Multimedia Health Education Can It Change Clinical Practice? Assoc Prof Leo Donnan Director of Orthopaedics Chief of Surgery RCH

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Multimedia Health Education Can It Change
Clinical Practice?Assoc Prof Leo
DonnanDirector of Orthopaedics Chief of
Surgery RCH
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What is DDH?

• A condition of the childs hip where there is
  incomplete development
• Range of disorders including - instability,
  subluxation and dislocation

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• If unstable hips are not detected and treated
  they may
• - not develop properly and eventually
  fail

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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

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Victorian Screening Program

• 72,000 births per year
• Geographically Spread
• 4.0 million in Melbourne
• 2.0 million in the bush

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• Clinical examination
• at birth
• six weeks
• regular intervals up to age two
• Ultrasound
• abnormal clinical findings
• risk factors at six weeks

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The Problem

• Poor documentation
• No uniform standard of examination
• Inconsistency in terminology
• Increased reliance on imaging
• Unclear referral mechanisms
• Multiple examiners

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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

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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

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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

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Learning Ability

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

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Challenge
High
ANXIETY
BOREDOM
Skill
Low
High
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Learning Types

• Visual
• Auditory
• Written
• Kinesthetic

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Sound
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Developing the Module

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

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Testing the Module

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

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Information easy to understand
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Recommend the use of the module
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Module met educational needs
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Knowledge
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Plt 0.001
Plt 0.001
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Confidence
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p lt 0.001
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Change in Clinical Practice
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Desired Change Pre Three Months Two Years
How frequently do you examine for DDH? (n164) 99 100 100
How often do you perform the examination from the side of the infant? (n164) 34 23 gt0.05 21 gt0.01
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Desired Change Pre Three Months Two Years
Do you refer all infants with clicks in isolation for further assessment? (n162) 88 46 gt0.001 34 gt0.001
Do you fully unclothe infants to examine their hips? (n162) 99 91 gt0.001 90 0.003
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Desired Change Pre Three Months Two Years
Hip creases are the most important physical feature of DDH (n164) 42 24 gt0.01 19 gt0.01
In a relaxed baby it is important to push firmly in testing for hip instability (n162) 43 60 gt0.01 46 0.77
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Desired Change Pre Three Months Two Years
The relationship between delayed motor development and untreated DDH is very strong (n161) 57 60 0.5 58 0.5
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What now?

• Increase accessibility of module
• online resource
• roll out to other clinical groups
• general practitioners
• midwives
• paediatricians
• Update the module
• response to feedback
• Watch for changes
• swaddling module developed

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Swaddling

• Recent trend for settling babies
• Whats old is new again!!
• High risk for DDH if not practiced safely

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• Navaho Indians

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Has it made a difference?
MOR at RCH (year to date)
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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

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Take Home

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