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MED

Wearing the slipper socks

Mar 29, 2016 09:00AM ● By MED Magazine

By Lori Atkinson

 

We’ve all been patients. And many of us have helped family members navigate today’s complex healthcare system. So we’ve seen firsthand what works and what doesn’t.

But how do we translate our good or bad experiences as patients into improving the patient experience in our own organizations?

The challenges of being a patient

In today’s healthcare environment, patients face many challenges. They can include:

●       Sifting through massive amounts of health care information on the Internet

●       Choosing a health care insurance plan

●       Worrying about privacy of personal data

●       Comprehending medical terminology

●       Recognizing and scheduling timely preventive care

●       Understanding test results and follow-up care recommendations

●       Self-managing multiple chronic diseases

●       Administering complicated medication regimes

●       Transitioning care from multiple providers at multiple facilities

 

Transitions of care mean high risk for patients

Transitions of care, i.e, the transfer of patient care from one healthcare provider or facility to another, can be a confusing and high-risk time for patients. The transition is often complicated by breakdowns in communication between providers and patients, as well as between providers themselves. These breakdowns can result from a number of factors including:

●       Failure to use standardized communication tools and processes

●       Failure to include the patient and family caregivers as part of the health care team

●       Failure to consider the health literacy of the patient and family caregivers

●       Failure to utilize health information technology (IT) to share patient data

Any of these mistakes can result in poor outcomes, hospitalizations and serious patient injuries.

Understanding what works

Nearly half of all Americans live with at least one chronic condition, and of these, 1 out of 4 sees at least three physicians regularly.1 Healthcare providers should consider the patient’s perspective on how confusing it can be to manage appointments, medications and self-care instructions from multiple providers. In order to improve both patient experience and health outcomes, it is important to know what interventions are most beneficial to a patient’s understanding of self-care, follow-up care and medication management.

A patient-centered care approach has the potential to improve patient outcomes and increase patient satisfaction. Studies show that when healthcare providers work with patients and family caregivers as a team, the quality and safety of healthcare rise, costs decrease, and provider and patient satisfaction increase.2

Studying the effects of patient-centered care, researcher Sarah Greene, MPH, and colleagues defined it as “care that honors and responds to individual patient preferences, needs, values and goals.”3 They identified pertinent attributes in the interpersonal, clinical and structural dimensions of healthcare, and they outlined a framework for a comprehensive approach to making patient-centered care a health system priority..3

For example, attributes in the interpersonal or relationship dimension may include:

●       Communicating empathetically

●       Finding common ground based on patient preferences

●       Ensuring responsiveness by the healthcare team to patient and family needs

Included in clinical or provision-of-care-dimension attributes are:

●       Using shared decision-making based on the best available evidence and patient preference

●       Coordinating care with community resources

●       Accommodating virtual visits as well as in-person visits

The researchers suggested these examples of structural or system-dimension attributes:

●       Providing a calm and welcoming space

●       Minimizing clinic wait times

●       Providing self-management tools

Patient care coordinators help patients understand and transition successfully across the continuum of care. Researchers found that patients who had a care coordinator were less likely than patients without one to report (1) that their care was poorly organized and coordinated, (2) that test results or medical records were not available at their scheduled appointments, (3) that they received conflicting information from different physicians, (4) that they did not receive follow-up instructions and (5) that their regular physicians and specialists were not sharing information about their care.4

Health literacy tools
Over a third of patients have limited health literacy, which results in their not understanding what they need to do to take care of their own health. Limited health literacy is associated with poor management of chronic diseases, poor ability to understand and adhere to medication regimes, increased hospitalizations and poor health outcomes.5 The AHRQ Health Literacy Universal Precautions Toolkit (see information in Resources section below) is designed to help healthcare organizations ensure that strategies and systems are in place to promote better understanding by all patients.

Pharmacist instruction

Patients often do not have a good understanding of the instructions for safe and effective medication use. Medication understanding is associated with better medication adherence, fewer drug-related problems and fewer emergency department visits.6 In a study of hospitalized patients who experienced medication instruction by a pharmacist, 72.8 percent indicated that it was “very helpful” to speak with a pharmacist about their medications before discharge, particularly about how to take the medications and how to prevent and manage side effects. Receiving an illustrated medication list (69.6 percent) and a follow-up phone call after discharge (68.0 percent) were also considered very helpful. Patients with limited health literacy indicated the greatest benefit.7

References

1.     Greene J, Hibbard JH. Why does patient activation matter? An examination of the relationships between patient activation and health-related outcomes. Journal of General Internal Medicine. 2012;27:520-526.

2.     Rathert C, Wyrich MD, Boren SA. Patient-centered care and outcomes:
A systematic review of the literature.
Med Care Res Rev. 2013;70(4):351-79.

3.     Greene S, Tuzzio L, Cherkin D. A framework for making patient-centered care front and center. Perm J. 2012;16(3):49-53.

4.     Doty MM, Fryer AK, Audet AM. The role of care coordinators in improving care coordination: The patient’s perspective. Arch Intern Med. 2012;172(7):587-588.

5.     AHRQ Health Literacy Universal Precautions Toolkit. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/ht.... Accessed January 14, 2015.

6.     Marvanova M, Roumie C, Eden S, Cawthon C, Schnipper J, Kripalani S. Health literacy and medication understanding among hospitalized adults. Journal of Hospital Medicine. 2011;6(9):488-493.

7.     Cawthon C, Walia S, Osborn C, Niesner K, Schnipper J, Kripalani S. Improving care transitions: The patient perspective. J Health Commun. 2012;17 Suppl 3:312-24.

Resources

The Institute for Patient- and Family-Centered Care
http://www.ipfcc.org/index.html

AHRQ Health Literacy Universal Precautions Toolkit
http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/literacy-toolkit/

National Transitions of Care Coalition
http://www.ntocc.org/

The Joint Commission Transitions of Care Portal
http://www.jointcommission.org/toc.aspx

AHRQ Care Coordination
http://www.ahrq.gov/professionals/prevention-chronic-care/improve/coordination/

HealthIT.gov Improved Care Coordination
http://www.healthit.gov/providers-professionals/improved-care-coordination



LORI ATKINSON, RN, BSN, CPHRM is a Research, Development & Education Manager with MMIC.