Partners for Health Information 2001-02

BACKGROUND
The Nonprofit Clinic Consortium (NPCC) is a membership agency made up of thirteen free and sliding scale primary health care clinics that have worked in the District’s poorest communities for the past 15-25 years and offer approximately 40% of the primary care currently available to the city’s uninsured.

The Nonprofit Clinic Consortium was formed as an umbrella agency - to provide a stronger common voice for the clinics, to capture efficiencies of scale, and to act as a vehicle for planning an building infrastructure in member clinics.

Partners for Health Information is an independent project funded by The National Library of Medicine National Network of Libraries of Medicine, with technical support provided by the GWUMC Educational Resources Division and Himmelfarb Library. Partners’ purpose is to improve the quality of care offered to low-income and uninsured residents by the community-based NPCC clinics, by providing computers, training, and Web resources directly to the clinics so their staff and patients have access to current, non-technical health information in English and Spanish.

PROBLEM STATEMENT
Our ISCOPES team will work through the Partners project to reduce disparities in access to information about health and community resources by providing Web-based training and Internet orientation to NPCC clinic patients and staff.

METHODOLOGY
This semester the team decided to formulate an informal needs assessment, in addition to the regular on-site education sessions that continued from the fall. Each team member of the Partners project continued to visit various NPCC clinics, which this spring included Mary's Center, La Clinica del Pueblo, SOME, Max Robinson, Spanish Catholic Center, Family Medical and Counseling Services, and Zacchaeus Bread for the City.

The team members interacted with both staff and patients, and introduced the Internet to novice patient surfers, helped clinic patients and staff navigate the Partners for Health Information Web page, and taught patients and staff to read Web health content critically. In particular, team members used the Partners Web site (www.gwumc.edu/~partners) as the home page from which to search for information concerning specific health conditions and diseases, prevention, medication, medical procedures, community resources, and social networks.

During these visits, team members also talked to the staff and patients to receive feedback about the Partners Web page, such as likes and dislikes about the structure and content of the site, as well as what additional information that they would like to see included on the site. This information was recorded and posted on Prometheus for other team members to view and evaluate.

The feedback gathered by team members was positive overall – staff appreciated access to resources such as MD Consult and MEDLINE, and patients enjoyed the opportunity to access information online that was specific to their concerns (e.g., medication sites, alternative therapies, disease support groups, healthy recipes, clinical trial opportunities, local job indexes, affordable housing and general entertainment sites).

Patients also suggested that the Partners site include information about accessing Medicare and Medicaid, and requested more frequent volunteer visits. In addition, by visiting the clinics, team members could not only evaluate patients’ progress with Internet skills, but could also work on particular clinics’ health promotion projects. For example, at Mary’s Center, team members worked with the Teen Clinic there to help the teens develop presentations for peers and classmates on health issues like self-esteem, substance abuse and STDs by using information they find on the Internet. And at SOME, team members trained patient volunteers who will in turn train other patients to use the Internet and search for health and community information through the Partners Web page.

CURRENT STATUS AND LONG RANGE PLANS
At present, team members continue to make clinic visits, and many have committed to long-term involvement with Partners for Health Information and the NPCC, with at least one team member who graduated in December continuing her clinic visits. Most team members continue to post “journal entries” to Prometheus, which discuss what lessons they learned and suggestions for other team members, and what feedback they received from staff and patients on the visit, the computer resources and the Web page. Additionally, one public health student has completed an interviews-based evaluation of the Partners project for her MPH special project.

Partners for Health Information is an ISCOPES team and a continuing project separate from ISCOPES; however, there is great potential for future ISCOPES contributions. Included among these are a more formal needs assessment, and more regular involvement with health promotion projects at other clinic sites, such as the Community Advocates group at the Washington Free Clinic and the Breast Health Education Program at Spanish Catholic Center.

LESSONS LEARNED
Many of the lessons learned by team members this year related to overcoming assumptions primarily related to the circumstances of the city’s safety net clinics and the residents they treat. In particular, incorrect assumptions about the willingness of clinic patients to take part in impromptu Internet training, the significance of the language barrier, and the difficulty of teaching patients to use the Internet, among others, were challenged and largely overcome. The Partners project also demonstrates great unevenness and variability among different NPCC clinic sites, each with their own distinct culture, politics, methodology of implementation and utilization of the project. Even the same clinic can have great variability of project utilization depending on the day of the week; therefore, team members have learned to be flexible and to tailor their efforts to the particular needs of their individual clinic. The Partners project thus represents multiple independent projects united by a common set of resources.