Introduction
Personal Digital Assistants have taken the medical world by storm. Besides giving providers instant access to medical information, PDAs are powerful tools for educating patients in the exam room. While we generally think of PDA medical software in terms of physician utility, many applications are just as useful to educate patients in clinical encounters right in the exam room. Some useful applications for patient education include drug references, to provide detailed information such as side effects and drug-drug interactions; health risk assessment tools and calculators, to promote altering modifiable risk factors; and image viewers, for visually educating patients about anatomic structures and disease processes. Providers can also easily learn to create their own documents thereby creating a "peripheral brain" of patient education information.
PDAs for Patient Education
With the amount of medical information growing at a dizzying rate, providers need to use every tool at their disposal to not only access information, but to sort useful from useless information. It is increasingly evident that the PDA is the perfect tool to aid practitioners in accessing current information and evidence-based practice.
We are all aware of the many medical applications available for the PDA. We also know firsthand that loaded with this software, the PDA is a powerful physician aid at the point of care. However, few have considered the PDA as a patient education tool specifically. As the following examples show, the benefit of actively using the PDA in the patient-physician or patient-provider encounter is tremendous. It readily provides specific information to help educate and motivate patients.
PDA Applications in Patient Education
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| ePocrates qR - drug reference |
Example: A patient recently started Coumadin. While an inpatient, she had learned from a nurse educator about the many possible drug-drug interactions. She wanted to know specifically about aspirin, since she used to take it daily. After quickly accessing Coumadin in the database, the provider showed the patient the plethora of drugs that show potential interactions. This reinforces the importance of consultation prior to starting any new medication, even over-the-counter drugs. Then by tapping on "aspirin" the provider gave the patient with the requested information.
Discussion: Here, the PDA is not only a rapid source of clinically useful information, but also serves as visual reinforcement to discuss multiple drug interactions. Actively scrolling down a long list of drugs that interact with Coumadin quickly and efficiently gets the message across.
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| STAT Cardiac Risk - CHD risk assessment tool |
Example: A provider had the usual difficulty of motivating a poorly compliant 52-year-old smoker with multiple CAD risk factors. The provider quickly opened the assessment tool, based on Framingham data, and entered the patient's particular demographic and clinical information from his medical record. The provider then pointed out the 31% 10-year CHD risk. Quickly adjusting the patient parameters for quitting smoking, lowering blood pressure and lowering cholesterol, the provider noted that the patient could cut that risk in third. The provider then discussed medication compliance and smoking cessation.
Discussion: In this case, the PDA became a powerful motivational tool. Patients are well aware that smoking is unhealthy. Many have a sense that lowering cholesterol and blood pressure is "heart smart." Yet, with the specific information provided by the PDA, patients can put a real number on their own unique risk and the benefit of behavioral change.
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| FireViewer - graphic viewer |
Example: A mother of a child with otitis media was unclear why her child did not need antibiotic drops to treat a middle ear infection. The provider opened a graphic viewer program on the PDA and displayed the appropriate picture. The patient was given a brief anatomy lesson of the structures of the ear and the appropriate use of eardrops. The provider also discussed the relationship of the middle ear to the Eustachian tube and this brought up the topic of prevention.
Discussion: Here, the PDA served as an anatomy reference tool. Illustrations are known to enhance a patients understanding of disease process and treatment. Too often, the typical exam room has only a few graphics posted on the walls or in flip charts. It is easy to maintain a list of commonly used illustrations right on the PDA to use when the appropriate situation arises. It is a fairly straightforward process to convert your favorite images (scanned or digital format) to the format supported by "FireViewer."
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| PregCalc Pro - pregnancy calculator |
Example: A pregnant patient at her routine prenatal visit wanted to know how big her baby was. The provider chose her name from a database within the pregnancy calculator and tapped the "measure" button. Measurements (interpolated from a table of standard ultrasound data) appeared based on the current gestational age. The provider was easily able to relay that the baby probably weighed a little more than a pound (532 g) and with the tape measure used to measure fundal height, made a 17 cm loop to show the baby's head circumference.
Discussion: While the provider mostly used this tool to calculate dates and track pregnant patients, and in this example it is used for a much more social reason - patient curiosity. Such a utility may not be strictly clinical or affect patient outcome, but it can serve a useful purpose in strengthening the patient-provider relationship.
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| Himando BMI - body mass index calculator |
Example: An overweight patient wanted to know his ideal body weight. The provider entered the patient's height and weight from the chart and tapped "calculate." This prompted a discussion of the patient's target body weight (BMI less than 25).
Discussion: Here, the PDA served as both a reference tool and a motivational tool. The provider may have used the calculator to guide decision-making in both overweight and anorexic patients. But the results and playful recommendations can also be displayed to the patient to encourage lifestyle changes. If this particular tool seems too direct or condescending for some sensitive patients, there are several other BMI calculators available for PDA's that don't provide commentary.
Conclusion
PDAs have become commonplace in the healthcare world. They are useful tools for providing quick access to medical information, but also helpful in terms of direct patient education. Many applications available on the Web are particularly pertinent to patient education and counseling. Custom files of useful medical and patient education material can be converted and installed on the PDA for use in patient encounters. Thus, the PDA is a cutting edge tool for patient education.
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Matt Lewis is a Family Physician practicing in Lawrence, Kansas. He received his medical degree from Stanford, trained at Swedish Hospital in Seattle, WA, and is currently a Fellow in Medical Education at the American Academy of Family Physicians. He owns a Palm Vx.