IT IS self-evident that we should build health services around the needs of the patient, isn’t it?
But this becomes all the more compelling when we consider the evidence: approaches to person-centred care such as shared decision making and self-management support can improve a range of factors in addition to patient satisfaction such as care quality and health outcomes. When person-centred care practices like these are adopted, people tend to choose less invasive and costly treatments because they have been informed and supported in their decision making.
And it’s good for health professionals too: there’s a positive relationship between levels of patient engagement and staff performance and morale.
We have seen our policy makers and health system drift towards a preoccupation with organisational efficiencies and budgets. These are important, but not as important as the needs of patients for individually-tailored attention. While Medicare is embedded in our health landscape and its current design effectively funds episodic care, relatively little attention has been given to how to better meet the needs of the more frequent users of the system: patients with chronic and complex conditions.
Health Care Homes provide us with an opportunity to transform the primary health care landscape. A key aspect of this will be better supporting patients to be active members of the health care team. This means enabling consumers to voice their experiences and for these to be used to underpin integrated care and drive improvement in services.
Two strategies that need to guide this focus are patient reported outcome measures (PROMS) and patient reported experience measures (PREMS). The former gauges measurable outcomes of care, the latter perceptions of experience with health care or service.
Raj Verma, from the NSW Agency for Clinical Innovation, has produced an overview of what PROMS and PREMS do. As Raj Verma says, PROMS and PREMS allow patients to provide direct feedback on their care.
PROMS record a person’s perception of their health using validated generic and disease-specific tools to measure symptoms, distress or anxiety and unmet needs.
PREMS, on the other hand, capture a person’s perception of their experience with health care or service including wait times, access to services, communication and support in managing a chronic condition.
These frameworks provide a basis for consistent and transparent information relevant to clinicians and consumers.
For the individual, PROMS and PREMS can help improve quality of care by informing care planning and management.
For the health service, these measures identify what’s working well and where there are areas for improvement.
For the health system, the measures provide a way of evaluating integration and outcomes.
By providing these measures of care and experience we can develop a consumer-centric approach which not only encourages patients and consumers to engage actively in care decision making, but also stimulates the clinician to take more account of and act on the individual needs of the patient.
The most effective therapies and population health strategies are obviously those which individuals understand and respond to.
The individualised trend is also being fuelled by advances in health and information technology, which enable people to respond to their own specific health needs, such as patient-controlled eHealth records or do it yourself diagnostic technology.
Another innovation developed by the Consumers Health Forum of Australia, which can strengthen systems aimed at maximising the lesson of patient experiences, is the Real People, Real Data project.
This is a cost-effective and easy-to-use tool for capturing and analysing consumer narratives of health, illness and the health system. The aim is to equip health services and consumers with a relevant and practical process that gathers and analyses consumer stories, using the evidence base to inform health decision making.
Health Care Homes should represent a new and innovative chapter in the development of integrated, person-centred health care.
While clinicians and health services may resist patient-focused feedback arrangements as being too much of a drain on resources and staff time, this does not need to be so if the reporting system can be made simple and systemised with the help of information technology.
It is time for health care to catch up with the contemporary realities of consumer-centric services made possible by the internet and information technology in virtually every aspect of modern business.
Why not in health care where individual attention and response is so vital to effective care?
Leanne Wells is the Chief Executive Officer of the Consumers Health Forum of Australia.
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