Multimedia Health Education Can It Change Clinical Practice?

Assoc Prof Leo DonnanDirector of OrthopaedicsChief of Surgery RCH

What is DDH?

■ A condition of the childs hip where there is incomplete development

■ Range of disorders including - instability, subluxation and dislocation

■ If unstable hips are not detected and treated they may

- not develop properly and eventually fail

The Impetus to do something

■ In Victoria children are still presenting with a late diagnosis of hip dislocation despite screening programs and use of ultrasound

■ Children facing lifelong disability from a condition that is easily managed if detected early

Victorian Screening Program

■ 72,000 births per year

■ Geographically Spread 4.0 million in Melbourne 2.0 million in the “bush”

■ Clinical examination at birth six weeks regular intervals up to age two

■ Ultrasound abnormal clinical findings risk factors at six weeks

The Problem

■ Poor documentation

■ No uniform standard of examination

■ Inconsistency in terminology

■ Increased reliance on imaging

■ Unclear referral mechanisms

■ Multiple examiners

The Scale of things

■ 72,000 births per year■ Expect

72 frank dislocations 720 unstable hips ???? dysplastic hips

■ 1012 MCH nurses in full/part time positions large work force dispersed will see very low rates of dislocation hrad to maintain skills

The Solution ?

■ Target the front line clinicians

■ Understand their difficulties

■ Define the barriers to early detection

■ Develop evidence based practice guidelines

■ Standardise the clinical examination

■ Apply education theory principles

Objectives

■ Knowledge - terminology, anatomy, pathology, associations, risk factors, examination, imaging

■ Change practice - improve clinical skills, confidence and referral procedures

■ Standardise approach - consistency across all health professionals

Learning Ability

■ Education level■ Cultural background■ Social class■ Literacy skills■ Trust in the information■ Emotional state

info

rmat

ion

flow

Challenge

SkillLow High

High

ANXIETY

BOREDOM

■ Visual■ Auditory■ Written■ Kinesthetic

Learning Types

Words

Pictures

SoundSound

Developing the Module

■ Focus groups■ Literature review■ Educational objectives■ Outcome measures■ Script development■ Story board■ Animation■ Testing

Testing the Module

■ Maternal and Child Health Nurses■ Range of municipalities■ 203 recruited

Information easy to understand

Recommend the use of the module

Module met educational needs

Knowledge

P< 0.001

P< 0.001

Confidence

p < 0.001

Change in Clinical Practice

Desired Change

Pre Three Months

Two Years

How frequently do you examine for DDH? (n=164)

99% 100% 100%

How often do you perform the examination from the side of the infant? (n=164)

34% 23%

>0.05

21%

>0.01

Do you refer all infants with “clicks” in isolation for further assessment? (n=162)

88% 46%

>0.001

34%

>0.001

Do you fully unclothe infants to examine their hips? (n=162)

99% 91%

>0.001

90%

0.003

Desired Change

Pre Three Months

Two Years

Desired Change

Pre Three Months

Two Years

Hip creases are the most important physical feature of DDH (n=164)

42% 24%

>0.01

19%

>0.01

In a relaxed baby it is important to push firmly in testing for hip instability (n=162)

43% 60%

>0.01

46%

0.77

The relationship between delayed motor development and untreated DDH is very strong (n=161)

57% 60%

0.5

58%

0.5

Desired Change

Pre Three Months

Two Years

What now?

■ Increase accessibility of module online resource roll out to other clinical groups

general practitionersmidwivespaediatricians

■ Update the module response to feedback

■ Watch for changes swaddling module developed

Swaddling

■ Recent trend for settling babies■ What’s old is new again!!

■ High risk for DDH if not practiced safely

■ Navaho Indians

Has it made a difference?

MOR at RCH (year to

date)

Summary

■ This initiative is aimed at improving the health and well being of children by facilitating early diagnosis and referral of DDH

■ The module significantly improves the clinicians knowledge, skills and confidence in making the diagnosis

■ Aim to ultimately reduce the need for complex surgery due to late diagnosis

Take Home

■ Refresh your knowledge■ Update your skills■ Use the resources