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BookmarkScienceDaily (Oct. 9, 2003) — COLLEGE STATION, Oct. 7, 2003 - Anyone who's ever jumped through hoops just to schedule a doctor's appointment or been bounced around by one referral after another knows the healthcare system isn't exactly consumer friendly, but a Texas A&M University professor believes a patient-centered approach would make healthcare more effective and efficient for everyone involved.
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Leonard Berry, who holds the rank of Distinguished Professor of Marketing in the Mays Business School at Texas A&M, has studied the healthcare industry and says that its future depends on a patient-centered approach. That means re-thinking how it does business.
"Patient-centered access warrants serious consideration given the stakes involved for patients, providers and payers," Berry says in an article appearing in the October 7 issue of Annals of Internal Medicine.
"Improving healthcare access is at the center of improving healthcare," Berry says.
Patient-centered access, Berry explains, refers to a patient's ability to secure appropriate and preferred medical assistance when and where it is needed. "Few concepts support all six of the Institute of Medicine's aims for the 21st Century: safety, effectiveness, patient-centeredness, timeliness, efficiency and equitability. Patient-centered access is such a concept," Berry adds.
Implementing patient-centered access, Berry explains, requires embracing three principles: working at the high-end of expertise, aligning care with need and preference and serving when service is needed.
Working at the high-end of expertise is a departure from what goes on now in the industry, Berry notes. It means that specialist physicians should do less of what generalist physicians can do, generalist physicians should do less of what non-physician providers - such as nurses and physician's assistants - can do, and non physician providers should do less of what clinical staff can do. What's more, each caregiver should do less of what appropriately instructed patients and families can do for themselves, he explains.
Berry says the application of information technology, team-provided care and alignment of skills with appropriate tasks are necessary to implement this principle. He points out as an example how the Mayo Clinic uses specifically trained non-physician providers for diabetes management after a physician conducts the initial evaluation and develops a care plan. The non-physician providers monitor the patients and involve the physician if necessary.
Another element of improving the healthcare industry involves recognizing that the current office visit model, with its allotted consultation time and face-to-face nature, often results in system overuse when patients only need to ask several quickly answered questions. It also results in system underuse when a 20-minute timeslot prevents the physician from covering all of the relevant issues with a patient, he notes.
Berry believes innovations - some of which are already in practice - such as appointments with non-physician providers, group appointments with a care team when appropriate, telephone consultations when a patient-provider relationship already exists and better use of online technology can help better serve patients and providers.
Serving when service is needed is an important aspect of Berry's patient-centered access plan. He says untimely service from a first-choice physician often sends patients to alternate providers and even emergency rooms, imposing added cost and inefficiency on the healthcare system.
Berry recommends implementing an "advanced access model," which entails having about 50 percent of appointment slots open at the start of the workday and eliminates the distinction between urgent and routine care, enabling most patients to schedule their appointments close to their own needs and timetable.
