INTRODUCTION
The era of 21st century is the era of technology. Not only technology has affected our daily lives but has also entered the field of medicine. Unlike past treatments, when the patients were completely dependent upon the doctors for their recovery, the new approach of consumer centered care, focuses on building relationship with patients and providing care and support to meet the individual patient and family’s requirements and priorities. This needs a lot of understanding between the patient, his family and the doctor/nurse. There should be an in depth know how of patient’s circumstances, his culture values and preferences because all these components have a major influence on various decisions.
The term “Patient centered care” was first coined in 1969 by a British psychoanalyst, Enid Balint. Later on “patient” was substituted by “consumer” and the priorities changed accordingly like consumer satisfaction, consumer support, etc. Although there were many who protested against the use of term “consumer”, because to them “consumer” word reflected towards some kind of economic transaction.
The purpose of this essay is to outline the benefits of this approach and the methodology adopted for treatment of patients suffering from “dementia”. Dementia is a neurological disease that makes a person lose his/her cognitive ability i.e. loss of ability to think or reason properly. The most common form of this disease is Alzheimer’s disease. Patients suffering from this condition rarely seek support or care. They prefer living in their own shell. In such cases, it becomes important for the doctors to explore the nature and behavior of the patients and cure them gradually. Consumer centered care intends to take a sneak peek into the background of the patient and his family so that the treatment can be planned according to the convenience of the consumer.
DISCUSSION
Having introduced the topic of interest, we can now start defining the methodology involved in the process of consumer centered care. There are several factors that contribute to this therapy. These include- leadership, a clear strategic vision, communication amongst every member, involvement of patient and his/her family members, building a supportive and caring environment, systematic feedback as well as measurement, advanced supportive technology and high quality of physical environment.
The literature study suggests that if a physician develops healthy relationship with the patient, starts understanding his/her feelings and shows empathy and support, there is a higher chance of positive health outcome.
But yes life is not a bed of roses. There are many barriers that affect the efficacy of this caring method. Some of them are listed below:
TIME: Consumer centered care require lot of time devotion to all the patients individually, which is practically impossible.
DISSOLUTION OF PROFESSIONAL POWER: The hospital staff loses its decision making power and experiences a loss of professional status.
LACK OF AUTONOMY: The desire to work independently in autonomy is not fulfilled. Since the physicians have to take care of how the patient and his/her family react to the situation and provide the treatment accordingly, the power to take sole decisions is finished.
LACK OF CLARITY: It is not at all easy for each and every physician to start from square one and understand the patient. To adjust to such new practices, is not everyone’s cup of tea.
COMMUNICATION DIFFICULTIES: Not every patient can be expected to be an extrovert. Some patients do not feel comfortable in discussing their lives with their physicians. In such cases, it becomes really hard for the physician to build trust between the two parties.
CONSTRAINTS OF INSTITUTION: The strictness and other rules that need to be followed in the nursing institutes are not always welcomed by the patients.
But apart from these barriers, there are certain things that are literally helping this methodology of treatment to gain access in other parts of the world successfully. Some of these things include:
v Having skilled, knowledgeable, enthusiastic and willing staff, that is ready to empathize with the patients
v Opportunities for involving the service user, their family and community (for example volunteers) in health care
v Providing a platform where the staff members can express their feelings and reflect on their own beliefs and values
v Opportunities for training and education followed by feedback from the consumers
v Organizing support for practicing this strategy
v Developing an environment of mutual trust and respect
v Developing an environment that is physically and spiritually enriched
v Having empathy with the client
There are various models that have been proposed to carry out consumer centered mental health education.
Medical (patient centered medicine): It involved in depth interaction between the patient and the physician on social as well as psychological levels. The patients are explained about their illness and the treatment is also explained. One doctor is assigned to one patient and the doctors are not interchanged so that the understanding between the patient and the doctor becomes stronger. In cases where the patients are suffering from “Dementia”, the doctors encouraged their patients to ask frequent questions, told them about the available packages, talked about moods, pain, etc, provided a clear picture of their illness along with continuous support and helped them make decisions.
Nursing (person centered medicine): This approach focused majorly on humanistic qualities rather than the behavior. According to this model, trust is developed through the closeness of relationship between the nurse and the patient. This can be achieved by having an overview of the person’s history.
Occupational Theory (client centered practice): According to this model it was important to need to view man holistically, to incorporate the use of occupation/ activity and to consider the person’s life stage and role demands.
The Tidal model: It focused on the importance of understanding the needs of the person. It also emphasized on providing the patient with physical and emotional security and encouraged the staff to arrange for people who might support the patient and help him/her lead an ordinary life.
Consumer Centered Care for Dementia
Kitwood (1997) is well known for his contribution to consumer centered care for people with dementia. He developed “dementia care mapping” tool to examine the quality of treatment from the perspective of the patient. According to Kitwood there are certain principles to be maintained during the treatment of dementia, which include
v regular and structured activity at the recreational
v therapeutic and interpersonal levels
v making the patients realize their worth and value by acknowledging a person by his very own name
v negotiating with the patients and asking about their preferences
v working together
v making older people more comfortable so that they can share their feelings and express themselves
v celebrating the moments of happiness together
v providing opportunities for relaxation in solitude or in company of the caretaker
v having heart to heart conversations
v providing space for expression of grief or anger
v enabling the sufferer to do things that he/she would otherwise not be able to do
Further Kitwood identified two types of interactions that are generally done with a dementia patient- creation, where the patient can offer something like a song or dance; giving, where the patient offers a gift or any other expression of gratitude. Brooker (2004) represented this very same idea in form of an equation. He said that PCC (person centered care) = V+I+P+S, where
V= valuing people suffering from dementia
I=treating them as individuals
P=respecting the perspective of the patient
S=providing a positive social environment
Later on further surveys and studies suggested that working with family carers was an important part of the whole process of treatment (Ericson, Hellstrom, Lundh, & Nolan 2001). When the perspectives of family carers and the professional carers were compared, there was a vast difference. Professional cares, although, also aim at catering to the individual needs of the patient with dementia, there was a difference in the emphasis concerning both who has better knowledge and the role and value of institutional care. Generally the patients preferred their home for treatment.
Introduction of this approach of treatment has numerous benefits:
v It is a two way process. The number of patients have increased remarkably as they are comfortable with the new environment and also the finances of the physicians are hiking
v It is more of a placebo effect, where the illness is getting cured by the affection and understanding of the doctor
v Even the staff gets an opportunity to know about the patients
v Faster and short time treatment
There are also some patients with complex health care needs. They are a great challenge and to provide them the best services, existing primary care practices have to be transformed. Variety of strategies has now been under consideration, like integrated clinical information systems, clinical decision support and additional resources to support enhanced access (home visits). Federal health reform legislation authorized many new programs for improved execution of consumer centered care for mental illness.
Community based health teams: These teams will provide preventive care and health promotion activities at a small scale. These will basically be home based practices.
PCHMs for high need individuals: The patient centered medical home (PCMH) is a new concept that aims at strengthening primary care by changing the existing practices and bringing in improved and more advanced methodologies. These teams consist of physicians and nurses, who provide complete treatment services in patient’s homes.
Community based collaborative care networks: This section will always award grants to local and state governments, hospitals and other centres for health care.
Primary care extension centres: Health extension agents are recruited to provide information to the patients and their families.
Increased Medicare and Medicaid payment rates: According to Affordable Care Act, a special 10% bonus was paid to the staff for home visits.
Medicaid health homes: All the states, under this programme, will be funded by the government to open health homes for patients suffering from chronic illness conditions.
Medical loss ratio requirements: Depending upon the market, ACA gives a reimbursement to the staff in return for their clinical services provided to the consumers.
SUMMARY AND NEXT STEPS
After consulting and studying the literature it is safe to conclude that the engaged consumers make better choices/ decisions and avoid negative outcomes. They are able to protest against the poor health care practices. There is now a wave of awareness; people are asking for what is good for them, rather then what is good in general. Seeing the overwhelming response of the patients, several consumer engagement strategies have now been proposed:
v Develop consumer-friendly, patient centered aids to support decision making and navigation and insert them in a “justin- time” and “in-the-right-place” manner to be useful to people as they go through the health care system
v Activate consumers to become more involved in preference-sensitive decisions that affect care and quality of life and give them tools—both existing tools and new tools—that will assist them in making choices that effect outcomes and costs
v Urge providers to value, promote and embrace engaged consumers
v Educate providers about the differences in patients’ readiness, ability and willingness to participate in self-management of their chronic medical conditions; test the use of simple activation assessment tools, such as PAM, by providers; develop and test additional methods of increasing patient activation
v Develop and test different mechanisms to assist patient navigation through the health care system across episodes of care and across the continuum of health care services, then evaluate the effectiveness of these strategies in improving quality, cost and satisfaction with care in diverse patient populations and communities
v Continue to collect data on outcomes, such as functional status, health-related quality of life, patient experience and patient activation, and feed this back to providers so they can change and modify care processes
v Develop payment systems that reward providers for shared decision making, patient satisfaction and patient-centered care
v Conduct research on when engagement has occurred, under what circumstances and whether it can be translated to other settings
The closing thought of this essay can be that the medical home, where consumer centered care and mental education is provided, is a new innovation in US health market. The confluence of rising health costs, an aging and less healthy population, payment reforms shifting volume to performance and increased access to clinical information technologies that enhance coordination and connectivity between care teams and consumers suggest that the medical home will likely be a permanent, near-term fixture on the U.S. health care landscape.
REFERENCES
v Judith A. Cook, 2005, Patient centered and consumer directed mental health services.
v Marci Nielsen, Barbara Langner, Carla Zema, Tara Hacker and Paul Grundy, 2012, Benefits of implementing the primary Care Patient-Centered Medical home: A literature review.
v Medical Home 2: The present, the future, Deloitte.
v National Ageing Research Institute, 2006, What is Person centered health care.
v Robert Wood, 2007, AcademyHealth, Improving quality health care: The role of Consumer Engagement.
v Whitepaper, 2012, Coordinating care for adults with complex care needs in the Patient-centered medical home: Challenges and Solutions.
