This program works with patients at the Shared Care Free Clinic to improve health literacy, understanding of health plans, and increased adherence to lifestyle changes.

The program employs the use of tools to help patients document a discussed change. All patients are provided with a health notebook that is brought to each doctor visit. Reminders to bring the notebook are included in reminder calls and on electronic and printed materials. The notebook is where the patient and physician record the negotiated care plan and is a place for patients to keep track of questions. It serves as a "traveling medical record" for the patient. Most patients have found these very helpful in keeping track of information and instructions. Teaching with the notebooks has also served the function of establishing a social contract between patients and a care team. Compliance with medication changes or substitutions as well as movement toward lifestyle goals has improved.

Patients also complete a preparation form in the waiting room. This helps patients organize for the visit so that the most critical issues can be addressed during the time allotted. It also identifies items that can be performed by other team members--work excuse, pick up supplies, or request for health information. It turns out that the most important question on the form was, "What exciting news do you have to share?" Being able to celebrate success and joys with patients is essential to long term relationships and empowerment.

The goal of this program is to educate during every visit, to assist patients in developing a longitudinal personal record of medical history and care plans, and to provide a tangible way to engage patients in their own care. The overarching goal was better compliance, recognition of medication side effects, and improved adherence to specific and agreed upon lifestyle changes.

Sixty percent of patients participate in care plan tracking with a health notebook, and 80% percent of patients complete a prep form to help organize visits.

After one year, 60% of patients participated in bringing notebooks and 50% of patients bring all medications to every provider visit. Eighty percent of patients complete the patient preparation form prior to the physician entering the exam room. Feedback from patients has been very favorable with the notebooks. Other providers have stated that the patients are very insistent that the care plan is written in their notebook.