Health Care Systems Today - Essay Example

Issue Change is inevitable in any evolving system. In the highly competitive scenario of health care systems today, the primary goal is providing cost-effective patient care while maintaining or even improving quality. And towards this end, efforts are continually being made at the organizational level to change or replace deficient and outmoded practices of care. But changing an established practice (or behavior) is difficult. It is more so in healthcare as it involves intricate relationships between organizations, medical professionals, caregivers, and patients (National Institute for Health and Clinical Excellence, NICE, 2007). Shared decision-making (SDM) which is a collaboration between patients and caregivers in the treatment process, is gaining recognition as the basic necessity of a patient-centric model of care. It is considered to be especially ideal for the treatment of chronic illnesses (Zoffmann et al., 2008). SDM is essentially based on a mutual selection of care goals arrived at by the patient and his physician, but is not well understood or appreciated by many health professionals. Following is a case scenario in point. The trustees of the Snowdon Fund Medical School and Hospital were keen that the organization should revitalize itself and become more productive to keep abreast of competition. A committee comprising of a nominated trustee, experienced administrators, clinicians, and senior nursing staff was formed to draw up a competitive strategy for the same. During a meeting of the committee, Prof. Jones, a senior professor and clinician made a strong case for adopting shared decision-making (SDM) to make the treatment more patient-centric and the hospital patient-friendly. Prof. Jones with more than two decades of experience in treating chronically ill cases was convinced that SDM was the way to go especially where the treatment of chronic diseases was concerned. A perusal of published medical literature (Legare et al., 2008) and her own discussions with her patients had persuaded her to believe that patients want to be involved in their own treatment. This was good, Prof. Jones opined, because with the ever-increasing number of patients taking medicines, allowing them to make informed choices would definitely reduce waste and unnecessary cost associated with non-compliance with the prescribed medication regimen, yet help the patients derive the full benefit of the treatment. In chronic illness, “adherence to physician designed programs is usually moderate to poor.” (www.amga.org). The hospital administrator was quick to point out that the idea was good but not easy to adopt. He was of the opinion that fully involving patients in clinical decision-making would be a daunting task for most clinicians as they were not trained to deal effectively with it. This attitude was to be expected from an administrator, as trustees and administrators are required to focus their energies on resource acquisition and management issues rather than on patient care (Shortell, 1983). According to Wagner (2000), chronic conditions, such as diabetes, cardiovascular disease, and asthma have become ubiquitous chronic conditions that are making long-term demands on the health care system. Prof. Jones agreed that a multidisciplinary care team needed to be developed to deliver care to patients suffering from chronic diseases. She suggested building teams on the lines of the Chronic Care Model described by the Agency for Healthcare Research and Quality (AHRQ, chronic2a, www.ahrq.gov), having a shared decision-making component. Prof. Jones indicated that the team could comprise of faculty physicians, a chief medical resident, residents in internal medicine, a registered nurse, diabetic educators, laboratory personnel and IT staff. Training of physicians in chronic illness management has become imperative given the fact that most healthcare systems are directed towards acute care. According to Prof. Jones, incorporating the AHRQ Chronic Care Model into the internal and family medicine curriculums would allow the acquisition of the necessary skills in the use of the Chronic Care Model at the novice (such as first-year residents) through expert (say, third-year residents) levels (chroniccare4, www.ahrq.gov). The curriculum for Chronic Care as proposed would inculcate a working knowledge of the Chronic Care Model through literature review and faculty training. According to Chen and Bodenheimer, “Chronic conditions are usually life-long in duration, without permanent cure….. The management of chronic conditions, then, requires a partnership between a healthcare team and the person living with a chronic condition.” (2008). Echoing the views of Wagner (www.impactbc.ca) a majority of the committee members said that the delivery of effective, efficient clinical care is best ensured by defining the roles and distribution of tasks among team members besides regular follow-up by the care team. The unanimous view among clinicians was that SDM can become successful only if patients could have access to good quality information to form an opinion about their health care in general, and, in particular, about their medications, the tests they undergo and so on. According to Clark, “….research published in peer-reviewed journals has shown that in the view of medical professionals, the information on the Internet is of highly variable quality.” (2002, p1). Also, considering the lack of control on the data that is accumulating, obtaining reliable and valid information is indeed difficult. Therefore, guidance of health professionals is required by patients to access good quality consumer health information, including health-related websites. The committee also felt it to be equally important to explain current scientific information related to the disease treatment to patients in a way that they can understand and utilize the information. Some of the senior clinicians were apprehensive of the fact that they had too little time at their disposal to regularly involve their patients in medical decisions. A clinical guideline can take a long time to be fully implemented, even up to 3 years (NICE, 2007). Several barriers to change model in healthcare can impede or prevent altogether the implementation of change. Coulter maintains that assumptions such as the physician knows the best, and therefore makes decisions on the mode of treatment without involving the patients are signs of physicians’ paternalistic approach which “should have no place in modern health care.” (1999). While the doctor may be well informed about the medical aspects of the disease and the therapeutics, only the patient is knowledgeable about the specific aspects of his or her illness, attitudes to risk, values, and preferences. And, both types of knowledge are needed to arrive at an effective treatment protocol for the illness (Coulter, 1999). To summarize the case scenario presented above, key individuals (i.e., a majority of the senior academician-clinicians) had specific understanding of the situation. They also had the knowledge to discuss the topic and provide new ideas which would help in the speedy implementation of SDM in chronic disease management. By imparting necessary training to the clinical team, they were hopeful of creating meaningful partnerships between care givers and patients with chronic illness. References AHRQ, Toolkit for Implementing the Chronic Care Model in an Academic Environment : Residents, Staff, and Patients Working as a Team, http://www.ahrq.gov/populations/chroniccaremodel/chronic2a.htm Accessed 21 March 2009 AHRQ, Toolkit for Implementing the Chronic Care Model in an Academic Environment : Health Professions Education for Chronic Care http://www.ahrq.gov/populations/chroniccaremodel/chroniccare4.htm Accessed 21 March 2009 Chen, E. & Bodenheimer, T. 2008.Applying the Chronic Care Model to the Management of Obesity. Obesity Management. October 2008, 4(5): 227-231. http://www.liebertonline.com/doi/abs/10.1089/obe.2008.0224 Accessed 21 March 2009 Clark, E.J. 2002. Health Care Web Sites: Are They Reliable?, Journal of Medical Systems, 26, p1 http://www.springerlink.com/content/t2872u48726654t8/fulltext.pdf?page=1 Accessed 20 March 2009 Coulter, A. 1999. Paternalism or partnership? Patients have grown up—and there’s no going back. BMJ, 319(7212): 719–720. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=10487980 Accessed 20 March 2009 http://www.amga.org/Research/Research/Adherence/olmsted.pdf Accessed 20 March 2009 Légaré, F., Elwyn, G., Fishbein, M. et al., 2008. Translating shared decision-making into health care clinical practices: Proof of concepts. Implementation Science, 2008; 3: 2 http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2265300 Accessed 20 March 2009 National Institute for Health and Clinical Excellence (NICE), 2007. How to Change Practice. http://www.nice.org.uk/media/AF1/73/HowToGuideChangePractice.pdf Accessed 21 March 2009 Shortell, S.M. 1983. Physician Involvement in Hospital Decision Making . The National Academies Press. http://books.nap.edu/openbook.php?record_id=527&page=73 Accessed on 21 March 2009 Wagner E.H., 2000. The role of patient care teams in chronic disease management. BMJ, 320:569-572. www.bmj.com/cgi/content/full/320/7234/569 Accessed 19 March 2009 Wagner, E. Patient-centeredness and the Chronic Care Model. www.impactbc.ca/files/presentations/Patient_Centeredness_And_The_ Chronic_Care_Model.ppt Accessed 20 March 2009 Zoffmann, V., Harder, I. & Kirkevold, M. 2008. A Person-Centered Communication and Reflection Model: Sharing Decision-Making in Chronic Care Qualitative Health Research, 18 : 670-685. DOI: 10.1177/1049732307311008 Read More