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Putting patients at the centre of primary care

It’s one of the great catchphrases of the modern medical curriculum – but what does patient-centred care actually look like in practice?

We recently brought you the patient-centred medical home model, a focus for primary care reform in the United States, and examined whether and how it could work in Australia.

This week, The George Institute and Consumers Health Forum of Australia are holding a panel on consumer-focused healthcare models and the role of innovation, so this longread from the Commonwealth Fund is timely.

The Commonwealth Fund piece looks at a handful of healthcare companies who have shirked the traditional medical model in various ways, with a particular focus on delivering care to patients with chronic or complex needs.

It’s worth reading the whole article, but some features that were of interest include:

  • an emphasis on multidisciplinary teams including physicians, nurse practitioners, social workers and case managers (typically an RN) or a ‘health coach’ (community health worker), as well as specialist visits on-site and complementary therapies such as acupuncture, yoga and tai-chi
  • provision of care outside of clinics, often in patients’ homes, as well as use of telemedicine and e-health to do ‘virtual rounds’
  • additional supports tailored to the patient eg free transport, mobile phones to stay in touch with their care team
  • use of tracking technology eg self-directed at-home monitoring of blood pressure, pulse oximetry, weight and other parameters including regular wellbeing surveys, which are linked into the practice’s central database via tablet
  • on-site pharmacies allowing medicines to be handed to the patient by their doctor during the visit, with explanations on how to take it, and how it works

Data suggests these models work, bringing down ED visits, hospital admissions and length of stay, and improving drug understanding and patient-doctor communication.

Getting more meta still, the piece also looks at ‘population health management companies’ who are contracted by primary care practices to manage high-risk patients, in a bid to improve outcomes.

Lots of food for thought ahead of Thursday’s #innovatehealth forum — we look forward to the debate.

Comments 2

  1. Tim Senior says:

    It’s worth observing that the closest we get to this sort of model in Australia currently is the Aboriginal Community Controlled health Service model. We often look at Aboriginal and Torres Strait Islander health as if it’s a special case for difficult circumstances, when perhaps we should be looking at it as the model for the rest of the Australian health service.

  2. Vern Hughes says:

    The misuse and abuse of the concepts of ‘person-centred’ and ‘consumer-centred’ health care are now rife. The ‘patient-centred medical home’ model, to be trialled amongst 65,000 consumers, is a good example. This is a doctor-centred model, and not a patient-centred model. Under this scheme, doctors are to be remunerated by the Commonwealth for coordinating the care of illness-specific categories of consumers, seemingly based on the rationale that there are savings to be made by restricting fee-for-service payments to multiple practitioners and replacing these by lump-sum payments to single GPs to cover multiple episodes of care. The information, payment and service design features of this model are doctor-centred. Whatever the advantages of this approach, it cannot be called anything other than a doctor-centred model.

    Hijacking the language of ‘patient-centred’ for continuations of provider-centred systems is smart manoevring by medical industry interests, but there can be excuse for governments to collaborate in this hijacking. Consumer-centred health systems are simply systems in which information systems, financing systems, service design and governance are centred in consumers and not in providers. If you have a continuation of provider-centred information systems, then you do not have a patient-centred practice. If funding systems remain under the control and direction of providers, you have a provider-centred system and not a patient-centred system.

    Contests for control of the ‘patient-centred’ language will continue for the forseeable future. We await the emergence of some political leadership in health care that can honestly distinguish between consumer-centred systems of health care and provider-centred systems.

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