My patient and I had spent most of the 45-minute appointment discussing the challenges of living with diabetes and some ways that he could begin changing his eating and exercise habits. I started to wrap up the visit and asked him, “Which of these changes can I follow up with you about next week?”
He looked at me incredulously and said, “You are supposed to tell me what to do: I’m not a doctor!”
I am not a doctor either, but as a nurse, my role as patient care provider, advocate, and educator does not mean I simply tell patients what they should do. The primary care clinic where I work has implemented innovative care strategies as part of the Patient Centered Medical Home Initiative (PCMH). These changes are exciting and challenging and put us on the front lines of a national movement. Every member of the team at my clinic is key to our model as each one has a role to play in the patient’s health journey.
Nurses play an important role in this model as they provide care and engage with patients in many different ways, including helping patients make sense of the evaluation they receive from the doctor, triaging patients’ medication issues and coordinating information among providers. In short, nurses give patients the knowledge they need to create health care goals and make decisions about the care they receive. But patients play an equally important role.
The patient-centered model puts the patients in the central role, arms them with the health knowledge and support that they need, and empowers them to make informed decisions about their own medical care. As the PCMH becomes the standard of care in the United States, patients will be in charge of the goals and direction of their care. Patients are gaining responsibility in systems in which, until now, they have had a limited role. As provisions of the Affordable Care Act continue to go into effect over the next several years and the PCMH model becomes more common, it is critical that patients are educated and brought in as willing team members and leaders in the health care system through the efforts of health care staff.
When a clinic makes the transformation to become a PCMH, “buy-in” on the part of everyone involved in the model is critical. That is, buying in to the methods of the clinic and supporting the changes being implemented, while providing feedback as necessary. In addition to staff buy-in, however, patient buy-in is crucial to care delivery transformation. We are finding that while the staff at the clinic is often excited about the changes, patients do not always understand the goal of these changes and why we want them to play a central role. To achieve this buy-in, we need to educate patients on the efforts of the clinic and on this new model of care. This element is crucial to the success of the PCMH model!
The process improvement team at our clinic has started several initiatives to engage current patients in the new medical home model. The team has sent letters to patients explaining the changes and the benefits to their care that these changes offer. And staff training has prepared everyone to explain these changes effectively. As the model takes hold across the country, we cannot take for granted that patients will fall in line. The objective is more patient-centered care, so we must take deliberate steps to get the patient on board first.
The patient whom I described above has made great strides towards becoming a decision-maker in his care plan. He has taken more control of his chronic disease and is very proud to tell me about his goals, including dietary changes and increased exercise. He says that he has learned more about diabetes and how to live with it in the past several months than he ever had before. Even though he is not a doctor, he has embraced his position at the center of his health care team.
Amberly Killmer is a nurse who blogs at Primary Care Progress.
