level of
Sub-
Topic s to Understandi Provider Time
Topic
Learn ng
Education Code -Receptive -Good
-Eager -Fair
-Mnemonic (TO, HTN) -Unreceptive -Poor
-ICD9 Code -Distraction -Refused
-CPT Code -Intoxication -Group
-Severity of illness
AP - Anatomy & Physiology HM - Home Management N - Nutrition
C - Complications HY - Hygiene P - Prevention
DP - Disease Process LA - Lifestyle Adaptations PRO - Procedures
EQ - Equipment L – Literature S - Safety
EX - Exercise M – Medications TE - Tests
FU - Follow-up MNT – Med Nutrition Tx TX - Treatment

19. Ask Advise Assess Assist
Readines Level of
Sub-
Topic s to Understandi Provider Time
Topic
Learn ng

20. Ask Advise Assess Assist
Readines Level of
Sub-
Topic s to Understandi Provider Time
Topic
Learn ng
TO - QT- EAGR - G - ABC - 5min

21. Adding Patient Education

22. Outcome and Standards

23. Select the code you want

24. Document Education

25. Pick Lists

26. Ask Advise Assess Assist
– The patient uses tobacco and wants to quit
• Provide resources and assistance
– Quit line information TO-HELP
– Tobacco handouts TO-L
– Refer to tobacco cessation specialist TO-IR
– The patient uses tobacco and does not want to
quit
• Provide and review tobacco treatment literature
– TO-L-RECPT-G-CL-3min-GNS
• Provide feedback on why they should consider quitting
– The patient has used tobacco and has quit
– The patient has never used tobacco
• Commend and promote abstinence

27. Ask Advise Assess Assist
• Set a goal and a quit date
• TO-QT-G-CL-5min – GS – will
quit on 6/25

28. Ask Advise Assess Assist

29. Ask Advise Assess Assist
• TO-IR INFORMATION AND REFERRAL
– OUTCOME: The patient/family will understand the process of referral and treatment
for nicotine dependence.
– STANDARDS:
• Discuss sources for tobacco cessation treatment
• Refer to nicotine treatment program or other resource as available.
• TO-QL QUIT LINE
– OUTCOME: The patient/family will understand how to access and benefit from a
tobacco quit line.
– STANDARDS:
• Explain to the patient/family that a quit line will enable to the patient to talk
with a specialist who can helpthem plan an individualized quit method and
may some times be used in coordination with other types of tobacco use
treatment such as group or individual programs and/or medications.
• Explain that people who use telephone counseling stop smoking at twice the
rate of those who don’t get this type of help.
• Provide the patient with the quite line phone number and hours of operation
or assist the patient in calling the quit line during the patient encounter.
• Explain how the quit line works and what the patient can expect from calling.

30. Clinical Reporting System

31. Table 6.25 IHS Clients Served by Location
Location 2001 2002 2004 2006 2008
Total Clients 696,060 812,301 1,214,646 1,696,881 2,202,279
Hospital 445,842 534,891 740,077 968,008 1,284,632
Health Center 225,617 253,526 430,931 596,006 715,628
Health Station 17,515 16,271 23,140 64,206 65,521
Location (Home) 6,339 6,719 15,505 32,741 21,701
School 189 157 879 5,278 12,004
Village Clinic 510 700 4,113 14,386 226,679
Administration/ 35 37 58 11,513 39,724
Other

32. Learning Preference
• Talk
• Video
• Small group
• Read
• Do/practice

33. Barriers to Learning
• No barriers
• Fine motor skills
deficit
• Doesn’t read English
• Hard of hearing
• Interpreter
needed
• Deaf
• Social stressors
• Visually
impaired
• Values/beliefs
• Blind
• Cognitive
impairment
• Distraction

34. Healthcare Communications
http://www.ihs.gov/healthcommunications/

35. Patient Education Handouts

36. RPMS Patient Wellness Handout
• Demographics
• Blood Pressure
• Cholesterol
• Allergies
• Vital Signs
• Diabetes Care
• Preventive Screening
• Medications
• Immunizations
• Patient Goals
• Physical Activity