Presentation on theme: "Seniors as Patient Safety Self-Advocates in Primary Care"— Presentation transcript:
1 Seniors as Patient Safety Self-Advocates in Primary Care Saundra L. Regan, PhDUniversity of CincinnatiDepartment of Family & Community MedicineCincinnati, Ohio, U.S.
2 Objectives of Today’s Presentation What are Patient-Centered & Family-Centered Health Care?What are the issues in Patient-Centered & Family-Centered Care and why is it so important in Geriatrics?The Seniors’ Empowerment and Advocacy in Patient Safety (SEAPs) tool.What is the Patient-Centered Medical Home (PCMH) in Primary Care?Next Steps
3 Brief Description of Patient-Centered & Family-Centered Health Care
5 Health Care is Facility-Centered Hospital Clinic Nursing Home
6 President Obama: Today: “It use to be that most of us had a family doctor. You would consult with that family doctor. They knew your history. They knew your children. They helped deliver babies.”Today:“Oftentimes, people don’t have a primary care physician that they’re comfortable with, so they don’t get regular checkups. They don’t get regular consultations. Preventable diseases end up being missed.”6/8/2010. Town Hall Meeting, Wheaton, Maryland President Obama Calls for Better Payment System for Primary Care Physicians
7 Patient-Centered Health Care* The healing relationship between physicians and patients and patients' familiesGrounded in strong communication and trustHighlighted by clinicians and patients engaging in a two-way dialogueSharing informationExploring patients' values and preferencesHelping patients and families make clinical decisions*Institute of Medicine's Crossing the Quality Chasm 2001
8 Patient-Centered Health Care* “Shared Information” — a physician tailors information to an individual patient's concerns, beliefs, and expectations, while also considering his or her level of health literacy"Shared deliberations”—engage the patient in discussions and decision-making to help arrive at a….“Shared mind"—that is, consensus on an approach to care that goes beyond informed consent.*R. M. Epstein, K. Fiscella, C. S. Lesser, and K. C. Stange, "Why the NationNeeds a Policy Push on Patient-Centered Health Care," Health Affairs, Aug (29)8:1489–95.
9 Family-Centered Health Care* Health care providers listen to, respect and honor patient and family perspectives and choicesHealth care providers communicate and share complete and unbiased information with patients, families, and other providersPatients and families are encouraged to participate and collaborate with their providers*http://www.familycenteredcare.org/
10 Issues in Patient-Centered & Family-Centered Care and the Importance in Geriatrics
12 Canadian Demographics Median age:total: 40.7 yearsmale: 39.6 yearsfemale: 41.8 yearsLife Expectancy:total population: yrs.male: yrs.female: 84 yrs.Fertility rate:1.5 children per womanTotal Population (2010 est.)34,019,000 (2010 est.)Age structure:0-14 years: 15.9%15-64 years: 68.6%65 years and over: 15.5%https://www.cia.gov/library/publications/the-world-factbook/geos/ca.html
13 Chronic DiseasesChanging epidemiology of disease burden from infectious disease to chronic disease related to:Aging populationLifestyle factorsExcessive calorie intakeDiminished physical activitySmokingAlcohol
14 Leading Causes of Death Ages 65 and Over* CancerHeart DiseaseChronic Lower Respiratory Disease (Chronic Bronchitis, Emphysema, COPD, Asthma)StrokeDiabetesAlzheimer’s (75+)*http://www.statcan.gc.ca/
16 Why Teach Seniors to be Patient Safety Advocates? Aging PopulationMore Chronic DiseaseOlder adults cared for in the community by their family and friendsHealthcare being provided by a family physician, general practitioner or healthcare team.
17 Senior Empowerment and Advocacy in Patient Safety
18 Senior EmpowermentThe best way to empower older adults is to teach them to be advocates for their own safety.If you don’t do it, who will?
19 Developing the ToolAt the time we started our study we couldn’t find an instrument to assess patients’ beliefs about participating in safety activities in a primary care office setting.We wrote a grant and received funding from the National Patient Safety Foundation to develop the Seniors’ Empowerment and Advocacy in Patient Safety (SEAPs) tool.
20 Seniors’ Empowerment and Advocacy in Patient Safety Four Areas of FocusOutcome efficacy: the belief that the actions will be a benefit to one’s health,Attitudes: concerns about barriers to participating in the actions,Self efficacy: confidence in one’s ability to effectively take action,Behaviors: performance of patient safety actions
21 Seniors’ Empowerment and Advocacy in Patient Safety Developed a tool that could be used to evaluate a program that taught older adults to be advocates in their own patient safety in a primary care office settingThe tool was tested and worked well with older persons regardless of gender, race, income or education level.
22 Why Teach Seniors to be Patient Safety Advocates? Older adults are at higher risk for errors in health care:Use the health care system more oftenOften have multiple health problemsOften see several doctors for careOften take multiple medicationsOur culture teaches us not to question our doctors and until recently we’ve not been taught to take an active role in our own healthcare
23 Seniors’ Empowerment and Advocacy in Patient Safety Using the tool in the community to evaluate a community intervention with older adults about patient safety.
24 Seniors’ Empowerment and Advocacy in Patient Safety Part I: Group Educational EventIntroduction and description of medical errors in physicians’ officesStories of medical errors that occurred to real patients (misdiagnosis, mishandled records)Group discussion of participants experiences with medical error and preventable problemsDescription and training in patient safety practices
25 Patient Safety Practices PREPARING FOR THE VISITWrite down all your medical problems and questionsWrite down all the medicationsLearn more about your medical problem before going to the doctorDEALING WITH THE OFFICE STAFFTry to make your appointment the first or last of the daySpeak up to the office staff, and let them know what you wantTALKING WITH THE DOCTORGive a thorough medical historyAsk questions about what your doctor tells youAsk questions about your medications
26 Patient Safety Practices MAKING DECISIONS ABOUT A DOCTORChoose your doctor wisely by checking him/her out beforehandGet another opinion if you are not satisfied with your careChange to another doctor or office if you continue to be dissatisfied with your careAFTER THE DOCTOR’S VISITCheck the medicine at the pharmacy to make sure it is the right oneLearn all you can about your health problemsCall or visit the doctor if you don’t get lab results in a reasonable amount of timeGENERAL IDEASTrust your gut feelings or instincts about whether something is working or notGet a friend or family member to come with you to the visit
27 Seniors’ Empowerment and Advocacy in Patient Safety Individual Training SessionIntroduction and description of PACE program (Present, Ask, Check and Express) (Cegela et al, 2000)Detailed instruction in how to present detailed information to the doctorTraining about communicating about medications and keeping a medication record formTraining about communicating about tests and their results and keeping a test results recordParticipant selection of patient safety practices and PACE skills to adopt
28 The PACE Guide Sheet Present Detailed Information Describe your problems and concernsAsk QuestionsAsk doctor to repeat or clarify information that is unclear about diagnoses, tests, medications, treatmentsCheck Your UnderstandingRepeat aloud what the doctor just saidSummarize your understanding of what the doctor saidEXPRESS Concerns
29 The PACE Guide Sheet Don't Forget To: Bring all your medications, or make a list of them and how they are takenAsk for a copy of test results or procedure reportsPractice:Participant selected a patient safety practice and a PACE skill to adopt and we role-played that skill
30 Results-Participant Comments PACE helped organize their thoughts and questions before they went into the doctor’s officeHave the 2 or 3 things that they really needed to talk about because they get in the doctor’s office and forget what they wanted to askIf I can go in with a summary of what is wrong such as, “I have a pain in my upper back that started 2 weeks ago after I worked putting in some flower gardens. It hurts when I have been standing or sitting too long so I have to get up a walk every so many minutes. Tylenol has really not been helping so I tried Advil and that helped a little more but the pain still comes back”
31 Results-Participant Comments Being able to tell the doctor what happened, when, how it feels and what you’ve tried to make it better is really helpful to the doctorSupplements: Many people expressed they don’t think of their supplements and vitamins as medication. Many didn’t realize their prescription medication and the supplements they might be taking could interact with each otherOver-the-counter: Many didn’t realize the importance of listing all medications, supplements, vitamins, other over the counter medications, eye drops and so forth.
32 Results-Participant Comments Specialists: Also many made the assumption that if one doctor put them on something another doctor would automatically know that and so it was important to always bring a list of your most recent medications, supplements, etc.Testing: almost everyone expressed the same thought, “they never think to call their doctor if they haven’t heard about test or procedure results.” Almost all believed that no news is good news.
33 A Cancer Test Result“No News is Good News”Or“No News is No News”
34 Seniors’ Empowerment and Advocacy in Patient Safety We developed safety self advocacy recommendations for patients that:Covered important areas of errors and safety in primary careAre realistic and feasible for many patients to undertakeCan be taught to patients in a community settingBUT………………..
35 Results-Participant Comments Their Parting Shot…….. If we are going to activate and empower patients to be their own patient safety advocates…..We need doctors and other healthcare providers who understand and incorporate this into their clinical practices
36 Next Steps We Enter……… The Patient-Centered Medical Home (PCMH) in Primary Care
37 Patient Centered Medical Home The American Academy of Pediatrics introduced the term “medical home” in the 1960’sThe Institute of Medicine began to use the term in 2001 as one of six aims for high quality in patient-centered careThe American Academy of Family Physicians adopted it in 2004The College of Family Physicians of Canada (CFPC) recommended it in 2009
38 Patient Centered Medical Home Core ComponentsPersonal physician with whom you develop an ongoing relationshipPhysician Directed Medical Practice of a Health Care TeamWhole Person OrientationCare is Coordinated and IntegratedQuality and SafetyEnhanced Access-Open accessPayment Reform