1. 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
RESULTS:
WORKSHOP CASE STUDY, CHART REVIEW, COMPUTER EXERCISE
BACKGROUND
Workshop: Case Study – Readability
Chart Review: BPPS and Steps
60 Minute Workshop: Residents
PURPOSE
Standard Observed
Flesch Reading Ease >=
(FRE) 0-100
Flesch-Kincaid Grade
Level (FKGL)
Conclusion: The BPPS simplifies language with action verbs and complete sentences leading to patient-centered behavioral change
40 BPPS
98 steps
Average steps were 2.5 per BPPS
Background:
Self-Efficacy Theory
Chronic Care Model
Disease Management Model
Practice reading dialogues aloud
Motivational Interviewing Techniques
How to establish Prescription Steps
Divide into groups of 3:
Patient
Practitioner
Facilitator/Recorder
From a Case Study, each 3-resident group
develops a BPPS
Group discussion
Confidence Levels (CL)
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. CL 7 8 9 10 %
17.3% % %
36.7%
Long Term Goal
23/40 BPPS (57.5%) did
not record a long term goal 1 7 9
How to Do a Behavioral Prescription
Start with Prescription Steps:
What would you like to change?
What are some things you can do to make that change?
What might get in the way of accomplishing this goal?
What can you do to overcome these barriers?
Is there any other help you need to accomplish this goal?
How confident are you that you can achieve this step at the present time on a scale of 1-10? (<7, redefine step)
At follow-up visit, review the steps and document on previous prescription, what % of the time they were able to comply
Redefine long-term goal and revise steps accordingly
Workshop: Case Study – 7 Criteria
18 residents completed a BPPS
Assessment of 18 resident BPPS’s using
7 criteria yielded a 77.0% average score
(97/[7 criteria x 18 BPPS])
Most commonly missed elements were:
Using abbreviations (Criteria 1)
Confidence level missing (Criteria 6)
Chart Review: 7 Criteria (81.8 % Average) 4
EVALUATION
of Resident Learning 8 10
1. Workshop: Resident presented with
new case study and prepares a BPPS
2. Chart Review: BPPS used with patients
Computerized Self–Learning Exercise:
Case Study and BPPS 2
Computerized Self-Learning Exercise : Case Study, Preparing & Revising a BBPS 5
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 Average Score
3. Guided Self-Assessment of 18 of 24 residents made corrections 93.5% Prescription Steps Using 7 Criteria in several Prescription Steps Average Score
BEHAVIORAL PRESCRIPTION
□ FMC □ PCCA □ PCCL □ PCCS □ AIM
FOR:____________________________ DATE:___________
PRESCRIPTION STEPS
7 Assessment Criteria For BPPS
Used active voice/first person (I will)
Avoided the use of abbreviations
Avoided symbols or signs
Avoided spelling errors
Used short simple language
(action verbs and complete sentence)
Written to be achievable at a
confidence level of 7 or higher
Written to be frequency-specific
On a scale of 1-10, how confident are you that you can do each step?
(Not at all (Totally Confident) Confident)
STEPS NUMBER
1. ___
___
3. ___
4. ___ 11
CONCLUSIONS
A one-hour workshop is sufficient to learn to appropriately write BPPS
A Chart Review indicated adoption of BPPS in resident’s patient panel
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
BPPS encourages realistic goal-setting with the patient in the office
Future research to focus on reviewing patient charts to assess patient behavioral changes
and health outcomes attributed to the BPPS 6
*Long Term Goal:
Patient Signature:___________________________________
Practitioner Signature: ______________________________
©Behavioral PSX/Prescription Steps (BPPS)- developed at West Suburban Medical Center 3 12
STFM, San Francisco Supported by HRSA Residency Training Grant, D58HP00249, CFDA For further information contact Michelle Domanchuk, (708)