Beyond health promotion: reducing need and demand for medical care.

A population's medical need represents its illness burden. Medical demand represents the service level requested for a particular need. Medical care costs are, in large part, a function of need and demand. Our review of health education programs designed to reduce health risks and reduce costs identified thirty-two programs with documented effectiveness, generally achieving claims reductions of 20 percent. Specific program features including chronic disease self-management, risk reduction, and increased self-efficacy appear important. A broadened definition of health promotion focused on increased personal responsibility for health-related actions and directed at improvement of long-term health outcomes also could reduce health care costs.

Patient education as medical intervention: a pilot study.

OBJECTIVE: To describe and assess the perceived impact of an innovative patient health informatics tool among members of a managed care organization. SETTING: Mixed-model HMO in Connecticut. DESIGN: Intervention group only, post-test only (telephone interview using structured protocol). PARTICIPANTS: Members of a Connecticut HMO who responded to a free video offer and met study eligibility requirements. INTERVENTION: Patient education videos from the entire Time Life Medical At Time of Diagnosis series. MAIN OUTCOME MEASURES: Knowledge of condition and treatment options, attitude and outlook towards condition, patient-provider communication, behavior change, physician contacts for condition. RESULTS: Study participants reported that the video improved their understanding and knowledge of treatment options for their condition. They also reported a positive impact of the videos on a range of attitudes and behaviors pertinent to their condition. Participants endorsed the involvement of their HMO in distributing the videos, and few adverse effects from use of the videos were observed. CONCLUSIONS: This study provides preliminary evidence for a positive impact of health informatics tools on patient attitudes, including expectancies for care, quality of patient-physician communication, and satisfaction with health plan. The fact that most persons responding to the video offer had their condition for several years suggests that distribution of health informatics tools should not be limited to the newly-diagnosed.