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Patient-centered decision making improved health outcomes
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Formulating care plans on the basis of patient-specific circumstances and needs was associated with improved health care outcomes, according to data reported in Annals of Internal Medicine, from a study funded by the Department of Veterans Affairs.
“In previous research, we have found that physicians do a pretty good job of following algorithmic treatment guidelines, but most tend to overlook patient-specific circumstances that are often essential to address … appropriate care,” Saul Weiner, MD, staff physician at Jesse Brown VA Medical Center and professor of medicine at University of Illinois at Chicago, told Infectious Disease News. “For instance, if a patient is uninsured, the cost of the antibiotic may be the single biggest factor that will determine whether the patient will take the medicine. Overlooking that issue can have serious consequences.”
Saul Weiner
Weiner and colleagues conducted an observational study in which 774 patients audio-recorded their encounters with 139 resident physicians. The researchers then identified “contextual red flags” that could potentially affect the patient’s treatment. When contextual factors were confirmed, either by physician questioning or the patient volunteering information, the physicians were scored according to whether they took into account the patient context when planning care.
There were 548 contextual red flags and 208 confirmed contextual factors. The care plans were considered contextualized for 123 of these factors and inattentive to patient context for the other 85. Among the 157 encounters that had available outcomes, 96 had contextualized care plans. Among those, 68 of the encounters (71%) had a positive outcome vs. 28 of the 61 encounters (46%) with care plans that were inattentive to patient context.
“At a superficial level, these results are not surprising, and they raise the ‘psychosocial’ or ‘contextual’ aspects of care to the same level of significance as clinical findings,” Weiner said. “Just as overlooking an important physical exam or laboratory finding can lead to bad outcomes, overlooking life context can lead to bad outcomes. Getting to know your patient as an individual and figuring out how you can tailor care to their unique situation directly impacts how well they do clinically.”
In an accompanying editorial, Hanan J. Aboumatar, MD, MPH, and Lisa A. Cooper, MD, MPH, both of Johns Hopkins University School of Medicine, wrote: “Patient-centered care can become more contextualized by addressing not only the ‘who,’ ‘what,’ and ‘why’ of health care, but also the ‘who else,’ ‘what matters most,’ ‘where,’ ‘when,’ and ‘how’ of improving patient outcomes.”
For more information:
Aboumatar H. Ann Intern Med. 2013;153:628-629
Weiner S. Ann Intern Med. 2013;158:573-579.
Disclosure: Weiner, Aboumatar and Cooper report no relevant disclosures.