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Patient-centered communications with doctors: How do you rate her/him?

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What do you think of your doctor's decisions about your care? A happy patient is well connected to a doctor. A new University of Iowa study finds that patients in regular contact with primary physician are most satisfied with their care. A new trend in American health care is the patient-centered medical home. Are your communications pretty good with your primary care physician? And if you're a doctor, how are your communications with your patients? Do they follow and respect your decisions? Or are patients rebellious and tend to walk away from conventional medicine if the prescriptions have unwanted side effects that last?

The approach revolves around a team of medical and health professionals who, working together, treat an individual, led by a primary-care physician who orchestrates the whole effort. The goal is the team knows everything about the patient, no matter how disparate the symptoms—from the earache last night to the long history of high cholesterol—and works together to treat the individual in a holistic way.

Patient-centered medical homes (PCMH) have gained popularity since the National Committee on Quality Assurance recognized them five years ago. There are more than 1,500 such practices recognized by the nonprofit health quality association.

How well do patients and doctors communicate?

Yet despite their growing popularity, questions remain about their effectiveness. In a new study, researchers at the University of Iowa evaluated a similar model being tested with military veterans, and conclude that maintaining a direct, regular channel of communication between the patient and the primary doctor is critical to success.

"This is a time of intense change in health care, and all of these aspects (with PCMHs) potentially contribute to more fragmentation," says David Katz, according to a November 18, 2013 news release, "A happy patient is well connected to a doctor." Katz is an associate professor in internal medicine at the University of Iowa (UI) and the corresponding author on the study, published in the Journal of General Internal Medicine. "That's why we can't lose sight of the doctor-patient relationship, and how we're communicating with our physicians."

Katz and his colleagues surveyed 4,393 veterans receiving care in medical facilities in the upper Midwest run by the U.S. Department of Veterans Affairs (VA) to evaluate their thoughts on the VA's Patient Aligned Care Team initiative, an approach to care much like the PCMH. The veterans needed to have at least three primary-care visits during the survey period, which lasted from 2009 to 2010.

In particular, the researchers sought to better understand whether continuity of care—measured by the concentration of visits with a primary-care physician and the duration of care with that physician—led to a patient feeling more satisfied with his or her relationship with the primary doctor

The research team found that it did, mainly because continuity of care seems to yield better communication between the individual and the primary-care doctor and thus a happier patient overall.

"I think that's a very simple implication of this study," Katz says, in the news release, "in the sense that it can improve the connectedness of the patient and improve the quality of the doctor-patient communication and the patient's satisfaction with their care."

Only half of patients in the study rated their involvement with their primary care physician as 'excellent'

The researchers found that the surveyed VA patients reported seeing their assigned care provider 80 percent of the time, higher than anticipated and comparable with rates in the private sector. Yet only half rated as 'excellent' their involvement with a primary physician in making a treatment decision in the past year.

Katz noted that several factors could influence the rating, such as if a patient had an acute problem that needed immediate treatment, reducing the time available for an involved discussion. Nevertheless, "part of it could improve with better training of physicians how to engage patients in shared decision making and giving patients more instruction on how to approach a primary-care visit," says Katz, also an associate professor in the College of Public Health.

The study looked at the patient-doctor relationship with treatment decisions. Katz noted further studies should examine screening and diagnostic visits

"What it all boils down to," Katz says in the news release, "is we have to make sure that during this time of primary-care redesign, that we pay attention to what is happening to the doctor-patient relationship and communication in particular."

Contributing authors from the UI are Mary Vaughan Sarrazin, research associate professor in internal medicine; and Kim McCoy, research assistant in internal medicine. The VA Office of Patient Care Services supported the research, through the VISN 23 Patient Aligned Care Team Demonstration Laboratory.

When it comes to holistic health, what's your vision for a new model of integrated care support for citizens' health through linked social and health care in the local area?

Can the field of holistic health locally incorporate integrated systems for smarter healthcare right here in Sacramento? After all, holistic health care is thriving in Europe since social scientists proposed integrated information systems for smarter health and social care. Here in the USA, more holistic health practices need to be integrated into most health care systems and be covered by insurance, for example.

A new European Science Foundation (ESF) position paper calls for increasing use of ICT to deliver health and social care services. The new position paper, Developing a New Understanding of Enabling Health and Wellbeing in Europe, published February 5, 2013 by the European Science Foundation, highlights the need for change in health and social care across Europe, says a February 5, 2013 news release, "Social scientists propose integrated information systems for smarter health and social care." The European Science Foundation (ESF) Position Paper, "Developing a New Understanding of Enabling Health and Wellbeing in Europe" is available online.

As social care and informal care are essential to improving health and preventing health problems, especially in an aging population, there are still large gaps of knowledge in how best to organize this, and how best to combine it with health care. The position paper sees Information and Communication Technologies (ICT), which are increasingly deployed in service sectors to enable consumer customization and better resource management, as the way forward for improved healthcare. For more information on ICT, check out the site, "ICT Center | Information and Communications Technologies."

The publication presents a vision for a new model of integrated care support for citizens' health through linked social and health care

It exposes current developments and challenges concerning demographic changes, ageing and established a concrete research agenda for ICT application focussing for instance on the relationship between patients and carers, the acceptability of ICT, the role of data, the organization and legal aspects or the financing challenge.

Developing a New Understanding of Enabling Health and Wellbeing in Europe underlines that "Research programs need developing at national and European level to stimulate a comprehensive and cohesive pattern of social science research into the means of achieving optimal ICT support as the enabler for a new integrated and partnership paradigm of health-related care." It highlights a number of priorities for important advances to be made toward the harmonization of healthcare delivery and informatics support:

  • Integrated delivery of health care and social care support of individual's health
  • Personalized care delivery including reasonable accommodation of individual choice
  • Ensure effective use of ICT applications based on user acceptability
  • Bring processes of consent, delegation, representation, coordination and privacy into the electronic era
  • Ensure respect for and teamwork with formal carers and the informal care team
  • Ensure equity in an electronic era regardless of digital literacy, assets and connectivity
  • Examine stable , sustainable models of trusted infrastructure provision
  • Establish governance, authentication, management, and sustainability principles.

This position paper is an outcome of the European Science Foundation's Exploratory Workshop, "The Challenges of Developing Social Care Informatics as an Essential Part of Holistic Health Care," held July 21-23, 2010 at Keele University (UK) with the participation of 23 international academics engaged in health care and informatics professions and disciplines together with legal, ethical, economist and patient interests.



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