January 25, 2013 4:51 pm by , Med City News

It’s pretty clear by now that the healthcare industry is pushing away from disease-centered care and toward patient-centered care. But there are some key things that need to happen before patients will really be able to sit at the center of their healthcare experiences.

The “whole patient” must be addressed, not just physical health

Diane Meier, director of the Center to Advance Palliative Care, brought up a point that’s not talked about as much. Treating the whole patient, she said, includes thinking about the patient within his social context — considering his socioeconomic status, family situation and other factors that play into how he accesses and receives care.

“If I give a patient a follow-up appointment two weeks after discharge from the hospital, but I don’t pay attention to whether they have transportation, can afford transportation or have someone who can help them get there, that was a waste of everybody’s time,” she said.

Other panelists noted that, with the way care works now, that may be outside the scope of the physician. “That really did not come up in conversations that I’ve had with clinicians and healthcare executives about how to restructure care and make it more patient-centric, and I think that’s because we really don’t know how to do it,” said Susan Hernandez, a Ph.D. student and research assistant at University of Washington.

The payment model must shift

Fee-for-service care doesn’t encourage doctors to spend time with patients. But a staple of patient-centered care revolves around the physician having enough time to address the whole patient, rather than feeling rushed to refer to a specialist unnecessarily or leaving questions unanswered.

“Once [the payment model] shifts in a fundamental way … you’re going to see team care really come of age,” said Blair Sadler, a senior fellow at the Institute for Healthcare Improvement and a faculty member at the UCSD School of Medicine.

Every piece of the system must be engaged

Dr. Jack Der-Sarkissian, a family physician at Kaiser Permanente, relayed the story of his father’s experience near the end of his life to demonstrate this point: “The healthcare system that he was engaged in was highly dependent on him to engage the healthcare system,” he said. “His physicians were not talking to each other … the pharmacy was not integrated with his physician, therefore [the physician] didn’t know whether prescriptions were getting filled.”

Part of that also means using nurse practitioners and physician assistants more effectively, allowing them to work to their highest degree or certification. Kaiser’s integrated team approach is a model for how this can be done. Der-Sarkissian said he works with care managers to help him reach out to patients with chronic diseases, a nurse practitioner who shares responsibilities and a pharmacy group that helps check for drug interactions and warns him when patients aren’t refilling medicines. “As long as patients know that we are all communicating, that we are all in agreement with the goal of treatment for that patient … I think that is what patients want and what patients expect.”

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