Reflections and Action Plan

My role, as an Orthotist, is to assess children with physical disabilities and fit them with the most appropriate brace. I often see children diagnosed with scoliosis at SickKids Hospital as we are one of the primary spine clinic centers for Ontario. Scoliosis, if not properly treated, can lead to a lifetime of disability (Rivett et.al, 2009). Therefore, the bracing I provide as an Orthotist is vital to prevent progression of the scoliosis curve, which if not treated properly can lead to chronic pain and disability. When treating these individuals, communication issues and health inequalities, both of which can impact client care and outcomes, must be taken into consideration to improve compliance of brace wear to allow for an optimal health outcome.

Reflecting on the topics discussed within the MHST 601 course allows myself to look beyond the biomechanics, muscle strengths, functional tests and pathology of a patient. The concepts discussed in this course have broadened my understanding of the social and ecological factors that can also influence the overall health outcomes of the patient. The purpose of this paper is to discuss and initiate an action plan on how to: (1) implement strategies to improve the lines of communication with patients and their families and; (2) identify any health inequalities early, when present, so that the likelihood of more positive health outcomes can be improved.

Communication between all healthcare teams, patients and parents is an essential element to ensure patients and the families are included and feel like advocates for their own health and/or their child's health. With the fast-paced evolution of technology, patient interactions are changing, and may not always occur face-to-face. For example, many of today’s patients are obtaining information through social media.

Social media in healthcare is a tool that is coming to the forefront as a potential method to improve health outcomes (Kind, 2015). Many healthcare providers will encourage their patients to research their diagnosis to become more aware of other treatments, and their symptoms and prognosis (Surani, 2017). These online interactions can enhance a patient’s interaction by providing more information that may not have been possible during an appointment (Surani et.al). A limitation to patients researching their diagnosis is that there is a multitude of non-evidence based articles that can mislead the patient. Therefore, providing information to the patient in a form of a website which contains curated resources of evidence based articles can act as a great resource to patients.

Patients with scoliosis will often research treatment options on their own, which I have found to be detrimental at times. For example, companies trying to sell health products will provide biased information on custom bracing for scoliosis. These companies can sometimes exaggerate the health benefits of their products. Disinformation can sometimes lead to compliance issues amongst patients. Non-compliance when wearing a brace can lead to the unnecessary progression of their deformity. To improve compliance with our patients at SickKids Hospital, improvement on the current webpage for my clinic would be beneficial. The webpage would provide information about medical devices that we provide along with appropriate ways to maintain and care for the device to ensure a proper fit. Evidence-based articles and appropriate links to the website would be within a curated space for patients to access to obtain further information. This online resource would greatly improve our current communication with patients, other health care providers and the general public.

Health outcomes as mentioned above are improved when there are different avenues of communication. Health outcomes can also be improved when one looks beyond the individual’s pathology or disease, and takes into account all factors related to that individual. For a patient with scoliosis, it is vital that the child receive a device to correct or prevent further deformity. Compliance by the child wearing the device depends on a multitude of factors that go well beyond the child and their diagnosis.

Different factors to consider in terms of compliance are physical, emotional, psychological of the individual as well as family and peer support (Rivett et.al, 2009). These factors would be the wider determinants of health for the scoliosis patient as it can greatly affect their health outcome. The Social Ecological Model (SE-Model) illustrates how the wider determinants of health work together to produce a health outcome and can be easily applied to the scoliosis population.

Within the SE-Model there are Individual, Interpersonal, Community, Organizational and Policy/Government Factors that make up the levels of the SE-Model. For the scoliosis patient the individual would be the patient themselves, interpersonal would include their family or support system, community would be school, organizational would be their living situation and government would be the funding that is allocated to medical device coverage.

Individual and Interpersonal factors that can affect medical device compliance include attitudes, expectations, family support, peer support, culture, and socio-economic status. A webpage would prevent these determinants from affecting brace compliance. Providing information on the expectations of the medical device, education about the device, and the goals of the device could assist the individual throughout the bracing process and improve their attitude towards the treatment we are providing. In regards to peer support, online forums are available for someone with scoliosis. These forums allow scoliosis sufferers to provide peer support by allowing them to communicate with others who are in the same situation.

Community and organizational factors include built environments such as schools and living conditions at home. The medical device will impose some limitations to school activities which need to be discussed and addressed. Informing the school on the child’s limitations to encourage accommodation would decrease embarrassment for the child and improve their self-esteem. It has been found that non-compliant patients are likely to not wear the brace to school (Rivett et.al, 2009). Therefore, improving the cosmetics of the brace and avoiding functional limitations would help increase compliance.

Government and policies are vital when it comes to medical devices as provincial and federal funding can help alleviate the stress of payment for the medical device. The socio-economic status of a patient and their family can greatly impact brace treatment due to lack of monetary funds. Socio-economic status is an individual factor, however, it is directly linked to the policy and government determinants. For all children who require a medical device for a disability, the Ontario government will pay 75% of the total cost of the device through the Assistive Devices Program (ADP, 2017). For someone with lower socioeconomic status the device would be covered 100% through Ontario Works (ADP, 2017). If parents still have difficulties finding funds to cover the cost of the brace Sick Kids will often subsidize to insure that most children will received a brace.

Looking back at the core topics discussed in the MHST 601 course has allowed me to become a better-rounded healthcare professional. I have found this course has started to fill a knowledge gap and has helped me to understand the greater picture of our healthcare system. As an Orthotist you are always assessing the patient objectively and can often lose the theory and fundamental foundations of health. To completely understand the health of a patient it is essential to look beyond the individual. Our healthcare system is always moving forward but the fundamentals of maintaining core values, communication and understanding the determinants of health, will always be there.

References

Assistive Devices Program. (2017, December 6). Retrieved from http://www.auditor.on.ca/en/content/annualreports/arreports/en09/301en09.pdf

 Kind, T. Professional Guidelines for Social Media Use: A Starting Point.  (2015). American Medical Association Journal of Ethics, 17 (5) : 441-447. Retrieved from http://journalofethics.ama-assn.org/2015/05/pdf/nlit1-1505.pdf

Rider, E.A., Kurtz, S., Slade, D., Esterbrook-Longmaid., H, Ho, M., Pun, J., Eggins, S., & Brance, W.T. The International Charter for Human Values in Healthcare: An Interprofessional Global Collaboration to Enhance values and Communication in Healthcare. (2014) Patient Education and Counseling. 96 : 273-280.

Rivett, L., Rotherberg, A., Stewart, A. & Berkowitz, R. The Relationship between Quality of Life and Compliance to a Brace Protocol in Adolescents with Idiopathic Scoliosis: A Comparative Study. (2009) BMC Musculoskeletal Disorders. 10:5. Retrieved from http://www.biomedcentral.com/1471-2474/10/5

Smith, J.N., & Coffin, Janis. (2018, May 2018). Social Media, Physicians, and Points to Consider. Retrieved from

http://www.podiatrym.com/pdf/2018/4/SmithCoffin418web.pdf

Surani, Z., Hirani, R., Elias, A., Quisenberry, L., Varon, J., Surani, S., Surani, S. Social Media Usage among Health Care Providers. (2017). BMC Research Notes. 10 : 654