Implementing an integrated
information prescription model
in family medicine
Francesca Frati, MLIS
In collaboration with
Roland Grad, MDCM, MSc, CCFP
Herzl Family Practise Centre, Montreal QC
STFM Conference for Practise improvement: health education and patient
education
Newport Beach, CA, November 10, 2007
Agenda
This session reviews
Background
1.

How the information needs of the community were determined

Existing health information models with a focus on the
Information Rx model
2.
Implementation
3.
Challenges
4.
Lessons learned several months after implementation.
Empowerment
1

It is increasingly believed that an informed patient is
an empowered patient, better able to act as partner
with his or her health professional (HP) with the goal
of achieving improved health outcomes.

“This type of partnership approach is known
variously as shared or informed decision making,
evidence based patient choice, or concordance.”
1. Coulter A, Ellins J. Effectiveness of strategies for informing, educating, and
involving patients. BMJ 2007;335:24-27. Available from www.bmj.com
The setting:
summer /fall 2007
Needs assessment: summer 2006

It was perceived that the health information
needs of the community were being met with
room for improvement.

Health consumers and HPs surveyed

Confirms that both consumers and HPs want
better access to consumer health information,
and information literacy instruction.

We felt that the addition of a librarian to the
health care team on site could help meet this
need.
Review of existing models

1. Patient and family resource centres in the
library setting


2.a. Patient and family resource centres within
the hospital community


Consumer health information provided by librarians
Patient education provided by nurses
2.b. Patient and family resource centres within
the larger community (clinics, malls etc.)

Patient education provided by nurses
Continued review reveals a third model

3. A review of existing resources revealed a
service model with a librarian acting on-site as a
member of the health care team with the support
of the affiliated hospital library.

Based on an innovative InformationRx model
first implemented at the Monkfield Medical
Centre in UK (see Information Prescription section
of article available from:
www.cilip.org.uk/publications/updatemagazine/archi
ve/archive2004/december/grimwood ).
Innovative how?

Consumer is referred to a service

InformationRxs are usually filled by




a medical or public library
a participating bookstore
or by the patient him or herself with the use of
recommended online resources
MedlinePlus InfoRx
(http://nnlm.gov/hip/infoRx/summary.html)
Our solution

The in-house InformationRx
service

Health information needs addressed for
consumers and for HPs

by a librarian on site as a new member of the
health care team.

supported by the adjacent hospital library
Where does Rx come in?

HPs are encouraged to refer their patients to the
Patient Information Coordinator
(librarian)

HPs can write a prescription for information
i.e. the question

Rx is filled by librarian


In person
By phone/email/fax
Why on site?

Avoid out of sight out of mind
(we have a library?)

Librarian is better placed to understand the
needs of the community

HP needs are addressed, not just consumers’

Integrated into practise


Documented in charts
Trust
The InfoRx pad

Pads were created to
make prescribing easier

Family health topics
were chosen with the
help of the Patient
Education Committee

Pads are in each
consultation room and in
the observation rooms
Consults

All consults are documented


Question
Recommended resources



Websites
Books
Pamphlets etc.

1 copy given to referring HP with Rx attached
who then puts in the chart

Treated as clinical encounter- schedule in
appointment scheduling software
Support for HPs

Giving patients the information & instruction
(“teach them to fish”)

Assist with the creation of patient level materials

Provide guidance and instruction to HPs on the
topic of consumer health resources & literacy
issues

Provide updates on new consumer resources
Operation

Librarian on-site 7 hours per week

Library provides support by



Handling overflow
Print collection
PFRC website to include family medicine topics

Patient Education Committee provides support for
decision making- predated service

Drop in encouraged

Pamphlet collection in room
Use of service to date

Opened 4 months ago

Seeing patients for 1 month

13 consults

Compare to library: 6-7 per month, mainly
divided between 2 people
Challenges

Meeting the health information needs of
consumers and HPs in a timely manner
can be difficult.

Meeting these needs in a family practice
setting presents unique challenges.

Meeting these needs at point of care
means changing the way the team works.
Big challenge #1- change
(based on my experience)

Support staff
 May not understand the need
 May not recognise the authority of unfamiliar professional

Nurses
 May not see how service is different from Patient Education
 May not recognise the skills a librarian brings to position
 Concern that librarian might provide inappropriate info or advice

Physicians
 May have trouble developing new habits (writing Rx)

Librarian
 May need to adapt communication style
 Learning curve specific to clinical setting
Big challenge # 2: time

Coordinator only on site 7 hrs per week
 All administrative aspects included in 7 hours

Start up issues
 Support staff




Nurses



Learning about service
Assisting with the evaluation of print materials
Physicians




Learning about service
Booking appointments
Ordering materials (signs, pads, furniture, computer etc.)
Learning about service
Writing InfoRx
Promoting service to Residents, consumers
Librarian

Doing it all in 7 hrs
Support from on high

Clinic chief meets with librarian on weekly
basis



Brings cases to librarian
Assesses needs
Problem solves
Creative solutions




InfoRx cases blog
Cases & challenges documented
Opportunity for discussion
Eventual wider audience
Evaluation

The chief of the unit is evaluating the service as
part of his patient perspective initiative

The library will include evaluation of the service
as part of its patient satisfaction survey

It was initially thought that a user postconsultation mini-survey would be administered
as part of day-to-day operation of the service- it
was decided that this is not practical
Lessons learned

“talk is cheap” – clinic chief

Residents use service more than FP Teachersthought it would be opposite

Nurses don’t use the service

Patience!

Too soon to tell
Thank you!