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1st Jul

2017

Patient-Centered Care-Why It Matters

Angela Wicker-Ramos, PT, DPT, CPT-LANA recently had an interesting article published in Impact, a major physical therapy publication. Her topic of discussion was patient-centered care, which has become progressively more elusive in health care today.

The definition of patient-centered care, according to the Institute of Medicine, is “Providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.”

Dr. Wicker-Ramos and co-workers performed a survey at their clinic, asking their patients what patient-centered care meant to them, and what they would prioritize for their physical therapy care. Their patients rated the physical therapist’s expertise as the highest priority, at 22 %, followed by comfort with the therapist (18 %), cost of treatment (17 %), time spent with the therapist (16 %), ease of contacting the therapist (15 %), and ease of scheduling (12 %). The respondents also in general agreed with the mentioned definition of patient-centered care.

Research conducted by Harvard Medical School furthermore reportedly was used to create similar principles of patient-centered care, developed by the Picker Institute. Dr. Wicker-Ramos pointed out that better treatment outcomes occur, when the patient is engaged with their physical therapist, and their therapist is understanding of their preferences and expressed needs. Their patients also are more compliant with their care when they feel that they have been understood by their therapist and that their treatment plan and goals are unique to them.

As Dr. Wicker-Ramos added, delivering such care means longer sessions, where the practitioner can spend sufficient time to understand the patient, in addition to providing excellent clinical care, and providing clear information and education, as well as outlining a specific plan of care and goals, unique to the patient, while also offering physical and emotional support.

However, as the author pointed out, the traditional physical therapy clinic model makes this a challenge. Most clinicians are finding that it is becoming harder to take the time to learn about a patient’s values, preferences, and expressed needs due to lowered reimbursement rates, and “the decreased value of skilled physical therapy in the current health care model.” According to Dr. Wicker-Ramos, clinicians are often forced to double-book, shorten treatment times, and pass off treatments to technicians and aides.

She also suggested that insurance companies dictating patient care presents one of the most difficult challenges we face in health care, where low reimbursement may dictate the length of treatment sessions and course of treatment. Dr. Wicker-Ramos recognized that our current health care system is fundamentally based on insurance, and that the insurance-based clinic models allow for access to care in those with limited means, but “it may not be the solution for getting the best patient-centered care for all individuals.” She finished by suggesting that out-of network clinical care is not always more expensive, as many people today have high deductibles and copays, and furthermore, research has shown that many people value other factors as the most important when having physical therapy. I can add to this, that with longer one-on-one sessions, more can be accomplished during each visit, including an earlier introduction of a thoroughly taught comprehensive home exercise program in addition to the hands-on clinical care, and therefore, less total number of treatment sessions is required to achieve the desired results.

I want to finish by saying that it is still possible to find quality patient-centered care among insurance contracted clinics, however unfortunately this is not the norm, and you have to do your own research and interviewing with specific questions, to make sure that your needs can be met.

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