What Does People Centered Health Really Mean?

There's been a lot of talk about "people centered health," but my impression is that there's not a really clear definition of the term. In this post, I'm going to attempt to have a go at a defnitiion. Neverthleless, my attempt is really to solicit some opinions and help in defining this. I'm concluding this post with my take on what are the "revolutionary" components of people centered health in the hopes of soliciting comments that can clear this up for me and others.

Perhaps not a definition, but a recent article by Joe Flower for the Center for Health Design, sheds some light on the subject:

Most physicians and health professionals agree that Mr. Elswit’s perception is typical: Sick people are treated
in effect like prisoners in many health-care settings. The people-centered health-care movement responds to this chronic neglect of the patient experience by proclaiming a call to arms. Hospitals, say leaders of this movement, should never add to the pain and trauma of being sick or injured.

There is no shortage of low-cost opportunities to build a better patient relationship. Some peoplecentered
practices are clinical, including the enforcement of such fundamental (but too often forgotten) measures as having doctors and nurses wash their hands between treatments, installing better ventilation in hospitals,
and responding reliably to the call button. (In a 2004 study of hospital accidents, the Center for Health

Design found that a major cause was patients struggling out of bed, alone, to go to the bathroom because no one showed up to help them.) Other innovations provide simple dignity: giving patients hospital gowns with
Velcro closure tabs or straps, for modesty; or training staff to answer telephones by the third ring, to knock
before entering a patient’s room, and to introduce themselves and explain what they’re there to do.

My impression is that there's real ambiguity with respect to this term. The problem with this is that the term can be used to push programs or agendas, leading to cynicism. I've seen doctors roll their eyes when they here this term. Not because they don't want change (they do), but because they've seen initiatives (under this guise) which have very little to do with improving care and more to do with hidden agendas. Even though there've been committed efforts to define what this is, it's not easy to really get handle on the meaning of this term (or phrase). Fortunately, the World Health Organization recently had a go of defining the core values of "people centered health:"

Empowerment
Participation
The central role of the family and community in any process of development, and
An end to gender and all other forms of discrimination.

WHO goes on to admit that, "Despite its long history and increasing popularity, people-centred health care has not been satisfactorily and collectively enunciated at the health system level." WHO goes on to describe the characteristics of such a system from the viewpoint of each stakeholder:

For individuals, patients and their families:

Access to clear, concise and intelligible health information and education that increase health literacy;
Equitable access to health systems, effective treatments, and psycho-social support;
Personal skills which allow control over health and engagement with health care systems: communication, mutual collaboration and respect, goal setting, decision making, and problem solving, self-care; and
Supported involvement in health care decision-making, including health policy.

For health practitioners:

Holistic approach to the delivery of health care;
Respect for patients and their decisions;
Recognition of the needs of people seeking health care;
Professional skills to meet these needs: competence, communication, mutual collaboration and respect, empathy, health promotion, disease prevention, responsiveness, and sensitivity;
Provision of individualized care;
Access to professional development and debriefing opportunities;
Adherence to evidence-based guidelines and protocols;
Commitment to quality, safety and ethical care;
Team work and collaboration across disciples, providing co-ordinated care and ensuring continuity of care.

In health care organizations:

Accessible to all people needing health care;
Commitment to quality, safety, and ethical care;
Safe and welcoming physical environment supportive of lifestyle, family, privacy and dignity;
Access to psychological and spiritual support during the care experience;
Acknowledgement of the importance of all staff - managerial, medical, allied health, ancillary – in the delivery of health care;
Employment and remuneration conditions that support team work people-centred health care;
Organisation of services that provide convenience and continuity of care to patients;
Service models that recognise psycho-social dimensions and support partnership between individuals, their families and health practitioners.

In health systems:

Primary care serves as the foundation;
Financing arrangements for health organisations that support partnership between health practitioners and people accessing health care;
Investment in health professional education that promote multidisciplinary team work, good communication skills, an orientation towards prevention, and integrates evidence about psychosocial dimensions of health care;
Avenues for patient grievances and complaints to be addressed;
Collaboration with local communities;
Involvement of consumers in health policy;
Transparency.

Conclusion

I highlighted in red the items which, for me, are the clearest components that can provide a notable change in health care. First off is giving people (patients) access to quality health information. This is easier said than done for we need to define what quality means (e.g., not skewed towards the Pharma view, etc.). Secondly, there's a holistic approach to delivery of health care. This could be quite revolutionary if we include alternative medicine (e.g., herbal medicine, acupunture, etc.) as a valid component of health care delivery.

Teamwork and collaboration (as equal partners) among various stakeholders such as doctors, ancillary staff, etc. combined with a focus on continuity of care seems to me as something that easier to state and much, much harder to execute. Last but not least are transparency and recognizing the importance of Primary care in the whole process.

These concepts are easy to put in a blog post. Nevertheless, I've been around enough doctors (e.g., Dad and brother) to know that these changes are extremely hard to imagine. Why am I writing about all of this? The reason is that I really believe (am I naive?) that the web presents a tool that can really drive these changes. How exactly can this tool (web) drive something as complex as change in health care? I'll leave that for my next post. :)

Presidential Debate and Health Care

As I wrote in the last post, it's pretty telling that my (unscientific) poll showed that most people are pretty pessimistic about any improvements to the health care system in the US (at least in the near future). This is pretty notable considering the hieghtened attention given to this topic during the recent presidential debates.
Although the economy seems to be trucking along at a decent pace, there do seem to be some pretty ominous clouds on the horizon if one takes into account how broken the health care system is, the mounting national debt (more than 50% GDP) and miscellaneous obligations (e.g., Social Security, Medicare, Medicaid, etc.). I'm no economist, but if this were a household, I don't think it'd be considered too stable.
If the country were a household and the primary bread winner lost her/his job, it'd be in a heap of trouble. A comparable situation would be if China and Japan decided to stop financing our debt by not purchasing anymore T-bills.
This all reminds me of the Jack Nicholson movie with the memorable line, "What if this is as good as it gets?" I mean, we all assume that, eventually, the health care system is going to get better. It's a key issue in the presidential election. Things have to get better, right?
But, what if this is really "as good as it gets?" How pessimistic should we be? Or is there really reason to be optimistic and believe that access to, quality and cost of health care are really going to move in the direction that we desire?

Unscientific Web Poll on Uninsured

First of all apologies for the lack of posts these past few months, but I've been considering expanding this concept of looking for new ideas on health and health care to a more advanced platform.

I started this blog to share what I've been reading or learning about health, but my main objective is to learn more from others. In order to accomplish this, I'm going to start posting more often and, hopefully, I'll get some more interesting feedback.

Nevertheless, I'm thinking of expanding beyond a blog and creating a site for people with the same needs as myself. Specifically, though I know there are a lot of websites devoted to Health care, I'm actually looking for something with more of a point of view (e.g., not so pro-Pharma and a bit more open minded). Any ideas would certainly be welcome on this.

On another front, I conducted a small, unscientific web poll soliciting a prediction on the number of uninsured Americans in the future and came up with the chart at the top of this post. For the most part, people would seem to be pessimistic (I'd count myself among them) about the future of the uninsured in America.

Even more interesting, the female respondents (70 out of the 200) were more realistic/pessimistic since 77% of these (compared to 71% of males) feel that the number of uninsured will increase. Even more interesting is the fact that 100% respondents in the 35-49 age group concur with the mayority of respondents (that the number of insured will increase).

Looking forward to your comments. :)

Globalization + Health Care Crisis = Medical Tourism

An interesting article came "across the wire" today about outsourcing some medical procedures globally. The gist of the article is that, considering factors such as the 46 million uninsured Americans, options such as getting medical procedures performed overseas are starting to look better and better.

The article talks about the positives and negatives (e.g., risk) of medical tourism. It goes on to mention the tale of a 60 year old Oklahoma woman who needed a hip replacement ($40,000 in the states) for which her employer (Coldwell banker) supported her in selecting an alternative option: surgery in India. According to the article:

"In addition to saving thousands — the three-week trip totaled about $12,000, including the surgery, travel and lodging for two and a tour of the Taj Mahal — she also underwent a new technique just approved this year in the U.S."

There seems to be more and more reporting on this subject. This article follows a recent article in Business 2.0 about the same topic. This article affirms that, "This year alone, upwards of 500,000 Americans are expected to travel overseas to get their bodies fixed, at prices 30 to 80 percent less than at home."

According to testimony given before the senate in June of this year, the savings for procedures performed in countries such as India can be substantial. For instance, heart bypass surgery costing between $55,000 and $86,000 in the U.S. would approximately $6,000 in India. Obviously, there are risk issues that need to be considered, but the aforementioned Oklahoma woman's comments are noteworthy, "It's either that, or do it in the States for $28,000 to $40,000," she said. In the U.S. do you not sign forms? They're not responsible. The risk of it didn't really weigh on me."

All of this really, makes one stop and consider where this could all go. What this tells me is that the players within the current U.S. health care system (e.g., hospitals, doctors, etc.) drag their feet (in addressing the health care crisis) at their own peril.

There are a lot of issues to consider with respect to medical tourism and there is no shortage of websites and blogs that address these such as:

Surber's Old Columns
Global Surgical Solutions Blog

What's your take on this?

Getting up to speed on health care reform

Dr. Mike Magee has an excellent blog on his Health Politics website where he ably discusses topics related to the current and future U.S. health care system. He also has a series of podcasts which are extremely well done and informative.

For instance, one of these discussed the history of our health care system and how it came to be mostly employer funded. Nevertheless, I want to mention the one entitled "Building Tomorrow's Health Care" which touches on the coming transformation of the U.S. National Health Care system. Dr. Magee specifies two characteristics of the coming transformation, mentioning that it will be:

1) Home Centered - Educational Empowerment and behavior modification.
2) Influenced by Information Technology - communication between patients and caregivers.

What's interesting according to Dr. Magee is that the typical power players (e.g., insurance companies, hospitals, etc.) are not calling all the shots. Non-traditional players could play a very strong role in the future. These include:

1) Technology Firms - Intel, Phillips
2) Banks - Offering Health Savings Accounts (HSA)
3) Governmental municipalities - San Francisco, Philadelphia, Chicago, Boston

Hope you tune into this website, podcast, blog and let me know what you think.

Public Health: The impact of social networks

Dr. Tom Valente is doing some interesting work investigating the effect of social networks in influencing behavior from a Public Health perspective. This relates to the study of doctor behavior when prescribing treatments (heavy influence from peers) as well as patient behavior. I was listening to some interesting podcasts from the University of Washington School of Public Heatlh.

Thomas Valente is Associate Professor and Director of the MPH Program, Preventive Medicine, Keck School of Medicine, University of Southern California. In his talk, he touched on collaborative diffusion of behavior and the key influencing factors. What I really liked was his introduction on the topic of social networks.

For instance, one hears much about social networks related to the Internet and sites such as MySpace and Facebook. Nevertheless, Tom makes an excellent point that the study of social networks dates back many decades.

Tom talked about the fact that, in order to promote change, social networks and, what he calls “collaborative diffusion,” are of paramount importance. What makes this so interesting within today’s context is that today’s Internet technologies (e.g., collaborative networks) can pretty much turbo-charge the exact factors which Tom highlighted as key to promote a more relationship-based healthcare and wellness system.

You can download the podcast by right clicking here and selecting to “save target” to your hard drive. You can then listen to this with your computer or your portable MP3 player.

The University of Washington has an excellent series of podcasts listed here.

Health information you can rely on

The Pew Internet Project just released a study concerning the way consumers search for health information on the Internet. Even more important, is the surprising data point stating that although health topics are one of the most popular searches by US users, only 15 % of consumers who search for health information "always" check the source of the information that they find.

A full copy of the report can be downloaded by clicking here.

Some other interesting answers given by those surveyed concerning their experience searching health topics on the Net:

• 35% said that the information affected their decision about seeing a doctor.
• 74% said that they felt reassured that they could make appropriate health care decisions.
• 51% said that they were eager to share their new health or medical knowledge with others.

The last point about sharing information is key because this is where web 2.0 technologies (upon which today's Internet is built) can be most effective. What's interesting about all of this is that this information lends credence to the thesis that web 2.0 technologies have a place within a new, people centered vision for health care.

The astonishing part is that users don't really check the source (or date) of the information that they're looking at. Nevertheless, I've gotta believe that, given options, users will value information provided by alternate sources. Specifically, wouldn't it be great to get different points of views on specific health conditions which aren't all based on purely scientific or "traditional" medical points of view? Even more, how about if users could get some type of "evidence-based" research to back it up?

I mention these because they are all possible using current web 2.0 techniques. I really wonder whether there is any interest in applying these technologies to such a problem when so few people seem to investigate the sources of the information they find. If you can, please let me know your opinion.