Group counselling improves quality for patients with limited health literacy

Anderson, Kristin M MD MPH
Siems, Lilly VK
Holloway, Seth C MPH CPH
Sultana, Nafeesa
Braund, Wendy E MD MPH MSEd
Harris, Linda M PhD

Molina Healthcare of Virginia, Reston, VA, USA, formerly with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services
Brown University, Providence, RI, USA, formerly with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services
Kidney Community Emergency Response Coalition, Tampa, FL USA, formerly with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services
Virginia College of Osteopathic Medicine, Reston, VA, USA
State Health Officer and Senior Administrator, Public Health Division, Wyoming Department of Health, Cheyenne, WY, USA, formerly with the Office of Disease Prevention and Health Promotion, US Department of Health and Human Services
Lead, Health Communication and e-health Team and Acting Deputy Director, Office of Disease Prevention and Health Promotion, US Department of Health and Human Services, Rockville, MD, USA

FUNDING

This work was supported by the Office of Disease Prevention and Health Promotion, in the Office of the Assistant Secretary for Health, US Department of Health and Human Services.

ETHICAL APPROVAL

This study was conducted as a quality improvement project.

PEER REVIEW

Not commissioned, externally peer reviewed.

CONFLICTS OF INTEREST

None.

ADDRESS FOR CORRESPONDENCE

Linda Harris, Office of Disease Prevention and Health Promotion, Office of Public Health and Science, US Department of Health and Human Services, 1101 Wootton Parkway, Rockville, MD 20852, USA.

Received 06 June 2011

Accepted 06 November 2011

Quality in Primary Care 20(1):p 5-13, 2012.

Background

The North County Health Centre in Reston, Virginia, recently enhanced the quality and accessibility of physician-coordinated behavioural counselling.

Methods

A patient survey confirmed that the clinic could improve behaviour change support. Physician time constraints, practice productivity issues and treatment priorities were identified barriers to systems change. Systems changes included team-work, group visits, community engagement and trusted online consumer resources. Validated statistical process control (SPC) techniques evaluated variation in monthly 90-minute group visits for Spanish- and English-speaking patients during which we reviewed evidence-based recommendations, hosted community speakers and held brief individual encounters using encounter forms with built-in motivational interviewing techniques

Results

On average, four English-speaking patients attended, with 42% of the participants who attended more than one meeting successfully achieving their self-reported goal. On average, nine Spanish-speaking patients attended, with eight (86%) of the participants achieving their goals. Documentation of recorded prevention counselling improved from 15% to 67%. Patients indicated that they found that what they learned is transferable to their everyday lives.

Conclusion

The total number of patient encounters in a clinical session did not dramatically change. Language preference was not a hurdle. Teamwork among patients, providers, staff and community members was a key to success. Group visits improved the amount of prevention counselling and helped patients with limited health literacy achieve their prevention goals.