Community Video Report (Winter 1974)

2: health Health maintenance, patient education start moving in U.S. By Ray Popkin Policy at the national, state and local level in health maintenance education and patient education—and the positions taken by various institutions on these issues—will have a direct impact on the ability of local groups to develop health communications programs utilizing video, cable, and other audiovisual techniques. We are passing along the following summary of major policy developments in hopes that fellow health communicators can better plan their programs, concepts, and funding strategies. We hope that this report will encourage greater input by health communicators in development of these policies. The popularity of health maintenance education and patient education among medical institutions has taken a dramatic upturn during the last year. Health maintenance education teaches the public to be members of an expanded health team that has knowledge of good health techniques that can prevent numerous types of illness and respond competently to emergencies and minor illnesses. Patient education assists people who have already contracted diseases in getting well and subsequent prevention. Health Maintenance Organizations (HMOs), which are prepaid health care programs, have displayed the most interest in health maintenance education, since their survival will depend on keeping the patient healthy rather than by treating the patient once they are sick. HMOs based on prevention Since HMOs provide unlimited service for a basic fee, their profit margins will depend on the success of preventative measures they offer to the public. The Georgetown University Medical School has two HMOs which have been teaching what is probably the most innovative patient education program in the country. Patients are being trained to use a stethoscope to detect early signs of heart and respiratory trouble and are also learning health consumerism, first aid and basic Symtomology. Dr. Keith Sehnert who is the primary health educator and curriculum designer for the program hopes to transfer sections of the material to video media sometime in the future for use around the country. Rural states need maintenance Rural Health systems are also especially interested in health maintenance edueation. In rural areas this is especially important as the major portion of population lives far from medical services. The Mountain States Regional Medical Program (RMP) is seeking ways to broadcast and cablecast such materials throughout Wyoming to people who can't leave their ranches for periods as long as five months during the winter. There is also a high incidence of strep throat in the area, which could be detected by the home health practitioner. In New Mexico, the RMP is researching new systems for rural health care delivery in consultation with the MITRE Corporation, one of the developers of two-way cable technology. They hope to incorporate a variety of health education, long distance tele-diagnosis, and interactive communication systems in their program. Health Systems, Inc. in Boise, Idaho, has initiated a series of education programs entitled “The Parents’ Role in Health Care.”’ It will deal with mental health, nutrition, emergency treatment, accident prevention, eye care, dental care and consumer issues. They have already made arrangements to have the sections of the course video taped in color so that they will be available for a small fee to other organizations in the country. --Kristin Moeller The American Hospital Association has taken a strong stance in the area of patient education by establishing a special health Ed. section. They have also recommended the formulation of a national clearing house for consumer health education, and the training of health Education practitioners. The Health Facilities Service which represents Medicade, Blue Cross, the AMA, and AHA and Health Insurance Council has also approved a resolution making patient education, when prescribed by a doctor for alleviation of specific conditions, a reimbursable expense under insurance programs. Resistance from profession While all this seems encouraging, there 1s still a lot of resistance among the older established ranks of the medical professions such as State Medical Societies. For instance the District of Columbia Medical Society which controls the purse strings of the D.C. area Regional Medical Program has forbidden the local RMP to expend any energy in the area of health maintenance or patient education, in fact research that was at one time conducted by the D.C. RMP has been destroyed. In other areas, programs in health maintenance are being attacked on such grounds as being solicitation of clients for doctors, which is considered unethical. Even President Nixon seems to support health education. In Feb., 1971, in his health message to Congress he stated ‘Jt is WASTING ! Bite No. Fart Be in the interest of the entire country, therefore to educate and encourage each of our citizens to develop sensible health practices. Yet we have given remarkably little attention to the health education of our people.’ (Since that time we know of no new H.E.W. funding in the area of health education.) President’s Committee on Health Education A Presidential commission was established called the President’s Committee on Health Education. This commission held hearings throughout. the country and sent out 600 questionnaires asking about current health education practices. In the letter of transmittal to the President the commission states ‘‘Unfortunately, the important, and often crucial role the individual can play in maintaining his own health has rarely becn clearly explained or adequately dramatized. “Our findings regarding the ignorance or apathy or both of American institutions and organizations, indeed, the public at large toward health education are chronicled in the body. of our report...While the need and demand for health care services have been rising, health education has been neglected. Many, perhaps most, major causes of sickness and death can be affected—and some prevented by individual behavior, yet the whole field of health education is fragmented, uneven in effectiveness and lacks any base of operations....The U.S. Office of Education in a report prepared for the Committee, could not cite a single program of research or evaluation it is supporting in the ‘area of school health education... .”’ The letter also states that of $75 billion spent for health care only four percent was spent on prevention with health education getting only a small portion of that money. Of the $18.2 billion allocated in 1973 from the federal budget less than one-fourth of one percent was allocated for health education. On the state level, the letter points out, less than half of one percent is spent on education. Overall the report makes a lot of excellent recommendations as well as some that have raised conflict within the Commission itself. In any case there is no way really delineated for these recommendations to be put into effect. The major recommendation is for the establishment of a “National Center for Health Education’’ which would be a part federal/part privately funded institution. This center would be’ charged with developing research programs in health education, reviewing programs and sponsoring demonstration programs. There was some conflict in the Commission on how this Center would be accountable to the public. In the President's Feb. message to Congress on health care, he asked that the Center for Health Education be established with federal support only in the launching phase, with the private sector later taking control of the entire operation. It is unclear how this organization will function at this point. Our hope is that it will include representatives of community-based organizations as well as people who are involved in telecommunications for it is developing communications systems such as CATV that offer real possibilities to reach millions of people with detailed and consistent quantities of health education materials. Health practitioners are relatively uneducated as of this point as to the great potential of cable to enhance health services. The President’s Commission also recommended among other things the adoption of model state laws for school health education, tax incentives for employee health training programs, training programs for health education specialists, the consulation with consumers on the location of and services offered by new facilities, and the identification of those health problems which can be most readily affected by education programs. The report also identifies the need for specific programming for different cultural and economic groups, finding that much of the material was stereotyped and irrelevant to many of the people to whom it was shown. In the President’s Report to Congress he also asked that an Office of Health Education be set up within H.E.W. ‘“‘to coordinate the fragmentation of efforts’. Hopefully this Office will in fact give encouragment to the many people within H.E.W. who wish to support such programs but who have had no agency vehicle through which to do so. Health educators organize Health Education Media Association is a new organization which has been formed to support health educators both in the area of continuing education for professionals and in the areas of health education for consumers. Their convention convenes in Atlantic City on March 16, and they are featuring a half day session devoted entirely to patient education. The panel features Arthur Dimmit director of the “Health Education for the Public’? program of the RMP in New Mexico, and Robert E. Potts, Ph.D., director of the Ohio State University patient education network which is probably the biggest patient ed program in the country. HEMA also hopes to start working on an evaluation service of available instructional materials, which has long been awaited by many who have tried to wade through tons of materials to find one film or video tape of use in their program. They will also be conducting regional workshops on various aspects of health communication. Members are entitled to a free subscription to Biomedical Communications, Hemagrams and reduced fees for conferences and workshops. (Membership is regular $25, Students $10 Sustaining $100) Their address is P.O. Box 5744 Bethesda, Md. 20014. Resources: 4 Biomedical Communications covers ail the new developments in medical education both patient and professional 4 times a year cost $5,750 Third Ave. N.Y., N.Y. 10017. Selected References on Patient Education H.E.W. pamphlet no (HRA) 74—4001 U.S. dept. of H.E.W., Health Care facilities Service, Office of Training and Education 5600 Fishers Lane Rockville, MD. 20852. University of Wisconsin-Milwaukee Resource List of Programs for Nursing and Related Health Services. Mrs. Phyllis Duke, T.V. Coordinator for Nursing, University of Wisconsin, Milwaukee, Francis Cunningham Bldg. Milwaukee Wis. 53201. Telecommunications and Health Services (See Book Review Section) Abt Associates Inc. Good basic introduction to applications of telecommunications to health problems. Mary Heider, PhD Dept. of Biomedical Communications, College of Medicine Eden and Bethesda Avenues, Cincinnati, Ohio 45219. These folks have one of the most exciting patient education programs in the country and have their work well documented. They have reports on viewer response, influence of video tapes on attitudes, video course outlines and video resource lists. [Note : Next issue we wil feature an article by Janice Cohen, who is working on a women’s self-help tape at Mt. Sinai Hospital, New York City.