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General interest items edited by Janice Flahiff

Parents unclear about process for specialist care for kids

Parents unclear about process for specialist care for kids.

No recommendations, but an interesting survey.

From the University of Michigan Press Release

Answers vary about the roles of parents and care providers in referral process, according to U-M’s National Poll on Children’s Health

ANN ARBOR, Mich. – Parents vary widely in views about their responsibilities in getting specialty care for their children, according to a new University of Michigan C.S. Mott Children’s Hospital National Poll on Children’s Health.

Most children get their health care from a primary care provider, known as a PCP, but when there are signs or symptoms of a more serious illness, the PCP often refer kids to a specialist.

According to this month’s poll, it’s a common occurrence. Among the 1,232 parents surveyed in this poll, 46 percent report that at least one of their children has been referred to a specialist.

But when asked about the process of getting specialist care for their child, parents had a wide range of views, says Sarah J. Clark, M.P.H. , associate director of the National Poll on Children’s Health and associate research scientist in the University of Michigan Department of Pediatrics.

Parents are divided over who is responsible for choosing the specialist: 52 percent say the PCP and 48 percent say the parent. They also differed in who should verify insurance coverage: 55 percent say the PCP and 45 percent say the parent.

Forty percent of parents say the PCP should make sure the wait time isn’t too long for a specialist appointment, but 60 percent say that’s the parents’ responsibility.

“This poll shows a wide range of views about who is supposed to do what, so it’s not unexpected that sometimes the process doesn’t work well,” says Clark. “If a referral is delayed or it doesn’t happen at all, a child’s health can be put at risk.”

The poll also found that parents of children with Medicaid insurance coverage are more likely than parents of privately-insured children to say PCPs should be responsible for choosing the specialist, calling to set up the appointment, and verifying that insurance will cover the specialist care. Clark says this indicates that PCPs should understand that their Medicaid patients may have different expectations about their roles.

Parents also were asked to rank the importance of different characteristics of specialists, and rated the following as very important:

  • knowing how to take care of the child’s specific condition (89%)
  • having training in pediatrics (80%)
  • being affiliated with a highly-rated hospital (62%)
  • being involved in research so child has access to latest treatment (50%)
  • appointment time convenient for the family schedule (43%)
  • drive time to the specialist (38%)
  • other parents recommending the specialist (38%)

“For a parent, hearing that a child needs to see a specialist is often cause for concern. Confusion about their responsibilities for arranging specialty care can add to parents’ anxiety,” says Clark, who also is associate director of the Child Health Evaluation and Research (CHEAR) Unit.

“Primary care providers cannot assume that parents understand their responsibilities around making specialty appointments.  Clear communication — ideally, with instructions written in plain language — will help parents ensure their kids get the care they need.”

Broadcast-quality video is available on request. See the video here:http://www.youtube.com/watch?v=uif7xpr5iy8&feature=youtu.be

Full report: C.S. Mott Children’s Hospital National Poll on Children’s Health

http://mottnpch.org/reports-surveys/seeing-specialists-roles-parents-providers-unclear

 

Website: Check out the Poll’s website: MottNPCH.org. You can search and browse over 80 NPCH Reports, suggest topics for future polls, share your opinion in a quick poll, and view information on popular topics. The National Poll on Children’s Health team welcomes feedback on the website, including features you’d like to see added. To share feedback, e-mailNPCH@med.umich.edu.

Facebook: http://www.facebook.com/mottnpch

Twitter: @MottNPCH

 

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February 1, 2014 Posted by | health care | , , , , , , | Leave a comment

[Reblog] Forms do not keep patients out of hospitals

A patient having his blood pressure taken by a...

A patient having his blood pressure taken by a physician. (Photo credit: Wikipedia)

 

From the 21 October 2013 KevinMD.com article by Kathy Neider, Physician

 

Over one year ago my office implemented an EHR (electronic health record). I’ve not done a note on paper since.

Last week, a Transition of Care (TOC) document was placed on my desk with a sticky note stating: “Dr. Nieder please fill out this form so we can bill a 99496 for your visit with Mrs. Jones yesterday.”

 

I pick up two sheets of paper with multiple questions including:

  • discharge Medications: (list)
  • present Medications: (list)
  • diagnostic tests reviewed/disposition (list)
  • disease/illness education (discussion documentation)
  • home health/community services discussion/referrals: (list)
  • establishment or re-establishment of referral orders for community resources: (list)
  • discussion with other health care providers: (list)
  • assessment and support of treatment regimen adherence: (discussion documentation)
  • appointments coordinated with: (list)
  • education for self-management, independent living and activities of daily living: (discussion documentation)

Please remember, I am now on an EHR. So I am expected to document electronically first then manually fill out forms. I have no discharge summary yet from the hospital.  The medications when she left the hospital state “resume pre-admission meds.” In order for me to list what tests she had I log in to the hospital portal and look them all up. Some of them have been scanned into my EHR, some not. She had a straight forward admission for a small bowel obstruction. She declined to keep the surgeon’s appointment as she was told there was nothing he could do for her.

A TOC visit is paid at a higher rate than other visits if the patient does not return to the hospital in the following 30 days. Hence, we hold the billing until that time. My understanding of the purpose of this new code is to improve coordination of care as a patient transitions from the hospital to home. Coordination would imply that there are other individuals involved and thus there is improved communication between us.

However my staff and I bear the brunt of gathering information (which is what we normally do anyway, so I guess it’s nice because now we get paid for it).

At what point will it become incumbent upon the hospital to send me the necessary information for treating the patient now that he/she is home again? How does it follow that improving care means the primary care doctor fills out even more forms, ultimately reducing the time spent with the patient?

The form will not keep the patient out of the hospital. Communication can keep the patient out of the hospital. True coordination of care might keep the patient out of the hospital. More busy work for the patient’s primary care doctor will not. Since the order of the day is using hospitalists, it is imperative that we improve our communication systems at the time of discharge and before the patient is seen again in the primary care office. Systems must stop thinking that one more form is going to save the patient. Especially another form on my back.

Kathy Nieder is a family physician who blogs at Family Practice 2.0.

 

 

November 3, 2013 Posted by | health care | , , , , , | Leave a comment

How much guidance do patients want with their medical decisions?

by  at KevinMD.com

The following column was published on November 10, 2011  inMedical Economics.

I recently saw two patients in my primary care clinic, each with new-onset hypertension.

The first, a middle-aged executive, brought printouts from the Internet and already had researched the various treatment options for high blood pressure. During the visit, we discussed this information, and I gave my thoughts on what to do next. He considered and appreciated my input but made it clear that the ultimate decision was his.

The second was an elderly gentleman in his 70s. Again, I discussed the various management approaches and then gave my opinion on what we should do. In contrast to the other patient, he said, “I want to do whatever you suggest. After all, you’re the doctor.”

As a publisher of a social media health Web site, I’ve observed closely the growth of the patient empowerment movement, facilitated by the Web making health information more accessible. According to the Pew Internet and American Life Project, 80% of Internet users go online to research their health, and this effort gives patients a greater voice in their care. Paternalistic decision making that traditionally drove the doctor-patient relationship slowly is being replaced by shared decisions. But not all patients embrace their new decision-making role.

In a recent study from the Journal of Medical Ethics, researchers interviewed more than 8,000 patients. Almost all wanted doctors to offer choices and help consider their options, but two-thirds preferred that the final medical decision to be left to the physician.

According to Farr A. Curlin, MD, an associate professor of medicine at the University of Chicago and one of the authors of the study, “the data [say] decisively that most patients don’t want to make these decisions on their own.”

There is a spectrum of how much physician involvement patients want. Some may want physicians only to suggest and inform but leave the ultimate decision to them. Others prefer doctors to have the final say.

The only way to know a patient’s preference is through a continuous relationship where that comfort level can be developed over time. After several encounters, a clinician should have a sense of how much, or how little, direction a patient needs.

Sadly, two factors in healthcare today work against such a sustained doctor-patient relationship. One is the fragmentation of medical care. More patients are seeing not only a primary care physician (PCP) in a clinic, but also a hospitalist when admitted to a hospital, along with an array of specialists both in the hospital and the clinic. According to a New England Journal of Medicine study, Medicare beneficiaries saw an average of two primary care physicians and five specialists working in four different practices. Without knowing the patient well, each provider may differ with his or her input in the medical decision process, which can frustrate patients who may have their own ideas of how much their doctors should be involved.

Next, consider the decay of primary care itself. There is a profound shortage of PCPs, with the American College of Physicians noting that “primary care, the backbone of the nation’s healthcare system, is at grave risk of collapse.” Patients who cannot schedule timely primary care appointments go to the emergency department, where they encounter clinicians they’ve never met before. The shortage is compounded by what is shown in the results of an Annals of Internal Medicine survey, which revealed that 30% of PCPs were likely to leave the field, citing burnout from time pressures, a chaotic work pace, and little control over their work. Both the shortage and attrition of primary care providers worsen the odds of forming long-term relationships with patients.

Having known my two patients with hypertension for years, I anticipated how much physician involvement they would need to make a treatment decision and was able to tailor my approach to meet their individual expectations. During this turbulent period of healthcare reform, we cannot lose sight of the importance of a continuous relationship between doctors and patients. Otherwise, our fragmented health system and deterioration of primary care will make it challenging to provide the proper amount of guidance for patient medical decisions.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

Related Resources

The internet has changed people’s relationships with information. Our data consistently show that doctors, nurses, and other health professionals continue to be the first choice for most people with health concerns, but online resources, including advice from peers, are a significant source of health information in the U.S.

Abstract

Background Although medical ethicists and educators emphasise patient-centred decision-making, previous studies suggest that patients often prefer their doctors to make the clinical decisions…

Conclusions Almost all patients want doctors to offer them choices and to consider their opinions, but most prefer to leave medical decisions to the doctor. Patients who are male, less educated, more religious and healthier are more likely to want to leave decisions to their doctors, but effects are small.
Choosing Wisely™ aims to get physicians, patients and other health care stakeholders thinking and talking about the overuse or misuse of medical tests and procedures that provide little benefit, and in some instances harm.

December 26, 2011 Posted by | Consumer Health | , , , , | Leave a comment

   

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