Patient-Centered Medicine: Who, What, and How?

2016 ◽  
Author(s):  
Mark D. Sullivan
Keyword(s):  
Health Care ◽  
Chronic Illness ◽  
Clinical Problem ◽  
Chronic Illness Care ◽  
Patient Centered ◽  
Patient Agency ◽  
Centered Care ◽  
Primary Means ◽  
Patient Centered Medicine ◽  
Clear Idea

We don’t have a clear idea where health comes from. Our efforts to reform health care to make it more patient-centered and more responsive to the challenges of chronic illness have been too superficial. Three lessons for chronic illness care are derived: 1) we cannot assume that death and disease are the most important targets for health care, 2) we must draw on the patient’s perspective to define the nature of the clinical problem and the criteria of success for our clinical interventions, and 3) we must always aim toward increasing the patient’s capacity for self-care. The patient-centered care of chronic disease requires that we recognize the patient as the primary perceiver and producer of health. We must move not only from the passive patient to the informed and activated patient, but to the autonomous patient. Patient agency is both the primary means and primary end of health care.

From Patient to Agent

2016 ◽  
Author(s):  
Mark Sullivan MD, PhD
Keyword(s):  
Health Care ◽  
Chronic Illness ◽  
Patient Autonomy ◽  
Clinical Problem ◽  
Patient Centered ◽  
Objective Health ◽  
Centered Care ◽  
Primary Means ◽  
Definition Of Health ◽  
Definition Of

In the 21st century, the primary challenge for health care is chronic illness. To meet this challenge, we need to think anew about the role of the patient in health and health care. There have been widespread calls for patient-centered care, but this model of care does not question deeply enough the goals of health care, the nature of the clinical problem, and the definition of health itself. We must instead pursue patient-centered health, which is a health perceived and produced by patients. We should not only respect, but promote patient autonomy as an essential component of this health. Objective health measures cannot capture the burden of chronic illness, so we need to draw on the patient's perspective to help define the clinical problem. We require a new definition of health as the capacity for meaningful action. It is recognized that patients play a central role in chronic illness care, but the concept of health behavior retards innovation. We seek not just an activated patient, but an autonomous patient who sets and pursues her own vital goals. To fully enlist patients, we must bridge the gap between impersonal disease processes and personal processes. This requires understanding how the roots of patient autonomy lie in the biological autonomy that allows organisms to carve their biological niche. It is time for us to recognize the patient as the primary customer for health care and the primary producer of health. Patient agency is both the primary means and primary end of health care.

scholarly journals Concordance and Patient-Centered Care in Medicaid Enrollees’ Care Experience With Providers

2021 ◽  
Vol 8 ◽  
pp. 237437352110340
Author(s):  
Iwimbong Kum Ghabowen ◽  
Neeraj Bhandari
Keyword(s):  
Health Care ◽  
Health Care Access ◽  
Patient Centered Care ◽  
Care Utilization ◽  
Federal State ◽  
Patient Centered ◽  
Care Experience ◽  
Centered Care ◽  
State And Local ◽  
Privately Insured

Patient-centered care is at the nexus of several overlapping institutional reforms to improve health care system performance. However, we know little regarding Medicaid patients’ experience with their doctors along several key dimensions of patient-centered care, and how their experience compares with Medicare and privately insured patients. We studied 4 outcomes using the 2017 National Health Interview Survey: patient–provider concordance on racial/sexual/cultural identity, respectful provider attitude, solicitation of patient opinion/beliefs during the care encounter, and patient-centered communication (PCC). The primary independent variable was Medicaid enrollee status. We dichotomized responses and ran multivariate logistic regressions for each type of care experience outcome, controlling for sociodemographic factors, health care access, and health care utilization of respondents. Compared to Medicare and privately insured enrollees, Medicaid enrollees reported much lower odds of seeing providers who treated them with respect (OR = 1.91, P < .001; OR = 1.62, P < .01) and who offered PCC (OR = 1.35, P < .05; OR = 1.35, P < .01), but similar odds of seeing concordant providers (OR = 0.78, P = .96; OR = 0.96, P = .72). Importantly, Medicaid enrollees reported higher odds of seeing providers who solicited their opinion/beliefs/preferences than their Medicare or privately insured counterparts (OR = 0.82, P < .05; OR = 0.87 P < .10). Medicaid enrollees report less patient-centered experiences in some important facets of their provider interaction than their Medicare or privately insured counterparts. Federal, state, and local policies and practices directed at improving these facets of patient–provider interaction are needed and should be aimed squarely at Medicaid providers, especially those working in geographic areas and settings with a disproportionate number of racial, gender, cultural, and linguistic minorities.

Abstract 002: Patient Provider Communication and Patient-centered Outcomes Among Patients With Atherosclerotic Cardiovascular Disease in United States: Medical Expenditure Panel Survey 2010-2013

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Victor Okunrintemi ◽  
Erica Spatz ◽  
Joseph Salami ◽  
Haider Warraich ◽  
Salim Virani ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Medical Expenditure Panel Survey ◽  
Medical Expenditure ◽  
Atherosclerotic Cardiovascular Disease ◽  
Care Providers ◽  
Patient Centered ◽  
Patient Reported ◽  
Centered Care ◽  
Nationally Representative

Background: With recent enactment of Accountable Care Act, consumer reported patient-provider communication (PPC) assessed by Consumer Assessment of Health Plans Survey (CAHPS) in ambulatory settings is incorporated as a complementary value metric for patient-centered care of chronic conditions in pay-for-performance programs. In this study, we examine the relationship of PPC with select indicators of patient-centered care in a nationally representative adult US population with established atherosclerotic cardiovascular disease (ASCVD). Methods: The study population consisted of a nationally representative sample of 8223 individuals (age ≥ 18 years) representing 21.6 million with established ASCVD (self-reported or ICD-9 diagnosis) reporting a usual source of care in the 2010-2013 pooled Medical Expenditure Panel Survey (MEPS) cohort. Participants responded to questions from CAHPS that assess satisfaction with PPC (four-point response scale: never, sometimes, usually, always ) :(1) “How often providers show respect for what you had to say” (2) “How often health care providers listened carefully to you” (3) “How often health care providers explained things so you understood” (4) “How often health providers spent enough time with you” We developed a weighted PPC composite score, categorized as 1 ( never / sometimes ), 2 ( usually ), and 3 ( always ). Outcomes of interest were 1) patient reported outcomes (PRO): SF-12 physical/mental health status, 2) quality of care measures: statin and ASA use, 3) health-care resource utilization (HRU): Emergency room visits & hospital stays, 4) total annual and out of pocket healthcare expenditures (HCE). Results: As shown in the table, those with ASCVD reporting ineffective (never/sometimes) vs. effective PCC (always) were over 2-fold more likely to report poor PRO, 34% & 22% less likely to report statin and ASA use respectively, had a significantly greater HRU (OR≥ 2 ER visit: 1.40 [95% CI:1.09-1.80], OR≥ 2 hospitalization: 1.35 [95% CI:1.02-1.77], as well as an estimated $1,294 ($121-2468) higher annual HCE. Conclusion: This study reveals a strong relationship between patient-physician communication among those with established ASCVD with patient-reported outcomes, utilization of evidence based therapies, healthcare resource utilization and expenditures.

scholarly journals Unique Challenges for Otolaryngology Patients During the COVID-19 Pandemic

2020 ◽  
pp. 019459982095483
Author(s):  
Melissa Ghulam-Smith ◽  
Yeyoon Choi ◽  
Heather Edwards ◽  
Jessica R. Levi
Keyword(s):  
Health Care ◽  
Health Care Delivery ◽  
Care Delivery ◽  
Patient Centered Care ◽  
Patient Centered ◽  
Intimate Contact ◽  
Respiratory Mucosa ◽  
Increased Risk ◽  
Centered Care ◽  
Upper Respiratory

The coronavirus disease 2019 (COVID-19) pandemic has drastically altered health care delivery and utilization. The field of otolaryngology in particular has faced distinct challenges and an increased risk of transmission as day-to-day procedures involve intimate contact with a highly infectious upper respiratory mucosa. While the difficulties for physicians have been thoroughly discussed, the unique challenges of patients have yet to be considered. In this article, we present challenges for patients of otolaryngology that warrant thoughtful consideration and propose solutions to address these challenges to maintain patient-centered care both during and in the aftermath of the COVID-19 pandemic.

scholarly journals Management strategy of healthcare organizations. PDRQ–9 method

2021 ◽  
pp. 243-248
Author(s):  
Ch. E. Karibdzhanov
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Health Care Research ◽  
New Paradigm ◽  
Healthcare Organizations ◽  
Patient Centered ◽  
Brief Assessment ◽  
Centered Care ◽  
Physician Relationship ◽  
Care System

The main source of success for a customer-centric organization is the ability to identify its customers, identify their needs, and use that information to develop a customer-centric strategy. In this regard, there is a widespread change in attitudes toward the construction of management in organizations. Whereas previously the competitiveness of an organization could be measured by its financial performance, now the intellectual potential of an organization is at the forefront. As the role of the patient in the health care system has intensified, the importance of patient participation has received increasing attention and has become central to health care research. In this regard, in today’s environment, the foundation of success in the treatment and delivery of professional care in medicine is primarily the degree of patient satisfaction. Patient-centered care acts as a new paradigm for the development of the health care system, which is characterized by a shift in the center of gravity to the patient. In this regard, in the field of health care, the relationship between the patient and the doctor, as perceived by the patient, is one of the main elements of the methodology of scientific research. The purpose of this article is to review and analyze the results of the PDRQ–9, which assesses the patient-physician relationship. The PDRQ–9 provides researchers with a brief assessment of the therapeutic aspects of the patient-physician relationship in the primary care setting. It is a valuable tool for research and practice purposes that includes monitoring the patient-doctor relationship.

scholarly journals Instilling the core concept of inter professional education

1970 ◽  
Vol 9 (3) ◽  
pp. 201-206
Author(s):  
S Bhattacharya ◽  
SK Bhattacharya ◽  
AP Gautam
Keyword(s):  
Health Care ◽  
Health Professional ◽  
Health Care Providers ◽  
Professional Education ◽  
Care Delivery ◽  
Care Providers ◽  
Patient Centered ◽  
Innovative Teaching ◽  
Centered Care ◽  
Teaching Learning

The Inter Professional Education (IPE) is an innovative teaching learning intervention in Health Professions’ Education during which members of more than one health profession learn interactively together to improve collaborative practice and/health of the patients. Thus this approach provides positive outcomes for students enhancing their awareness towards other professional groups, improving knowledge and understanding of how to work in an inter professional team and strengthening their communication and collaboration skills. Within the hierarchical nature of many clinical settings, the aims of IPE courses intersect with socialization of health professional (HP) students into roles of responsibility and authority. The IPE in HP courses emphasizes the practice of frequent high quality communication, strong relationships and partnerships among health care providers to maximize the quality of care thus improving the efficiency of care thereby improving clinical outcomes. Health Professional Schools are this motivated to opt for inter professional education to improve the learning of the students, health care delivery and patient outcomes. Keywords: Inter professional relations; patient centered care; education DOI: http://dx.doi.org/10.3126/hren.v9i3.5591   HR 2011; 9(3): 201-206

An Integrative Approach to Abdominal Pain

2019 ◽  
pp. 339-362
Author(s):  
Marika Alois ◽  
Terry Kit Selfe ◽  
Irene M. Estores
Keyword(s):  
Health Care ◽  
Abdominal Pain ◽  
Health Care Professionals ◽  
Gastrointestinal Disease ◽  
Integrative Approach ◽  
Patient Centered ◽  
Integrative Health ◽  
Bowel Diseases ◽  
Centered Care ◽  
Functional Gastrointestinal Disease

This chapter discusses abdominal pain in the context of functional gastrointestinal disease (FGID) and some chronic inflammatory bowel diseases, recognizing the huge burden it places on the health care system and emotional costs to patients and health care professionals. It presents a review of several modalities that include mind–body medicine practices, natural products, botanicals, manual and movement-based therapies, and pharmaceuticals that can be used as part of an integrative health plan for patients presenting with FGID and abdominal pain. It describes an integrative approach that weaves in concepts of patient-centered care, effective communication, empathic listening, mindfulness, and evidence-informed practice.

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