Seniors as Patient Safety Self-Advocates in Primary Care

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Seniors as Patient Safety Self-Advocates in
Primary Care

• Saundra L. Regan, PhD
• University of Cincinnati
• Department of Family Community Medicine
• Cincinnati, Ohio, U.S.

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Objectives of Todays Presentation

1. What are Patient-Centered Family-Centered
   Health Care?
2. What are the issues in Patient-Centered
   Family-Centered Care and why is it so important
   in Geriatrics?
3. The Seniors Empowerment and Advocacy in Patient
   Safety (SEAPs) tool.
4. What is the Patient-Centered Medical Home (PCMH)
   in Primary Care?
5. Next Steps

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Brief Description of Patient-Centered
Family-Centered Health Care
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• Health Care Is
• Physician-Centered

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• Health Care is
• Facility-Centered
• Hospital
• Clinic
• Nursing Home

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President Obama 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 dont have a
primary care physician that theyre comfortable
with, so they dont get regular checkups. They
dont 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
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Patient-Centered Health Care

• The healing relationship between physicians and
  patients and patients' families
• Grounded in strong communication and trust
• Highlighted by clinicians and patients engaging
  in a two-way dialogue
• Sharing information
• Exploring patients' values and preferences
• Helping patients and families make clinical
  decisions

Institute of Medicine's Crossing the Quality
Chasm 2001
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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 deliberationsengage 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 Nation
• Needs a Policy Push on Patient-Centered Health
  Care," Health Affairs, Aug. 2010 (29)8148995.

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Family-Centered Health Care

• Health care providers listen to, respect and
  honor patient and family perspectives and choices
• Health care providers communicate and share
  complete and unbiased information with patients,
  families, and other providers
• Patients and families are encouraged to
  participate and collaborate with their providers

http//www.familycenteredcare.org/
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Issues in Patient-Centered Family-Centered Care
and theImportance in Geriatrics
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The Aging Population
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Canadian Demographics

• Median age
• total 40.7 years
• male 39.6 years
• female 41.8 years
• Life Expectancy
• total population 81.29 yrs.
• male 78.72 yrs.
• female 84 yrs.
• Fertility rate
• 1.5 children per woman

• Total 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
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Chronic Diseases

• Changing epidemiology of disease burden from
  infectious disease to chronic disease related to
  
• Aging population
• Lifestyle factors
• Excessive calorie intake
• Diminished physical activity
• Smoking
• Alcohol

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Leading Causes of Death Ages 65 and Over

1. Cancer
2. Heart Disease
3. Chronic Lower Respiratory Disease (Chronic
   Bronchitis, Emphysema, COPD, Asthma)
4. Stroke
5. Diabetes
6. Alzheimers (75)

http//www.statcan.gc.ca/
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Who Cares for Older Adults?
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Why Teach Seniors to be Patient Safety Advocates?

• Aging Population
• More Chronic Disease
• Older adults cared for in the community by their
  family and friends
• Healthcare being provided by a family physician,
  general practitioner or healthcare team.

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Senior Empowerment and Advocacy in Patient Safety
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Senior Empowerment

• The best way to empower older adults is to teach
  them to be advocates for their own safety.
• If you dont do it, who will?

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Developing the Tool

• At the time we started our study we couldnt 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.

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Seniors Empowerment and Advocacy in Patient
Safety

• Four Areas of Focus
• Outcome efficacy the belief that the actions
  will be a benefit to ones health,
• Attitudes concerns about barriers to
  participating in the actions,
• Self efficacy confidence in ones ability to
  effectively take action,
• Behaviors performance of patient safety actions

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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 setting
• The tool was tested and worked well with older
  persons regardless of gender, race, income or
  education level.

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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 often
• Often have multiple health problems
• Often see several doctors for care
• Often take multiple medications
• Our culture teaches us not to question our
  doctors and until recently weve not been taught
  to take an active role in our own healthcare

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Seniors Empowerment and Advocacy in Patient
Safety

• Using the tool in the community to evaluate a
  community intervention with older adults about
  patient safety.

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Seniors Empowerment and Advocacy in Patient
Safety

• Part I Group Educational Event
• Introduction and description of medical errors in
  physicians offices
• Stories of medical errors that occurred to real
  patients (misdiagnosis, mishandled records)
• Group discussion of participants experiences with
  medical error and preventable problems
• Description and training in patient safety
  practices

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Patient Safety Practices

• PREPARING FOR THE VISIT
• Write down all your medical problems and
  questions
• Write down all the medications
• Learn more about your medical problem before
  going to the doctor
• DEALING WITH THE OFFICE STAFF
• Try to make your appointment the first or last of
  the day
• Speak up to the office staff, and let them know
  what you want
• TALKING WITH THE DOCTOR
• Give a thorough medical history
• Ask questions about what your doctor tells you
• Ask questions about your medications

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Patient Safety Practices

• MAKING DECISIONS ABOUT A DOCTOR
• Choose your doctor wisely by checking him/her out
  beforehand
• Get another opinion if you are not satisfied with
  your care
• Change to another doctor or office if you
  continue to be dissatisfied with your care
• AFTER THE DOCTORS VISIT
• Check the medicine at the pharmacy to make sure
  it is the right one
• Learn all you can about your health problems
• Call or visit the doctor if you dont get lab
  results in a reasonable amount of time
• GENERAL IDEAS
• Trust your gut feelings or instincts about
  whether something is working or not
• Get a friend or family member to come with you to
  the visit

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Seniors Empowerment and Advocacy in Patient
Safety

• Individual Training Session
• Introduction and description of PACE program
  (Present, Ask, Check and Express) (Cegela et al,
  2000)
• Detailed instruction in how to present detailed
  information to the doctor
• Training about communicating about medications
  and keeping a medication record form
• Training about communicating about tests and
  their results and keeping a test results record
• Participant selection of patient safety practices
  and PACE skills to adopt

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The PACE Guide Sheet

• Present Detailed Information
• Describe your problems and concerns
• Ask Questions
• Ask doctor to repeat or clarify information that
  is unclear about diagnoses, tests, medications,
  treatments
• Check Your Understanding
• Repeat aloud what the doctor just said
• Summarize your understanding of what the doctor
  said
• EXPRESS Concerns

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The PACE Guide Sheet

• Don't Forget To
• Bring all your medications, or make a list of
  them and how they are taken
• Ask for a copy of test results or procedure
  reports
• Practice
• Participant selected a patient safety practice
  and a PACE skill to adopt and we role-played that
  skill

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Results-Participant Comments

• PACE helped organize their thoughts and questions
  before they went into the doctors office
• Have the 2 or 3 things that they really needed to
  talk about because they get in the doctors
  office and forget what they wanted to ask
• If 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

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Results-Participant Comments

• Being able to tell the doctor what happened,
  when, how it feels and what youve tried to make
  it better is really helpful to the doctor
• Supplements Many people expressed they dont
  think of their supplements and vitamins as
  medication. Many didnt realize their
  prescription medication and the supplements they
  might be taking could interact with each other
• Over-the-counter Many didnt realize the
  importance of listing all medications,
  supplements, vitamins, other over the counter
  medications, eye drops and so forth.

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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 havent heard about test or procedure
  results. Almost all believed that no news is
  good news.

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A Cancer Test Result

• No News is Good News
• Or
• No News is No News

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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 care
• Are realistic and feasible for many patients to
  undertake
• Can be taught to patients in a community setting

BUT..
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Results-Participant CommentsTheir 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

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Next Steps We EnterThe Patient-Centered
Medical Home (PCMH) in Primary Care
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Patient Centered Medical Home

• The American Academy of Pediatrics introduced the
  term medical home in the 1960s
• The Institute of Medicine began to use the term
  in 2001 as one of six aims for high quality in
  patient-centered care
• The American Academy of Family Physicians adopted
  it in 2004
• The College of Family Physicians of Canada (CFPC)
  recommended it in 2009

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Patient Centered Medical Home

• Core Components
• Personal physician with whom you develop an
  ongoing relationship
• Physician Directed Medical Practice of a Health
  Care Team
• Whole Person Orientation
• Care is Coordinated and Integrated
• Quality and Safety
• Enhanced Access-Open access
• Payment Reform

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THE TEAM
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THANK YOU!QUESTIONS? COMMENTS?

• saundra.regan_at_uc.edu