2005 Model Practice Application (Public)

Information & Education Campaign for Health Care Providers

Santa Cruz County Health Services Agency

Information and Education Campaign for Health Care Providers: In 1998, the Disease Control Unit had published a booklet for county physicians on reporting guidelines for communicable diseases. The Essential Reporting Guidelines were revised and an information campaign was developed to increase communicable disease reporting while educating physicians and other healthcare providers on bioterrorism issues. A “brand” was developed for Public Health emergency preparedness efforts that would enable providers to easily identify the materials and associate them with timely, helpful information on communicable disease. The goal was to publish an up-to-date Essential Reporting Guidelines which would be distributed to approximately 90% of healthcare providers in the county.

The campaign decided to publish the guide in a binder format so that new pages could be mailed to providers and out-of-date information could be discarded without having to publish a completely new guide. This would also enable staff to quickly respond to emerging infectious diseases such as West Nile Virus and SARS. In the first quarter after the initial distribution of the binder, there was a 20% increase in communicable disease reports and had 37 individual requests from providers for the new binder over the next year. A key element needed to replicate this guide would be a graphic artist who develops a "brand" and can organize the material to be “user-friendly”.

The group addressed the issue of communicable disease reporting by health care providers to the Disease Control Unit. The relevance of this issue was determined by the number of communicable diseases reported by secondary sources, such as school nurses and laboratories. After receiving “second-hand” information, the Public Health Nurses would have to contact the primary care physicians to get complete information on the patient. Often, the primary physician would inform the PHN that they were unaware of their reporting duties or didn’t know what forms to use. In order to use PHN time more efficiently and increase communicable disease reporting by primary health care providers, the Essential Reporting Guidelines were updated and organized in a more “user-friendly” format. This was an opportunity to educate local physicians about bioterrorism agents and accomplish two goals in one project, i.e. education on BT issues and increased reporting and surveillance. The idea of organizing communicable disease reporting forms and information is not new, nor is the idea of organizing bioterrorism information. What is different about the publication of the ALPHA binder is the idea of combining both the communicable disease reporting information and forms with the bioterrorism materials in the same publication.

While the Public Health Agency developed the concept, there was a great deal of collaboration with local health care providers in a key way. Staff conducted phone surveys or key stakeholders in the health care provider community and local hospitals. These providers were asked to describe the type of information they would find most helpful to their practice as well as the most effective dissemination methods. This process increased buy-in from stakeholders.

The cost for design was $1,500. The cost for 1,500 binders, printing of all materials and tabs came to $8,242 for a total cost of $6.49 for each complete Essential Reporting Guidelines. Since the initial publication, this program has printed four pages of West Nile Virus materials for an additional cost of $295.24 for 1,500 binders. The low cost of printing and delivering additional materials means that new additions to the binder will be able to be sustained. The funding source was the bioterrorism grant money from the CDC.

The staff time used to develop the binder cost about 10% of a Health Educator’s work load and about 5% of an administrative assistant’s work.

The specific tasks that achieved each objective of the publication of the guidelines were as follows:

• Needs assessment/phone interviews – October 2002 through March 2003
  
  
• Materials developed, gathered and assessed for inclusion – Jan. 2003 through June 2003
  
  
• Materials given to graphic artist and consultant who developed a format and a “look” that would be uniform throughout the guide – June to October 2003
  
  
• Printing, collating, sorting – November 2003
  
  
• Distribution begun with delivery to major clinics – December 2003 – distribution is ongoing – approximately 500 binders have been delivered to clinicians throughout the county. Requests from other health jurisdictions are filled as received.

Requests are continually received for copies of the binder. The Medical Director of Physicians Medical Group, which represents about 50% of the healthcare providers, took the binder to a national conference in order to share it with other physicians. To ensure that physicians continue to use the binder, all of the Public Health Nursing staff are asked to reference the guidelines when speaking with physicians about reportable disease. Several requests have also been received based on Public Health nurses’ referrals. The guideliens are also referenced in the agency's quarterly Public Health Update newsletter, which is distributed to all providers throughout the county.

To determine the effectiveness of our publication and information campaign, the number of communicable diseases reported in the first quarters of 2003 (pre-distribution) was compared to the first quarter of 2004 (post-distribution of the guidelines). An increase of 20% in disease reporting occurred after the guidelines had been distributed. While it cannot be determined if this was solely due to the distribution of the new guidelines at this time, data is continually collected to determine if there is an upward trend in reporting over time. Thirty-seven individual requests for the guidelines were received after the initial distribution as word-of-mouth advertising spread. This is a good indication that the guidelines are “user-friendly” and used by providers.

The best endorsement is from those who have used the new binder and find it educational and helpful. Because of these spontaneous endorsements from providers, the program feels that the guidelines were well worth the cost and resources invested in it. It seems to have enhanced the agency's relationship with the community healthcare providers, an unintended consequence, but a welcome one. The guidelines have proved to be a very effective tool for the Public Health nurses who work on tuberculosis cases with community physicians. Public Health Nurses are able to reference it when doing phone consultations with the physician looking at the same pages. This approach seems to expedite treatment of TB cases, another unintended consequence. For these reasons, the publication of the Essential Reporting Guidelines met our objectives of increased reporting, education and awareness of emergency preparedness in the Public Health Department.