If patient education is done well, it improves health outcomes

First, let’s agree on the goals of patient education. The learner is educated when he or she:
— Has his or her questions answered
— Understands enough to make informed decisions
— Develops basic self-care skills to survive
— Can recognize problems and how to respond

If patient education is done well, it improves health outcomes. Self-care behaviors change to accommodate the new medical situation, and the patient knows how to spot problems early and intervene, minimizing new problems. If the patient was terminally ill, education could improve quality of life.

Agree?

Well I just read a systematic review of the literature that found patient education that is part of a cardiac rehab program did not change health outcomes. It does not contribute to fewer deaths, heart attacks, heart by-pass or angioplasty, or admission to hospital for heart-related problems.

This makes no sense.

Were the patients taught evidence-based self-care skills that are known to improve health outcomes?  Research shows diet and lifestyle changes, appropriate medication self-administration, and early recognition of signs and symptoms with timely intervention are effective.

I suspect inadequate or inappropriate patient education is the cause of the lack of health outcomes.

Were patients’ understanding evaluated?
Were they able to perform the skills taught?
Did they have the resources to perform those skills regularly at home?
Did they receive health coaching to learn to apply those new self-care skills, and sustain those behavioral changes?
Was their understanding and implementation reassessed in follow-up appointments?

If the systematic review is correct, and patient education does not change health outcomes, then the diet and lifestyle changes, medication, and recognition of problems have no impact on health outcomes.

Conclusion:
Either
Our prescribed self-care interventions do not change health outcomes
Or
Our patient education is inadequate, and does not help patients understand what they need to do, teach them how to do it, or help them obtain the support and motivation to sustain health-promoting behaviors over time.

Oh, at the end of this systematic review they did say,
“Although there is insufficient information at present to fully understand the benefits or harms of patient education for people with heart disease, our findings broadly support current guidelines that people with heart disease should receive comprehensive rehabilitation that includes education. Further research is needed to evaluate the most clinically and cost-effective ways of providing education for people with heart disease.”

Really? Further research is needed to evaluate the most clinically and cost-effective ways of providing education?

We know how to most efficiently and effectively teach. The research is unequivocal: Assessment, individualized teaching with active involvement, evaluation of understanding, and health coaching over time to help the learner apply these new skills consistently.

The problem:  This standard of quality is not universally applied when a study refers to “patient education” as an intervention.

You wouldn’t say a medication doesn’t work if all the studies you looked at used different forms of the medication in different doses, including some placebos.

How do we change that?

Article:
Anderson L, Brown JPR, Clark AM, Dalal H, Rossau HK, Bridges C, Taylor RS. Patient education in the management of coronary heart disease. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD008895. DOI: 10.1002/14651858.CD008895.pub3.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008895.pub3/full

© 2017 Fran London, MS, RN

2 Responses to “If patient education is done well, it improves health outcomes”

  1. Sandra Cornett says:

    Fran:
    Part of the problem is that they don’t spell out the patient education intervention very well in these studies and they don’t control for extraneous variables that may influence the outcomes. Many studies detail what they teach, but not HOW the education is done. Until we determine how the patients are taught, these studies don’t help. My 2 cents!
    Sandy

  2. I absolutely agree. If we want to measure the impact of patient education, the first step is to make sure the education is provided in consistent, evidence-based ways.

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