Last month, we described how policy is created in the AAPA, spotlighting various pathways to policy consideration and adoption. This month, we look more closely at the process, using one policy as the vehicle to navigate the occasionally treacherous road to policy creation.

I currently serve on the AAPA's Professional Practice Council (PPC), a volunteer body charged with focusing on policy. To be exact, the charge of the PPC is to “Monitor public and private trends that affect the delivery of health care” and to “Develop policy recommendations on ethical and professional issues affecting PAs and physician-PA teams.” Since joining the PPC a couple of years ago, I've been interested in looking for ways to promote health literacy, which was a key project of AAPA past president Cindy Lord. During her term in office, Lord also talked about creating “sustainable' AAPA efforts, to avoid “reinventing of the wheel” as leadership comes and goes.

During the June 2008 to June 2009 leadership year, the PPC kicked around the idea of developing policy related to promoting health literacy and more specifically on providing guidance to PAs about the importance of seeking reliable health information for both ourselves and our patients. As with many policy ideas, this one got no further than discussion. When the leadership year 2009-2010 began, however, and as the council worked early in the year to flesh out our agenda and goals for the year, this idea surfaced again. This time, we decided to take the preliminary steps to create a policy related to health literacy and reliable health information.

As a card-carrying policy nerd, I thrive on philosophical discussions about the role of policy. To me, policy is a living, breathing organism that both guides and reflects the work of the AAPA. Policy has many roles, and one of the most important is to reflect the philosophy of an organization. Many of the AAPA policies do just that, providing a “name tag” for us as an organization and telling our colleagues and patients who we are and what we stand for. Certainly the notion that you can get 40,000 people to agree on everything is problematic, but we can agree on a surprising number of things. Policy plays a role in both shaping and reflecting this. And, of course, one does not have to convince a majority of 40,000 members that something is policy worthy, just a majority of the AAPA House of Delegates. I am never without wonderment at the democracy of such a tool.

So in the fall of 2009, I and my then-PPC colleague (and fellow health literacy fan) Steven Johnson put together some language for the policy. Steven and I worked to craft language that would be spare, promote health literacy, and remind PAs of the importance of outreach to colleagues from other professions (in this case, medical librarians) who can be powerful partners. Our next step was to share this language with the entire PPC for their comments and/or revisions. This was just one of many policy projects, and the review by the council usually takes place in the late fall. Policy needed to be shined and ready to submit to the House of Delegates officers by March 30, 2010.

Some policies are more controversial than ours was, and we weren't surprised to find widespread support for our proposal within the PPC. The next step, however, where the PPC sends out a proposed policy for review by other PAs outside the PPC, can be dicier. This outside review often includes members of the Board of Directors, other AAPA committees and councils, and possibly state chapters or other constituent groups, leaders, or members known to have expertise in particular areas.

But the outside review again went smoothly, and there was widespread agreement that our policy looked worthy. This does not always happen, of course, and many policies meet their maker during this wider review. It just takes a few well-placed criticisms or concerns about a policy to doom it. And even when a review is positive, second thoughts by PPC members (or any other body going through this same process) can also shelve a policy proposal.

But not so with this policy, which by this time had the catchy title 2010-C-01-PPC Reliable Consumer-oriented Health Information.

Here's how it looked out of the chute, as submitted by the March 30 deadline:

Policy: The AAPA encourages physician assistants to identify and utilize reliable and accurate consumer health information to encourage patient compliance and improve health education. Health education information should be culturally, age, and gender appropriate. Provision of such resources is consistent with AAPA efforts to promote health literacy.

Rationale/Justification: Identifying reliable, accurate sources of consumer-related medical information for patients is time consuming and requires access to information not always immediately available or known to PAs. Collaboration with health information experts, including medical librarians, can assist the PA in finding appropriate resources available for patient education that is available online, through government (e.g., CDC) and health advocacy groups (e.g., March of Dimes). For instance, MedlinePlus, from the National Library of Medicine within the National Institutes of Health, is a vetted and current source of health information for consumers and providers. MedlinePlus is constantly updated, includes extensive information about drugs, and offers multi-language tools, an illustrated medical encyclopedia, interactive patient tutorials, and health news.

Patients are inundated through television, radio, internet and print media with health-related products and information. The process of directing patients through the maze of available information is critical in supporting the ongoing process of health education and health literacy.The treatment and management of illness such as hypertension includes counseling, patient and clinician agreed upon goals, patient adherence, and subsequent follow-up with clinicians; but none of this can begin without accurate information. Providing reliable evidenced-based information in a format that is specific to the patient's language skills, culture, and gender allows our patients to participate in their care and empowers them to return to these same sources with future questions and concerns. This may include directing patients without home internet access to public libraries.

This policy complements and augments ongoing efforts to promote health information literacy and promotes the Academy's commitment to an interdisciplinary concept of patient care by encouraging connections to colleagues in the health information field.

As we rolled toward the late May convening of HOD, we heard from one state delegation who had concerns about adding the phrase evidence based to the policy. As this was hardly a deal breaker, we assured the commenter that we'd be glad to add that at HOD. Additionally, excellent comments were made about some of the language of the resolution being inconsistent with other AAPA policy language related to definitions of culture. We were most receptive to that as well.

At the HOD hearing—two days of testimony, where any member can say anything—we heard again from the delegate, and we worked with him to make the change. But this is where it can get tricky. When changes are proposed, they can submarine a policy quicker than you can count to one. What happens is this: A change is proposed, and in a somewhat complex process, the change is voted on. Best case scenario, the change is added, and HOD approves the revised policy. But bad things can happen here to good policy ideas. The revision can spark other revision ideas, and you can end up debating periods, commas, and apostrophes until everyone is so sick of the deal that they vote it down and kill the resolution.

Such was not the case here, however. The words evidence based were added, a few words were taken out and replaced with language about culture consistent with other AAPA policy, delegates agreed that it all made sense, and the final policy—assigned the number at HOD of 2010-C-01, C being for the reference committee designation which you all remember from last month's HOD tutorial—flew through the process with flying colors, with this final wording:

HP-3300.1.7.2

The AAPA encourages physician assistants to identify and utilize reliable and accurate consumer health information to encourage patient compliance and improve health education. Health education information should be evidence based and appropriate to the patient's culture and level of literacy. Provision of such resources is consistent with AAPA efforts to promote health literacy.

Not bad!

And the rest, as they say, is history. Our little policy lived to see the light of day of the policy manual, and all the world is better off knowing that we support reliable health information and health literacy. Okay, maybe not the whole world, but this policy does underscore the AAPA's commitment to outreach and health literacy, two laudable components of a comprehensive statement of AAPA policy. And, might I add, effective ways to improve patient care.

Next month: How the AAPA Policy Manual is organized.

Contact me with your policy questions! j.eddy.anderson@gmail.com
Jim Anderson is a physician assistant in the Department of Neurological Surgery at Harborview Medical Center in Seattle. He is a former chair of the AAPA's Committee on Diversity and a member of the JAAPA editorial board.