The growing need for patient teaching

As we begin the 21st century, there is a dramatic increase in the need for patient education. Diagnostic related groups (DRGs) and managed care systems have resulted in earlier discharges, day surgery for procedures that used to require an in-hospital stay-and the struggle to keep patients with inadequate home support systems in the hospital for an extra day or two. Many of the procedures patients and their caregivers are performing-such as giving intravenous (IV) medications, flushing IV lines, and changing dressings-were once performed only by physicians or nurses. In addition to technical skills, patients and caregivers must also learn how to interpret data in order to decide when to seek medical help. Difficult decisions about what symptoms to call a physician for, when to take the patient to the emergency room, or whether a wound is healing properly are in their hands. Nurses and other health care professionals must take on the daunting task of teaching a great deal of material, sometimes in too little time, to patients who may not be willing, ready, or able to learn.

The aging of the U.S. population is also increasing the need for patient education. Older Americans are the fastest growing segment of our society. In fact, Americans age 85 and older-the „oldest-old“-have the highest rate of population increase of any age group. Health care advances and medical technology have helped older citizens to live longer. However, older Americans continue to experience an increasing number of chronic health conditions, physical disabilities, and functional limitations, and therefore depend heavily on health care services, particularly nursing care. The dramatic growth in the number of elderly people needing care and the implementation of the prospective payment system have increased the need for home care and rehabilitative programs in long-term care institutions. Chronic disorders account for a large portion of the country’s expenditures on health care, in a health care system that has been focused on curing acute disease. The number of Americans living with chronic health conditions-diabetes, cancer, emphysema, heart disease, musculoskeletal diseases, AIDS, chronic mental illness, dementia, alcoholism, and blindness-is increasing dramatically. This dramatic increase in health care needs and the shift away from acute hospital care is creating unparalleled opportunities for nurses who are effective patient teachers.

Cost containment studies show that educating patients results in significant savings. Educated patients maintain better health and have fewer complications; as a result, they require fewer hospitalizations, emergency department visits, and clinic and physician visits. As the growth of health care continues to outpace inflation in many countries around the world, health policy makers have increasingly focused their attention on cost containment. Managed care has a major focus on reducing the supply of services. There is increasing attention to lowering health care costs through primary prevention efforts, including early identification and management of diseases before they progress to more serious and expensive conditions. Examples of primary prevention efforts include smoking prevention programs, child immunization programs, and environmental clean-up efforts. Examples of secondary prevention include mammography screening and education to help people recognize and self-manage symptoms of acute, self-limiting disease.

Studies by managed care organizations have consistently shown patient teaching to be cost-effective. Following is a summary of studies that show the cost-effectiveness of specific patient teaching programs.

  •  Asthma group education-reduced emergency room admissions and hospitalizations. Cost per patient was $37. Savings were $217 per patient, resulting in a cost benefit ratio of 1:5.8. (Cost-benefit ratio = cost of education per patient divided by total savings per patient.)
  • Asthma pediatric education-reduced annual emergency room visits from 7.4 to 1.9 per child. Cost per patient was $180. Savings were $687, resulting in a cost benefit ratio of 1:3.8
  • Prenatal care/nutrition counseling and smoking cessation-reduced pre-term births from 6.9 percent to 1.7 percent. Cost per patient was $93. Savings were $183, resulting in a cost benefit ratio of 1:2
  • Diabetes education in a public health department-reduced hospitalizations by 44 percent. Cost per patient was $150. Savings were $442 per patient, resulting in a cost benefit ratio of 1.29
  • Chronic pain counseling in an outpatient clinic-reduced clinic visits by 36 percent. Cost was $101 per patient. Savings were $312 per patient, resulting in a cost benefit ratio of 1:3.1

In none of the studies, did costs exceed savings. On the average, for every dollar invested in these and similar programs, between $3-4 were saved.

Interdisciplinary collaboration, patient education