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Thursday, January 27, 2011

What value does the patient-centered medical home bring to patients?

A prospective medical home adopter recently asked me: “What do your patients think about being part of a medical home?” I immediately responded: “They love it!” However, after thinking about this question further, my honest answer is that most of my patients do not realize what a patient-centered medical home (PCMH) is or that when they come to our office they are in one. I decided to informally survey a few patients to confirm my suspicion. The results? Only one even knew that we “were involved in some study thing ... involving the medical home.” And even this patient may only have known because we have fliers and newspaper clippings around the office about the PCMH. This got me thinking, what do patients gain by belonging to a PCMH? I came up with the following:

  • One-stop shopping for medical needs. People lead very busy lives these days and any model that helps them package things they need in one place is valuable (look at Wal-Mart, for example).
  • Continuous care with a personal physician who knows them well. According to several studies, Americans value having a personal physician. The benefits are real but are difficult to quantify.
  • Easy access to your family physician and his or her team of caregivers. Technology and improved efficiency in office processes brought about by the PCMH allow more appointments. Medical home offices ensure patients have access to these appointments in innovative ways.
  • Continuity of care between office visits and across dimensions of health care. A sense of security develops when patients know there is a stable team behind them planning for care even when that care occurs outside of the physical team environment.
  • Behind-the-scenes care. Preventive reminders and adherence to evidence-based guidelines happens seamlessly. This is why patients often don't realize they are part of a PCMH.
  • Access to improved technological management of care. Americans love technology. Medical homes use this technology to proactively organize and take more complete and scientifically founded care of patients.

We can also learn from pilots going on around the country. Group Health in Washington found that patients involved in a medical home were significantly happier with their experience. In many pilots, assessments of patient experience and opinions are lacking or ongoing. In future years, we look forward to hearing more from the center of the medical home: the patient.

–Melissa Gerdes, MD

Friday, January 7, 2011

E-mail communication with patients

We have been communicating with patients via e-mail for about a year. Since we use GE Centricity's electronic health record system our health system chose to use their platform to offer e-mail, refill requests and online appointment scheduling for patients as well. Our regional clinic piloted the software and found it easy to use. We set up clinical and clerical e-mailboxes within the clinic's system so clinical questions go to a nurse or physician and appointment requests go to clerical. Through the system, patients may e-mail a particular physician if they wish.

Surprisingly, e-mailing with patients is not commonly used, which is similar to our experience with virtual office visits. I think this correlates with phone access. If access is good, then patients are simply not incentivized to change to a new mode of communication. Patient users have a learning curve – albeit not steep – to set up a secure account and learn the software. Patients also seem to have some mistrust at first as to where their message goes. And if we do not respond quickly, there is more mistrust.

E-mail capability does offer convenience and another mode of communication for certain patients. For us, certain groups of patients are our biggest users. Those are patients who are shift-workers or are frequently out of town for work or for education. Other than these groups, we have a hard time getting patients to sign up for usage. When we query patients why they do not subscribe, the most common response is a concern about security. We explain that they must set up a password protected account; however, this seems to make the software seem more complicated than it is.

For those patients who do use e-mail, they generally ask simple questions like if they can increase a medication. They also ask if they need to come in for an appointment or exam, which helps streamline triage. The e-mail communication becomes a permanent part of the patient’s chart, which our attorneys tell us lessens our risk of claims regarding these non-face-to-face interactions. With e-mail communication, only the printed communication happened. Nothing less and nothing more was said or heard.

Everyone worries about the potential for patients who “overuse” e-mail by writing pages and pages of information for the clinician to sift through. We have found this really does not happen very often. Usually, patients' e-mails are very simple and to the point (as I find with most e-mail). For the few patients who have been very verbose and tangential, I have found that it is best to address this right away. I will either e-mail them my specific preferences for how they should communicate via e-mail or address it during their next office visit.

Our physicians have incorporated into the work flow printing an “invitation” and instructions about e-mail to nearly every patient we see as they leave the office. Even with this commitment, less than 20 percent of our patients utilize this service.

–Melissa Gerdes, MD

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About the Author

Melissa Gerdes, MD, is a family physician practicing at Methodist Family Health Center – South Arlington in Arlington, Texas, and former president of the Texas Academy of Family Physicians.

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