AARP Surveys Detail Patient and Caregiver Dissatisfaction With Chronic Care

Newly released findings from AARP Public Policy Institute surveys of chronically ill patients and their caregivers describe complaints about poor communication and care coordination, especially during patient transfers. The institute's recommendations to solve these problems, says one FP who is well-versed in caring for such patients, sound much like the principles undergirding the patient-centered medical home.

AARP conducted a survey of Americans ages 50 and older who had at least one serious chronic medical condition and at least one episode of care at a hospital or other care setting during the past three years. A second survey polled caregivers ages 45 and older who provided unpaid care to a friend or family member, such as those recruited for the first survey. The surveys formed the basis of AARP's report "Chronic Care: A Call to Action for Health Reform." (116-page PDF; About PDFs)

According to the results of the patient survey,

The survey also found that patients who were more engaged in managing their own illnesses experienced fewer health problems. The least engaged patients were more likely to report experiencing problems, appeared sicker, had more contact with the health care system and were less likely to follow their providers' advice.

Caregivers had even more concerns about quality of care and communication. About two-thirds of these respondents reported that the health of the patient they cared for had worsened because of a lack of needed health care attention.

Many caregivers also reported concerns about poor communication among clinicians, a lack of clinician visits after hospital stays, patients' lack of understanding of medical advice, and patients who received unnecessary tests and conflicting information.

"These findings point to both the need and the opportunity to improve care coordination for people with chronic illness, particularly patients who have caregivers," said the report's authors.

Among recommendations included in the report are

Family physician and self-styled geriatrician Dale Moquist, M.D., of Sugar Land, Texas, said the AARP recommendations are "right in step with the principles of the medical home."

"The medical home is designed for acute care, but it is also very much for chronic care," he told AAFP News Now.

For example, medications can be a big problem for patients older than age 65, according to Moquist, who said about 80 percent of his patients are in this age group. Handling medications is a key part of coordinating these patients' care, he explained, because many of them take multiple drugs prescribed by several physicians, not all of whom are communicating with one another. Frequently, medication dosages need to be changed or certain drugs eliminated completely to avoid interactions.

In Moquist's practice, patients bring in their bag of medications at each visit, and then members of his nursing staff examine and update the patients' medication lists. New prescriptions are faxed or e-mailed to pharmacies as needed, he said, "and always there are changes in the meds."

Patient transitions from the intensive care unit to a hospital ward, or from a skilled care unit to home, can be particularly tricky because health care professionals then have to reconcile both prescribed and OTC medications. With the proper coordination of care in the medical home environment, he said, including use of health information technology, these processes are much easier and safer for patients.

"The medical home is made for the elderly and their chronic health problems. It's one-stop shopping, and it can coordinate care," Moquist said.