Patient Provider Relationship HINF Medical Methodologies Session 19

Objective To review the requirements of effective patient provider relationship To review the requirements of effective patient provider relationship To discuss how technology can contribute to enable this effective relationship To discuss how technology can contribute to enable this effective relationship

Reference American Healthways and John’s Hopkins (2003) Defining the Patient- Physician Relationship for the 21 st Century. outcomes/PatientPhysician.pdf American Healthways and John’s Hopkins (2003) Defining the Patient- Physician Relationship for the 21 st Century. outcomes/PatientPhysician.pdf

Principal Elements of Relationship Communication Communication Office Experience Office Experience Hospital Experience Hospital Experience Education Education Integration Integration Decision-making Decision-making Outcomes Outcomes

Does This sound Familiar? It has been way too long since you’ve been in to see me. Do you have any idea how hard it is to get an appointment? I understand that it can be, but it is very important that you come in regularly OK, but can you guarantee that we will have more time to really discuss what is going on with me? We’ll set a longer appointment time. Are you taking your medications as prescribed? Uh…not really. I hate pills! Exercising regularly? Uh…no.

Symptoms of the Disease… Fewer providers + managed care = less access for patients Fewer providers + managed care = less access for patients Greater life expectancy + life “excesses” = more patients with chronic disease = more encounter time required Greater life expectancy + life “excesses” = more patients with chronic disease = more encounter time required Healthcare consumerism + technology = information overload Healthcare consumerism + technology = information overload = BREAKDOWN OF THE PATIENT-PHYSICIAN RELATIONSHIP Don Caruso, MD – Associate Medical Director Mike House – Chief Information Officer, Cheshire Medical Centre)

Communication All parties should acknowledge patients as most knowledgeable about their symptoms All parties should acknowledge patients as most knowledgeable about their symptoms Patients should provide feedback and Physicians should welcome feedback Patients should provide feedback and Physicians should welcome feedback Physicians should implement a social questionnaire as part of their initial intake Physicians should implement a social questionnaire as part of their initial intake Role of patients’ gender, age, race and religion must be recognized Role of patients’ gender, age, race and religion must be recognized Traumatic news must be delivered appropriately Traumatic news must be delivered appropriately

Communication Patient’s designated advocate must be respected and included in care relationship Patient’s designated advocate must be respected and included in care relationship Physicians provide current, scientifically based “best medical practices” in an ethical and timely fasion Physicians provide current, scientifically based “best medical practices” in an ethical and timely fasion Patients should seek – physicians should promote – active, collaborative discussions with patients Patients should seek – physicians should promote – active, collaborative discussions with patients Relationship must mirror our daily lives by relying on methods of communication that are not limited to inflexible, one-on-one visits Relationship must mirror our daily lives by relying on methods of communication that are not limited to inflexible, one-on-one visits

Office Experience Patients should be able to access healthcare in a timely fashion (assuring flexible access is also essential) Patients should be able to access healthcare in a timely fashion (assuring flexible access is also essential) Details of office practices and procedures should be available in written form Details of office practices and procedures should be available in written form Physicians and their staff should review medical information form periodically to help minimize duplication of information and the consequent burden on patients Physicians and their staff should review medical information form periodically to help minimize duplication of information and the consequent burden on patients Physicians office staff should be polite, professionals and well-trained to facilitate the care experience Physicians office staff should be polite, professionals and well-trained to facilitate the care experience Telephone communication between patients and office should be designed to be effective and efficient and avoid frustration and overload Telephone communication between patients and office should be designed to be effective and efficient and avoid frustration and overload

Office Experience Physicians should continually evaluate their scheduling systems for effectiveness Physicians should continually evaluate their scheduling systems for effectiveness Office visits should be used as opportunities to review care plans Office visits should be used as opportunities to review care plans Both patients and physicians make effort to be on time for appointments Both patients and physicians make effort to be on time for appointments Both patients and physicians enter appointment prepared. Both patients and physicians enter appointment prepared. There should be sufficient redundancy to absorb unexpected events There should be sufficient redundancy to absorb unexpected events

Office Experience A responsive and effective system for referrals is essential A responsive and effective system for referrals is essential Physicians should communicate to patients the value of regular, face-to-face medication reviews Physicians should communicate to patients the value of regular, face-to-face medication reviews

Hospital Experience Healthcare team should attempt to personalize care in the hospital Healthcare team should attempt to personalize care in the hospital Which physician in charge of care – and that physician’s role – should be clearly defined to the patient Which physician in charge of care – and that physician’s role – should be clearly defined to the patient Effective communication is imperative to avoid errors Effective communication is imperative to avoid errors Prior to procedures, patients must be effectively educated Prior to procedures, patients must be effectively educated Communication with the family, as approved by the patient, should be coordinated by a designated family member or advocate Communication with the family, as approved by the patient, should be coordinated by a designated family member or advocate

Hospital Experience Physicians should ensure comprehensive discharge planning Physicians should ensure comprehensive discharge planning Patients should make sure that their discharge information or inpatient records available at outpatient setting Patients should make sure that their discharge information or inpatient records available at outpatient setting Caring and attentive emergency room staff and timely evaluations are vital Caring and attentive emergency room staff and timely evaluations are vital ER staff should communicate to the patient’s responsible physician all arrangements for follow-up care and details of the particular visit ER staff should communicate to the patient’s responsible physician all arrangements for follow-up care and details of the particular visit A strong patient-physician relationship should ensure that the emergency room is used for “true emergencies” A strong patient-physician relationship should ensure that the emergency room is used for “true emergencies”

Education Physicians and patients must work as partners to create an ever-evolving self-care program Physicians and patients must work as partners to create an ever-evolving self-care program Education should address physician-patient knowledge differences, culture and language Education should address physician-patient knowledge differences, culture and language Each patient should receive a tailored education package Each patient should receive a tailored education package Physicians should be open to education by patient Physicians should be open to education by patient Physicians should discuss with patients the risks associated with prescribed treatment Physicians should discuss with patients the risks associated with prescribed treatment

Education Physicians should furnish patients with educational materials or resources Physicians should furnish patients with educational materials or resources Physicians should familiarize themselves with and incorporate guidelines into treatment plan Physicians should familiarize themselves with and incorporate guidelines into treatment plan Patients should incoporate guidelines into their self-care programs Patients should incoporate guidelines into their self-care programs Patients should share with physicians any outside information with providers involving changes to the prescribed treatment program Patients should share with physicians any outside information with providers involving changes to the prescribed treatment program Physicians should remain objective when reviewing outside information Physicians should remain objective when reviewing outside information

Integration Physicians or their staff should facilitate patients’ movement through the system in a prompt and efficient manner Physicians or their staff should facilitate patients’ movement through the system in a prompt and efficient manner Patients who schedule their own appointments should recognize their responsibility to inform primary physician Patients who schedule their own appointments should recognize their responsibility to inform primary physician Physicians, with patients’ consent, provide information promptly to other care providers Physicians, with patients’ consent, provide information promptly to other care providers Both patients and physicians recognize that EMR is the optimal method for having shareable medical information Both patients and physicians recognize that EMR is the optimal method for having shareable medical information Patients should share their own personal medical information with care providers Patients should share their own personal medical information with care providers

Integration If EMR is not available, patients should have a copy of their all test results If EMR is not available, patients should have a copy of their all test results Physicians must remain abreast of specific formularies and coverage of medications Physicians must remain abreast of specific formularies and coverage of medications

Decision-Making In decision making process, physicians should consider patients’ personal, religious, economic and psychosocial factors, as well as clinical In decision making process, physicians should consider patients’ personal, religious, economic and psychosocial factors, as well as clinical Physicians are obliged to see that patients receive sufficient information and patients are obliged to educate themselves to be able to ask questions and understand the consequences of the decision Physicians are obliged to see that patients receive sufficient information and patients are obliged to educate themselves to be able to ask questions and understand the consequences of the decision Physicians and patients should explicitly define and discuss realistic expectations Physicians and patients should explicitly define and discuss realistic expectations Patients have right know all of their options regardless of physician’s beliefs, values and interests Patients have right know all of their options regardless of physician’s beliefs, values and interests Patients have the responsibility to fully disclose their adherence to recommendations Patients have the responsibility to fully disclose their adherence to recommendations

Decision-Making Role of advocates must be identified Role of advocates must be identified Patients should write down their preferences of care Patients should write down their preferences of care

Outcomes Clinical or disease specific: patients and physicians should understand and discuss clinical practice outcomes Clinical or disease specific: patients and physicians should understand and discuss clinical practice outcomes Patient-centred outcomes: Physicians should appreciate patient-centred outcomes as valid objectives Patient-centred outcomes: Physicians should appreciate patient-centred outcomes as valid objectives Physician-centred outcomes must be objectively defined and advocated in the health system Physician-centred outcomes must be objectively defined and advocated in the health system Self efficacy of patients is a common outcome. Self efficacy of patients is a common outcome.