quality care Engaging patients for better treatment outcomes - PowerPoint PPT Presentation

Systems for patient-centered care Protocols & systems to deliver high quality care Engaging patients for better treatment outcomes Dhivya Ramasamy

To make eye care work, we need the patient to… Follow up visit Self Care Treatment Acceptance of Advice Diagnosis & Advice Seek Care

How many of our patients effectively complete their Glaucoma patients’ treatment? adherence to essential Fewer than 20% of annual review visits patients receiving drops to less than 30% Acceptance of spectacle prescription by the fourth year cataract surgery is in outreach camps reported to be a actually procure Fewer than 15% mere 14% in the spectacles of diabetics are community and 45% aware that they in hospital based Follow up must have their settings eyes tested Self Care regularly Treatment Compliance with Acceptance wearing spectacles of Advice among school Diagnosis children remains as & Advice Seek Care low as 30% Venkataswamy G, Brilliant G, Social and Economic Barriers to Cataract Surgery in Rural South India: A Preliminary Report; Visual Impairment and Blindness; Dec 1981 T Snellingen, B R Shrestha, M B Gharti, et al. Socioeconomic Barriers to cataract surgery in Nepal: the south Asian cataract management study; Br J Ophthalmol 1998 82: 1424-1428 Gogate P, Mukhopadhyaya D et al. Spectacle compliance amongst rural secondary school children in Pune district, India. India J Ophthalmology 2013; 61:8-12 Sleath B, Blalock S, Covert D, Stone JL, Skinner AC, Muir K, Robin AL. The relationship between glaucoma medication adherence, eye drop technique and visual field defect severity. Ophthalmology 2011 Dec; 118(12):2398-402

Ensuring that patients complete their treatment process Follow up visit Self Care Treatment Acceptance of Advice Diagnosis & Advice Seek Care Right Diagnosis?

Barriers to effective service delivery To the provider To the patient  Lack of integration within  Poor access Owning the problem: the eye care system  services are not affordable  Lack of trained manpower  lack of a support system How can we address these barriers that  Poor awareness  Low demand  Poor patient compliance to  about the services available affect effectiveness of eye care treatment advice  about their own eye condition  Poor uptake of services services?  misconceptions  Lack of regular follow up  fear  Lack of community  Lack of confidence in the leadership in support and provider promotion  poor previous experience  Lack of policy support  lack of comprehensive  Preference for free services services  no perceived improvement in condition

Within the Hospital Follow Aware of Seek up / one’s eye Eye Diagnosis Treatment Recovery Self- condition Care care PROVIDING INFORMATION Health education Counselling ENABLING COMPLIANCE Make it accessible Enabling compliance. Examine the & affordable barriers ENSURE PATIENT CENTERED CARE Ensuring positive patient experience

Patient Centered Care Dhivya Ramasamy

Patient Centered Care • Patient at the centre of service design & care giving process • Making services affordable • Patient friendly systems & facility • "Providing care that is respectful of and responsive to individual patient preferences , needs & values • Ensuring that patient values guide all clinical decisions ."

Demystifying PATIENT CENTERED CARE

Patient Centered Care :10 Goals 1. Creating Access for patient care 2. Maintaining dignity & Being responsive to patient needs 3. Enabling informed decision making 4. Getting proper informed consent 5. Transparent pricing & Minimizing cost of the treatment 6. Ensuring follow up for all category of patients 7. Ensuring & Facilitating patient feedback 8. Ensuring availability of appropriate patient amenities 9. Patient is always right 10. Putting in place a process of continuous improvement

Goal 1 CREATING ACCESS FOR PATIENTS

Patient at Aravind Vision Centre, Manamadurai: “When elderly patients have to visit the Madurai hospital they need to have someone to accompany them. But one can come alone to the Manamadurai clinic. It is very useful to have this clinic here”

Emergency Patient at one of our Vision Centres: ID Card 4 km

Creating Access for Patient Care • Have the hospital / clinic open from 7.30 am to 6.00 pm – Round the clock Emergency care • Ensure vulnerable patients & who need emergency care are given priority – Young infants, Elderly, Bilateral blind, Physically challenged – Availability of wheel chairs / stretchers

Creating Access for Patient Care • While referring to other clinics, inform the patient about the need & document the reason for referral • While referring to other clinics give the option of timing to the patient • Avoid appointments for treatment, unless requested by the patient • Appointments on days convenient to patient

Goal 2 Maintaining Patient’s dignity & being responsive to patient needs

Being “Present” Daycare Patient: “It was around 1:00pm and it must have been their lunch time. They said what they had to say very rapidly – as if they had to finish saying what they wanted to say – not really caring about us”

Avoid Labeling Patients

Maintaining Dignity & Being Responsive To Patient Needs • Minimize waiting time – While advising review visits, document required investigations to be done on arrival • Inform the patient - if care will be delayed, location of clinics etc. • Identify specific areas of our service that require patient information

Monitoring waiting time

Monitoring waiting time

Monitoring waiting time

Goal 3 ENABLING INFORMED DECISION MAKING

Enabling informed decision making • Counselling Paying Inpatient: • Information brochures “When I take my mother for the doctor’s rounds, we are • Display materials anxious to know what the • Involve the patient’s doctor has to say about her eye. But they did not allow us relatives & friends inside. The doctor just looked • Ensure understanding at the eye and took notes”

Informed Decision Making • Patient was admitted for RE surgery • But patient wanted LE surgery • In Ward, patient herself changed the wrist band. • This was not checked in ward or block room. • The block room doctor saw the wristband on the left hand and blocked the LE • Surgeon found the error in the Operating room Involving Patients In Decision Making

Goal 4 GETTING PROPER INFORMED CONSENT

Getting proper informed consent • For all procedures & processes • Special consent if the visual outcome is poor • Ensuring patient understands the procedure & the risks / benefits involved

Goal 5 TRANSPARENT PRICING & MINIMIZING COST OF THE TREATMENT

Minimal & Evidence based Investigations • Discontinued culture and sensitivity tests for all patients • ECG and physician opinion done only for select patients

Balance efficacy and cost Be aware of the cost of your prescription • Chalazion prescription • Glaucoma medication • Rationalize the choice of drug • Knowledge of drugs is important to choose the right drug

Patient Cost > Treatment Cost • Avoid unnecessary review visits • Rationalize review visits • Consider all other costs that patient would incur – travel, food, lost wages, attender costs

Transparent pricing & Minimizing cost of the treatment • Ensuring all activities are taken care the same day/visit • Relying more on clinical diagnosis than investigations • Minimal & Evidence based investigations • Package pricing & absorbing unforeseen expenditure • Minimal charges for readmissions and resurgery

Goal 6 ENSURING FOLLOW UP FOR ALL CATEGORY OF PATIENTS

Performance Assessment • Acceptance rate = No. of patients opting for surgery Total no. of patients advised for surgery • Follow up rate = No. of patients who keep their appointment Total no. of patients advised follow up

Counselling High risk Written Communication Follow up Display Information Material brochures

Counselling

Counselling Doctors Patient Convey Provides necessary Specific instructions information Streamline Helps clarify processes doubts

Counselling Types of Choice of Flow in Patient Surgeries lenses daycare aware

Taking alternative medicine 23 On wheel chair 27 Other ailments more important than DR 95 Visited another Ophthalmologist 111 Uncontrolled blood sugar 85 Not satisfied with previous treatment 26 Too much waiting time in clinic 100 Too much travel time 148 Leaves unavailable 64 Financial difficulties 190 No one to accompany me 201 Eyes were OK at the time 248 Not aware of importance of eye check up 92 Follow-up scheduling Problem 29 Forgot date 147

Solution Targeted Counseling • Specific coding • Good Compliance • Patient better • Prevent Vision • Easy transfer of aware Loss disease severity • Reminders to patients Timely E1/E2 Treatment

Emergency coding

Strategy Code E1 Tracking Targeted Missed Counseling Patients Treatment Phone calls Status PRIOR DAY