Health-e VOICE Distance Learning

A Web - Based Clinical Risk Communication-Distance Learning Tool

Military personnel returning from tactical deployments and wartime service often describe disabling medical symptoms. Since the Gulf War, veterans presenting with unexplained symptoms and illnesses have received considerable attention. Unfortunately, health care providers treating these veterans often disregard these symptoms and ailments as psychological or stress related. Often, one of the reasons is insufficient knowledge and skill in risk analysis and clinical risk communication practices on the part of providers. In 1994, an Institute of Medicine workshop found that clinical communication often occurred unilaterally from clinician to patient with little attention given to eliciting the concerns, thoughts, and feelings of the patient. For many patients, particularly those with a post-deployment or military concern, the diagnosis of stress may be an invalidating and perhaps an infuriating experience leading to reduced trust and dissatisfaction in their providers and the health care system. It is important for health professionals who care for military personnel and veterans to be prepared to address the concerns of patients who present with ambiguous symptoms as fully as they do for people with more clinically identifiable diseases. Efforts to improve providers' communication skills in these situations are critical to improving the primary care of post deployment personnel presenting with medically unexplained physical symptoms (MUPS). Despite this need, there has been minimal research concerning effective strategies that would improve the communication of health risks in a clinical setting.

In a recent report, the US Department of Health and Human Services (HHS) identified emerging interactive health communication technologies as a powerful force in achieving their "Healthy People 2010" public health communication goal. Providers, particularly physicians have been increasingly integrating computers and the Internet into their practices. A recent survey suggested that 96% of physicians believe that the Internet will improve the quality of health care in the near future and make medical practice easier. Currently, web-based tools specifically designed to enhance providers' clinical risk communication skills are lacking. To fill this void, members of the DoD Deployment Health Clinical Center and their associates are developing a web-based interactive distance learning tool to increase Department of Defense (DoD) health care providers' effectiveness when communicating with recently deployed veterans about deployment-related health concerns.

This tool, known as Health-e VOICE is specifically targeted to:

• Address the needs of DoD providers to practice effective clinical risk communication through simulated interactive learning experiences,
• Reduce required training time for busy providers,
• Reach the broadest provider audience,
• Train across specialty areas,
• Eventually allow convenient CME training via the electronic media.

Qualitative research using focus groups will be used to develop the Health-e VOICE tool. It will rely on the mental models theory to identify provider and patient knowledge, beliefs, misconceptions, and values around deployment related health concerns and MUPS.

Focus groups will be conducted in six locations: Hawaii, Texas, North Carolina, Washington state, Washington DC, and Germany. All of the venues will be in tri-service locations. The investigative team for the study will host four different focus group meetings at each location. The focus groups will be comprised as follows:

• Physicians,
• Other health care providers,
• Previously deployed veterans with deployment related health concerns and their spouses, and
• Previously deployed veterans without deployment related health concerns and their spouses

Each focus group will take approximately three hours and will use a semi-structured interview format.

The Health-e VOICE distance-learning tool is aimed at presenting to DoD providers knowledge and skills to achieve improved clinical risk communication practices. The Health-e VOICE protocol is based on the hypothesis that improved clinical risk communication may alleviate unnecessary patient distress and physical health concerns, reduce frustration and tension in the doctor-patient relationship and reintroduce patient trust in both care providers and the health system.

Health-e VOICE Briefing - [Power Point Presentation, 98KB]