Promoting MedlinePlus utilization in a federally qualified health center using a multimodal approach

Authors

  • Mechelle Sanders Department of Family Medicine Research Programs and Department of Public Health Sciences, University of Rochester, 1381 South Avenue, Rochester, NY 14620
  • Kate Bringley Woodward Health Center, Anthony L. Jordan Health Center, 480 Genesee Street, Rochester, NY 14611
  • Marie Thomas Department of Family Medicine Research Programs, University of Rochester, 1381 South Avenue, Rochester, NY 14620
  • Michele Boyd Department of Family Medicine Research Programs, University of Rochester, 1381 South Avenue, Rochester, NY 14620
  • Subrina Farah Department of Family Medicine Research Programs, University of Rochester, 1381 South Avenue, Rochester, NY 14620
  • Kevin Fiscella Department of Family Medicine Research Programs and Department of Public Health Sciences, University of Rochester, 1381 South Avenue, Rochester, NY 14620

DOI:

https://doi.org/10.5195/jmla.2018.216

Keywords:

Federally Qualified Health Centers, MedlinePlus, National Library of Medicine, Health Literacy, Training

Abstract

Background: Most patients want more health information than their clinicians provide during office visits. Written information can complement information that is provided verbally, yet most primary care practices, including federally qualified health centers, have not implemented systematic programs to ensure that patients receive understandable, relevant, and accurate health information at the point of care. MedlinePlus in particular is underutilized.

Case Presentation: The authors conducted a multimodal intervention to promote the use of MedlinePlus at a federally qualified health center. We provided MedlinePlus training to clinicians and patients through group and one-on-one trainings and multimedia promotion. We administered pre- and post-intervention surveys to patients, clinicians, and nurses to assess changes in the use and recognition of MedlinePlus at the point of care. We used quantitative and qualitative data to understand the impact of the intervention. A National Library of Medicine grant provided resources that supported equipment and staff. Group training improved use of MedlinePlus by clinicians and staff. One-on-one training was most effective for patients, particularly when it was integrated into the work-flow.

Conclusions: A multimodal approach can promote use of MedlinePlus among community health center patients. However, the process is labor- and resource-intensive and requires careful attention to work flow and leveraging of brief opportunities.

References

Strull WM, Lo B, Charles G. Do patients want to participate in medical decision making? JAMA. 1984 Dec 7;252(21):2990–4.

Bodie GD, Dutta MJ. Understanding health literacy for strategic health marketing: eHealth literacy, health disparities, and the digital divide. Health Mark Q. 2008 Oct;25(1–2):175–203.

Braddock CH III, Fihn SD, Levinson W, Jonsen AR, Pearlman RA. How doctors and patients discuss routine clinical decisions. informed decision making in the outpatient setting. J Gen Intern Med. 1997 Jun;12(6):339–45.

Braddock CH III, Edwards KA, Hasenberg NM, Laidley TL, Levinson W. Informed decision making in outpatient practice: time to get back to basics. JAMA. 1999 Dec 22–29;282(24):2313–20.

Burge S, White D, Bajorek E, Bazaldua O, Trevino J, Albright T, Wright F, Cigarroa L. Correlates of medication knowledge and adherence: findings from the residency research network of South Texas. Fam Med. 2005 Nov–Dec;37(10):712–8.

Sela-Katz P, Rabinowitz I, Shugaev I, Shigorina G. Basic knowledge of the medication regimen correlates with performance on cognitive function tests and diagnosis of dementia in elderly patients referred to a geriatric assessment unit. Gerontology. 2010 Mar; 56(5):491–5.

Hwang JP, Holmes HM, Kallen MA, Ensor J, Etchegaray J, Saab R, Arbuckle RB, King KM, Escalante CP. Accuracy of reporting current medications by cancer patients presenting to an emergency center. Support Care Cancer. 2010 Oct;18(10):1347–54.

Marks JR, Schectman JM, Groninger H, Plews-Ogan ML. The association of health literacy and socio-demographic factors with medication knowledge. Patient Educ Couns. 2010 Mar;78(3):372–6.

O’Connell MB, Johnson JF. Evaluation of medication knowledge in elderly patients. Ann Pharmacother. 1992 Jul–Aug;26(7-8):919–21.

Alibhai SM, Han RK, Naglie G. Medication education of acutely hospitalized older patients. J Gen Intern Med. 1999 Oct;14(10):610–6.

Clary C, Dever A, Schweizer E. Psychiatric inpatients’ knowledge of medication at hospital discharge. Hosp Community Psychiatry. 1992 Feb;43(2):140–4.

Louis-Simonet M, Kossovsky MP, Sarasin FP, Chopard P, Gabriel V, Perneger TV, Gaspoz JM. Effects of a structured patient-centered discharge interview on patients’ knowledge about their medications. Am J Med. 2004 Oct 15;117(8):563–8.

McCarthy DM, Waite KR, Curtis LM, Engel KG, Baker DW, Wolf MS. What did the doctor say? health literacy and recall of medical instructions. Med Care. 2012 Apr;50(4):277–82.

Kim N, Talwalkar J, Holmboe E. Challenges in ambulatory resident education: medication knowledge in disadvantaged patients. Conn Med. 2006 Oct;70(9):549–57.

Roth MT, Esserman DA, Ivey JL, Weinberger M. Racial disparities in the quality of medication use in older adults: baseline findings from a longitudinal study. J Gen Intern Med. 2010 Mar;25(3):228–34.

Saha S, Beach MC, Cooper LA. Patient centeredness, cultural competence and healthcare quality. J Natl Med Assoc. 2008 Nov;100(11):1275–85.

Sepucha KR, Fagerlin A, Couper MP, Levin CA, Singer E, Zikmund-Fisher BJ. How does feeling informed relate to being informed? the DECISIONS survey. Med Decis Making. 2010 Sep–Oct(5 suppl):77S–84S.

Engel KG, Heisler M, Smith DM, Robinson CH, Forman JH, Ubel PA. Patient comprehension of emergency department care and instructions: are patients aware of when they do not understand? Ann Emerg Med. 2009 Apr;53(4):454–61.

US National Library of Medicine. About MedlinePlus [Internet]. The Library; 2017 [cited 27 Jan 2017]. <https://medlineplus.gov/aboutmedlineplus.html>.

Burgess S, Dennis S, Lanka S, Miller N, Potvin J. MedlinePlus Connect: linking health IT systems to consumer health information. IT Prof. 2012 May;14(3):22–8.

Carman KL, Dardess P, Maurer M, Sofaer S, Adams K, Bechtel C, Sweeney J. Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health Aff (Millwood). 2013 Feb;32(2):223–31.

Health IT.gov. Meaningful use and the shift to the merit-based incentive payment system [Internet]. Office of the National Coordinator for Health Information Technology (ONC); 2017 [cited 22 May 2018]. <https://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-5-achieve-meaningful-use>.

Creswell JW. A concise introduction to mixed methods research. Thousand Oaks, CA: Sage Publications; 2014.

Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009 Apr;42(2):377–81.

Damschroder L, Aron D, Keith R, Kirsh S, Alexander J, Lowery J. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009 Aug 7;4(1):50.

Neta G, Glasgow RE, Carpenter CR, Grimshaw JM, Rabin BA, Fernandez ME, Brownson RC. A framework for enhancing the value of research for dissemination and implementation. Am J Public Health. 2015 Jan;105(1):49–57.

Sikon A, Bronson DL. Shared medical appointments: challenges and opportunities. Ann Intern Med. 2010 Jun 1;152(11):745–6.

Downloads

Published

2018-07-02

Issue

Section

Case Report