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As a health educator at Integrative Rheumatology, a private practice in Charlotte, N.C., Latisha Williams, MPH, CHES, CHC, works with patients to teach them how to better manage their disease.
In the two-and-a-half years that Ms. Williams has worked at Integrative Rheumatology, she’s answered countless questions about exercise, nutrition and complementary therapies, among other topics. “Patients are looking for ways to reduce pain that go beyond just taking medications,” she says. “They want to reduce inflammation, and are looking for nutrition tips, exercises and alternative therapies that will help them reduce symptoms, such as chronic pain and stiffness, and improve their quality of life.”
According to one study, health educators can help physicians grow their practices and improve patient satisfaction. The study found adding a health educator to your existing staff can also generate additional net revenue, improve patient care and help lead the practice into the future of population management and quality improvement.1
Ms. Williams
“Most patients want to understand how they can do more and improve their condition without hurting themselves,” says Ms. Williams. “They want to learn more about their disease state, and we can put them in touch with physical therapists, nutritionists and other resources to help with the non-medical aspects of their care.”
However, most rheumatology practices don’t have a dedicated health educator on staff, according to Ms. Williams, and even in hospital settings, health educators typically split their time between different departments.
The Rheumatologist recently spoke with several health educators to learn how they work with rheumatologists to achieve quality outcomes and provide excellent care to patients with rheumatic diseases.
Meeting Patients’ Ongoing Needs
Caitlyn Bednarek, MEd, CHES, director of patient education and advocacy, Low Country Rheumatology, a member of Articularis Healthcare Group, views her role as that of a patient liaison and advocate.
“Physicians, unfortunately, don’t always have the time to sit down with a patient to address all of their questions or develop a step-by-step action plan,” says Ms. Bednarek.
Ms. Bednarek
Studies show that providing information to patients with rheumatic diseases helps them better manage their condition. A poster presented at the 2019 12th Annual Rheumatology Nurses Society Conference found that although two-thirds of patients seek health information primarily from their healthcare provider, physicians scored lowest in terms of accessibility and communication. In addition, 57% of patients reported their physician had not recommended any resources to them.2
Another 2019 study found patients with rheumatoid arthritis (RA) who received patient education interventions documented significant improvements in behavior, pain and disability.3
To complement the information provided by the rheumatologist, Ms. Bednarek has developed patient education materials that physicians can give to their patients or direct them to. The practice’s patient education categories include preparing for an appointment, nutrition (supplements and weight loss) and presc-riptions (both oral and injectable).
Ms. Bednarek also implements a group session for patients every year, just before Medicare enrollment deadlines, to answer basic Medicare questions and provide information for patients to consider when selecting a plan, such as long- and short-term costs, what prescription drugs are covered, etc.
Reducing Opioid Use
Many patients with RA are prescribed opioids to provide chronic pain relief. A study published in May 2019 Arthritis & Rheumatology found chronic opioid use among patients with RA doubled between 2002 and 2015. The study went on to add that patients with severe pain and those who took antidepressants are more likely to become long-term opioid users.4
Robyn Wiesel, MCHES, associate director of public and patient education at the Hospital for Special Surgery (HSS), New York, says health educators work with chronic pain patients, such as those with rheumatic diseases, to explore treatment options other than opioids.
Ms. Wiesel
“We recently completed a study that showed how complementary practices, such as meditation and mindful breathing, can help patients manage their chronic pain and, in some cases, minimize their need for medications such as opioids,” Ms. Wiesel says. “Our study demonstrated that alternative approaches were effective in reducing pain and stress and improving self-management and general well-being.”5
HSS is expanding the program to patients in its rheumatology clinic who use opioids to help with chronic pain.
“As a nonprofit hospital, HSS’s health education programs are open to everyone in the community, whether they are a patient at HSS or not,” Ms. Wiesel says.
Holding Community Education Events
Health educators do more than provide patients with health information, they also study the needs of specific patient populations and design health messages and programs to meet those needs.
Titilayo Ologhobo, MPH, HSS’s associate director of outcomes, uses community surveys and assessments to identify problems and address issues important to HSS patients and community members with musculoskeletal and rheumatic conditions.
For example, HSS conducted a survey to identify the muscle, bone and joint health needs of people living in the five boroughs of New York City and nearby suburbs.5 Osteoarthritis and osteoporosis were the most commonly diagnosed conditions among respondents, and falls were also a significant issue.
Ms. Ologhobo
“By understanding the needs of the community, we can identify gaps in care and any health disparities,” says Ms. Ologhobo. “We also build meaningful relationships with community organizations to design programs that offer self-management skills and positive health outcomes.”
Applying the data collected in the survey, HSS implemented health education classes to meet specific community needs, such as therapeutic yoga to provide pain relief, relax sore muscles, ease sore joints and help build strength. Another class, Tai Chi, provides such benefits as improved balance, strength, flexibility and maintenance of bone mass.
Promoting Healthy Lifestyles Through Social Media
Social media platforms, such as Facebook, Twitter and Instagram, can help rheumatologists promote their practices, share information with patients on new research and treatments, and offer tips on safe exercises for arthritis patients to perform and ways to manage flares.
Ms. Bednarek also handles social media for Low Country Rheumatology and regularly posts information on the practice’s Facebook and Instagram pages about how to get started on a weight loss plan, healthy eating tips and recipes, advocacy events related to rheumatic conditions and how patients can get involved, physical activity tips and workouts, and connecting with others who have rheumatic disease.
Offering Options, Empowering Patients
“Patients today are more educated and often want more than just a prescription for pain medication,” Ms. Wiesel says. “They want to know about all available options to help them feel more in control of their disease, such as exercise. We have one physician who writes prescriptions for ‘swimming, twice weekly.’”
Ms. Wiesel says patients often ask about alternative therapies, such as massage, meditation and exercise, and whether they may benefit their condition.
“Patients often explore alternative therapies on their own before discussing it with their rheumatologist,” Ms. Wiesel says. “As health educators, we can field these types of calls for doctors and educate patients on the potential benefits or consequences of these treatments.”
Health educators can ask patients about the outcome they hope to achieve with an alternative approach and educate patients about their options, focusing on how alternative therapies may complement traditional medicine, but shouldn’t be used to replace medication.
Helping Patients Better Manage Their Conditions
According to Ms. Ologhobo, participants in health education classes have reported better physical function, less fatigue, and reduced pain and stiffness.
“What they learn in class complements their treatment plan. In our exercise classes, patients learn how to move correctly so as not to exacerbate their pain and also how to maintain an exercise regimen at home. They learn they don’t have to rely solely on pain medications to control their rheumatic disease,” she says.
According to Ms. Ologhobo, another bonus of the health education exercise classes is that the instructors are familiar with arthritis. “They can work with individual patients to suggest ways to move that don’t impact their affected joints,” she says.
“As health educators, we look at each patient holistically and implement tailored strategies to help them to live better with arthritis,” Ms. Ologhobo concludes.
Linda Childers is a health writer located in the San Francisco Bay Area.
References
- Chambliss ML, Lineberry SN, Evans WE, Bibeau DL. Adding health education specialists to your practice. Fam Pract Manag. 2014 Mar–Apr;21(2):10–15.
- Metelski L. What people with lupus want: Results from health education surveys. Presented at Rheumatology Nurses Society Annual Conference; Orlando. 2010 Aug 7–10.
- Senara SH, Wahed WYA, Mabrouk SE. Importance of patient education in management of patients with rheumatoid arthritis: An intervention study. Egypt Rheumatol Rehabil. 2019;46(1):42–47.
- Lee YC, Kremer J, Guan, H, et al. Chronic opioid use in rheumatoid arthritis: Prevalence and predictors. Arthritis Rheumatol. 2019 May;71(5):670–677.
- Wimmer M, Wiesel R, Adams B, et al. Complementary practices as alternatives to pain: Effectiveness of a pain management program for patients in an orthopedic clinic [abstract]. Arthritis Rheumatol. 2018; 70(suppl 10).
Editor’s note: Positions of those interviewed were current when this was written, but may have changed before publication.
