08.04.2015
Institut für Hausarztmedizin
Institut für Hausarztmedizin
The Patient an important driver for change
in healthcare
Chronic Diseases
The epidemic of the 21. Century
60% of all diseases
43% of population
Prof. Dr.med. Claudia Steurer-Stey
70% of patients > 65
Leiterin Chronic Care
80% of GP consultations
Institut für Hausarztmedizin der Universität Zürich
70% of costs
mediX Gruppenpraxis und Medizin im Schauspielhaus
Institut für Hausarztmedizin
Institut für Hausarztmedizin
Chronic Disease
“HAMSTER CARE”
Across the globe doctors are
miserable because they feel
like hamsters on a treadmill.
They must run faster just to
stand still…The result is a
reduction in the quality of
care and an increase in
burnout among doctors.”
Gaps in quality care lead to morbidity and mortality
Best practices could avoid millions of sick days and billions in lost
productivity
Patients and families increasingly recognize the defects in
Morrison and Smith,BMJ
2000;321:1541
their care.
Bodenheimer and Pham, Health
Affairs 2010;29:799-805;
Dyrbye, JAMA 2011;305:541
Uncoordinated, fragmented System
Institut für Hausarztmedizin
Orthopedist
Cardiologist
Patient
The Chronic Care Model (CCM) is an evidence based
framework with 6 central elements for the provision of
high quality care to patients with chronic disease leading
to better outcomes
Endocrinologist
Gastroenterologist
Dermatologist
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08.04.2015
Institut für Hausarztmedizin
Institut für Hausarztmedizin
With chronic disease
The role of the patient changes
The patient inevitably becomes a principal
caretaker
Preparation for that role is necessary
www.improvingchroniccare.org
www.hausarztmedizin.uzh.ch
Institut für Hausarztmedizin
Chronic disease
The role of the patient as a central
Institut für Hausarztmedizin
Participation and Partnership
instead of
Paternalism and Priests
caregiver on the health care team has to receive
more attention
Institut für Hausarztmedizin
Institut für Hausarztmedizin
Patient Partnership
The Expert Patient: A new approach to chronic
disease management for the 21st century
‘The Expert Patient programme is not simply about educating patients about
A partnership of patient physician/healthcare team
Their condition or giving them relevant information. Neither is it based on a
that embodies a central role for the patient is the crux of
model of care whereby a health professional educates or instructs a patient
and then measures success on the basis of patient compliance.
appropriate care for chronic disease
It is based on developing the confidence and motivation of
complementary knowledge and reciprocal responsibilities
(shared decision,empowerment)
the patient to use
their own skills, information and professional services
to take effective control over life with a chronic condition.
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08.04.2015
Institut für Hausarztmedizin
Institut für Hausarztmedizin
Patient-team partnership
The engaged patient
«the block buster drug» of the century
• Hospitalisation rate
• Emergency visits
• Costs
If people don’t want to do
something,
or think they are not able to do it
they won’t do it!
Institut für Hausarztmedizin
practice evidence-based medicine
Help patients to gain the knowledge,
skills, and confidence to be informed,
active partners in their care
• Quality of life
Institut für Hausarztmedizin
Stories of success
“Physicians and hospitals are paid more for
complications and acute deteriorations of chronic
diseases than for proper patient engagement and
management to prevent complications
Heartfailure
“The rewards in payment system are
perverse…..”
Diabetes mellitus
Arthritis
Leatherman S. 2003 Health affairs; 22: 17-30
COPD
Asthma
“ Switzerland needs more chronic care teams
Depression
if tackle growing burden of chronic disease
Stafford N. BMJ 2011;343 OECD reviews of health
sytems
Institut für Hausarztmedizin
Institut für Hausarztmedizin
The new era of patient engagement
Partners and phones “My smartphone doctor”
 > 90’000 Health Apps
• Google Health, Microsoft
HealthVault, patientslike,
23andme
• Blessing or evil?
• Personal data business,
market
08.04.2015
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08.04.2015
Institut für Hausarztmedizin
European Patient Forum www.eu-patient.eu
Institut für Hausarztmedizin
Patients have influence “Angelina Jolie Effect”
Attempts and a chance to encourage politicians and policy-makers to commit to a
healthier Europe where patients are part of the solution to make health
systems more effective and quality-oriented.
Institut für Hausarztmedizin
„Care delivery value chain“
Institut für Hausarztmedizin
PROMS (Patient reported outcome measures)
could help transform Healthcare
• « Dedicated teams: maximum value in care delivery
• Tight coordination of care over the fully care cycle
• Sharing of patient information »
• Considering patient views
seek to ascertain patients’ views of their symptoms,
their functional status, and their health related quality of
life
measure health by comparing a patient’s health at
different times
the outcome of the care received can be determined
Porter and Teisberg, Redefining Health Care 2006
Institut für Hausarztmedizin
Why consider patients’ views?
Black N BMJ 2013;346:f167
Institut für Hausarztmedizin
The Patient an important driver for change in healthcare
Most healthcare aims to reduce symptoms, minimise disability, and
improve quality of life—these are aspects that only patients can assess
Patients welcome being involved, and this may have health benefits in
itself
Patients’ response rates are invariably better than clinicians’ (a patient
only has to complete one questionnaire whereas a clinician has
to do it for every patient)
The measure avoids observer bias (inevitable if asking clinicians to
assess their own practice)
THE
DOCTOR
WILL SEE
YOU
NOW
Considering patients’ views increases public accountability of health
services and healthcare professionals
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