Systemwide Patient Education

Description

Systemwide patient education efforts provide information regarding the dangers of prescription drug misuse and abuse. They can target broad populations (patient groups, youth) or populations with or who are at risk for substance use disorders (Haegerich, Paulozzi, Manns, & Jones, 2013).

Objective(s)

To provide knowledge about and change attitudes toward prescription drugs, ultimately resulting in their safe use and proper disposal

Typical Elements

  • Systemwide patient education includes assessment, feedback, motivational interviewing, and brief interventions.
  • Information is provided on the effects of a particular drug, adherence (how to take the drug properly), the dangers of misuse and abuse (American College of Preventive Medicine, 2015), and the risks and benefits of a particular drug, so patients can make informed decisions (Pennsylvania Medical Society, 2014).
  • Patients are told how to securely and responsibly dispose of unused medication (see Prescription Drug Takeback Programs).
  • Several key points are emphasized (Health Team Works, 2011):
    • Sharing prescription drugs is illegal
    • Avoid openly discussing your medications with others
    • Keep prescribed medication in a safe, locked place (not a medicine cabinet)
    • Treat prescription drugs like cash or credit cards—many medications have a high street value and are stolen from homes or vehicles
    • Even some over-the-counter drugs (such as pseudoephedrine) have abuse potential and should be safeguarded
  • Education is tailored to individual patient's needs and considers the patient's influences and experiences as defined by his or her language, culture, gender, race and ethnicity, age, cognitive function, educational level (including literacy and health literacy), and local community resources (Substance Abuse and Mental Health Services Administration [SAMHSA], 2011).
  • Prevention efforts are focused on patients who have or are at risk for a substance use disorder.
    • Note: Primary care centers, hospital emergency rooms, trauma centers, and other community settings provide opportunities for early intervention with at-risk substance users before more severe consequences occur (SAMHSA, 2013).
  • For patient education to become institutionalized, a "normative shift" in healthcare practice is needed. Each department within an agency must see the benefit of integrating prevention into primary care practice (The National Center on Addiction and Substance Abuse at Columbia University [CASA], 2012, p. 6).
  • Before implementing systemwide patient education, the organization's readiness to implement effective strategies or programs in clinical practices must be determined. Sites considering this strategy should do the following (Health Team Works, 2008):
    • Study the model and its associated guidelines
    • Determine if and how it can be best applied within their practice, given the patient population
    • Determine whether it can generate revenue or remain cost-neutral for their site (CASA, 2012)
    • Identify behavioral health resources in their community for brief therapy referrals
    • Determine the best way to implement screening in their practice
      • Note: Most sites incorporate screening into an overall health history questionnaire.
    • Consider how to administer the brief assessment instrument for patients who need additional assessment
    • Develop a staffing plan for screening and assessment
    • Select a leader for the implementation, who will also coordinate training and monitoring
    • Train clinicians (and non-clinical staff) and assign responsibilities
      • Note: For example, determine which staff members will administer the screenings, complete the flow sheets, arrange referrals, and handle billing.
    • Establish a record-keeping system that protects client confidentiality
    • Reinforce the strategy with staff through (1) reminders, (2) collecting success stories, and (3) accepting feedback to modify the implementation, as needed

Populations

Patients and individuals who have or are at risk for a substance use disorder

Outcomes

  • Findings from a systematic literature review note that the quality of evidence for the effect of patient education programs is moderate to low (Haegerich et al., 2014).
  • Based on the scant availability of published research on screenings and brief interventions for drug use, in 2008 the U.S. Preventive Services Task Force concluded that the evidence regarding screening for illicit drug use was inadequate to evaluate the balance of benefits and harms of screening adolescents, adults, and pregnant women (SAMHSA, 2013).

Guidelines

Use, Abuse, Misuse and Disposal of Prescription Pain Medicine Clinical Reference.

Practice Guidelines for the Treatment of Patients with Substance Use Disorders (2nd ed.).

An SBIRT Implementation and Process Change Manual for Practitioners.

Best Practices to Address Opioid Abuse, Misuse and Diversion.

Pennsylvania Guidelines on the Use of Opioids to Treat Chronic Non-Cancer Pain.

Medication Guidelines.

Systems-Level Implementation of Screening, Brief Intervention, and Referral to Treatment. Technical Assistance Publication (TAP) Series 33.

Acknowledged by

U.S. Department of Health and Human Services, Behavioral Health Coordinating Committee. Addressing Prescription Drug Abuse in the United States.

References

American College of Preventive Medicine. (2011). Use, abuse, misuse and disposal of prescription pain medicine clinical reference. Retrieved from https://c.ymcdn.com/sites/www.acpm.org/resource/resmgr/timetools-files/painmedsclinicalreference.pdf

Haegerich, T. M., Paulozzi, L. J., Manns, B. J., & Jones, C. M. (2014). What we know, and don't know, about the impact of state policy and systems-level interventions on prescription drug overdose. Drug and Alcohol Dependence, 145, 34–47.

Health Team Works. (2008). Screening, brief intervention, and referral to treatment: Strategies for implementing SBIRT in clinical practices. Retrieved from https://www.integration.samhsa.gov/clinical-practice/HealthTeamWorks_Strategies_for_Implementing_SBIRT_in_Clinical.pdf

Health Team Works. (2011). SBIRT guideline supplement: Prescription drug abuse prevention. Denver, CO: SBIRT Colorado.

The National Center on Addiction and Substance Abuse at Columbia University. (2012). An SBIRT implementation and process change manual for practitioners. Retrieved from http://www.casacolumbia.org/sites/default/files/files/An-SBIRT-implementation-and-process-change-manual-for-practitioners.pdf

Pennsylvania Medical Society. (2014). Pennsylvania guidelines on the use of opioids to treat chronic noncancer pain. Retrieved from https://www.pamedsoc.org/detail/article/PA-Opioid-Guidelines

Substance Abuse and Mental Health Services Administration. (2011). Managing chronic pain in adults with or in recovery from substance use disorders. Treatment Improvement Protocol (TIP) Series 54. HHS Publication No. (SMA) 12-4671. Rockville, MD: Author. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK92048/pdf/Bookshelf_NBK92048.pdf

Substance Abuse and Mental Health Services Administration. (2013). Systems-level implementation of screening, brief intervention, and referral to treatment. Technical Assistance Publication (TAP) Series 33. HHS Publication No. (SMA) 13-4741. Rockville, MD: Author. Retrieved from https://www.integration.samhsa.gov/sbirt/TAP33.pdf