Why patient centricity is a myth

Most health care for people with chronic conditions happens in the community, not with any clinician. Michael Gill, founder of Dragon Claw, says we need to encourage care-coordination and self-care.

The phrase ‘patient centricity’ makes us all feel good. People who use the term regularly may spend a little more time with a patient, may express a little more concern or may try and push the policy envelope just that little bit further. Thank you for this. While the direction and sentiment are laudable, the pace and scope are just far too narrow, especially in terms of those with chronic conditions.

People with chronic conditions have high errors rates in their care, poorly managed drug-to-drug interactions and conflicts with management approaches across their health care, all of which contributes to poor health outcomes[1]. Professor Libby Roughead[2] states that:

• 40% of Australians report living with three or more chronic conditions
• 80% of Australians aged 65 years and over live with multiple chronic conditions
• People with multiple chronic conditions see eight or nine different health providers a year
• People with multiple chronic health conditions will be taking more than five different medicines concurrently and many will be taking ten or more different medicines, in addition to their non-pharmacological treatments

Of the 365 days in a year most people would spend less than half a day (12 hours) dealing directly with any clinician. Those with a chronic condition may get up to four days or 96 hours and if things are not good spend time in hospital, perhaps adding another four days.  What this means is that the interaction of the person with the system for chronic conditions occurs to a rough maximum of about 2% of the entire year!

What is clear is that the patient, their carer and their family are patient centric for the remaining 98% of the year and not the clinical world. The intention here is not to devalue the contribution of clinicians or medications but to underline that:

• most health care happens in the community; and
• care provision is really about carer and patient activity aided by professional help.

The key opportunity in this dynamic is to encourage care-coordination and self-help care.  Associated with this concept is the idea of wellness instead of illness care – maximising what the person has in terms of health. We need to move the locus of control, the centre of data ownership, the management of care to be much more closely aligned with the chronic patient and their immediate carers. The implications of this are:

• Health care data and information is ‘owned’ by the patient and not by the clinic;
• Patients need to be given the tools to monitor their own health;
• Mechanisms must be developed with allow for better ways to co-coordinate both the provision of clinic care and other forms of care[3] .

I represent a group of over 22 dedicated volunteers now developing solutions to address the three points above. We are focusing on just three chronic diseases and are moving rapidly, launching our initial online approach earlier this year.

Our concept is radical in that it promotes patient centric self-care and attempts to provide coordinated care management. It does not provide medical advice. The website is designed to use online technologies to provide community and support for Rheumatoid Disease, Lupus and Juvenile Arthritis and care givers. There are no other sites in Australia like it and, we believe, only two distantly similar sites globally. The site is planned to customise the user view depending upon disease stage and the presence of co-morbidities.

0 Comments

1. 

   aitanaviejo

   September 16, 2015 at 1:16 am

   I am happy to read this post

   I am so glad to read this post, because I am worried about my health this year, and I am trying to find a good way to solve the problem. This article is really helpful.