Family physician Anjana Sharma, M.D., of San Francisco, remembers exactly when she understood the importance of patient engagement in primary care. As she tells it, Sharma "fell in love" with the concept as a resident from 2011-2014 at Cambridge Health Alliance Family Medicine Residency in Malden, Mass.
In an interview with AAFP News, Sharma explained that the residency was in the process of developing a patient-centered medical home clinic. "We kept calling things patient-centered, and finally I asked in meeting, 'It's patient centered -- where are the patients that you talked to about this?'"
Turns out the program didn't have a formal process to elicit patient feedback on the changes they were proposing. "And so, it spurred me to start a patient advisory council at that residency clinic," said Sharma.
The work evolved into an "on-the-ground process of bringing patients to the table -- talking to them about quality improvement, doing walkthroughs at the clinic with them, identifying areas where they felt passionate about making a change, and then feeding that information back to the medical leadership."
"It was so eye-opening and so gratifying to give patients a voice in more than just their own medical care," said Sharma.
- Learn about the value of patient engagement and how to implement the concept at the practice level through 11 case studies, a webinar and more delivered by a team associated with Family Medicine for America's Health.
- The patient engagement team responsible for the work is centered at the University of California, San Francisco, (UCSF) Center for Excellence in Primary Care.
- April 4 is Patient Engagement Day, which will be highlighted with a UCSF-hosted free webinar that will feature findings from practices already doing patient engagement activities.
That experience -- and her passion -- made Sharma a valuable player in recent years in a patient engagement project organized by the University of California, San Francisco, (UCSF) Center for Excellence in Primary Care.(cepc.ucsf.edu)
A little background information is critical at this point.
In 2013, a collaboration of eight leading family medicine organizations launched Family Medicine for America's Health (FMAHealth),(www.fmahealth.org) an initiative dedicated to demonstrating the value of primary care and driving continued improvement of the U.S. health care system.
The AAFP joined seven founding partners in this effort: the AAFP Foundation, American Board of Family Medicine, American College of Osteopathic Family Physicians, Association of Departments of Family Medicine, Association of Family Medicine Residency Directors, North American Primary Care Research Group and Society of Teachers of Family Medicine.
FMAHealth President and Board Chair Glen Stream, M.D., of Indian Wells, Calif., told AAFP News that patient-centered care was an important aspect of FMAHealth from the very beginning.
"We are strong advocates for all practices having some mechanism for the patients' voice in the design and delivery of their health care," said Stream, a former AAFP president. "It's essential that we listen to what patients have to say.
"Patient engagement is embedded across the whole project, and it's especially important at the practice level when there are issues of cultural proficiency and health equity," he added. "You don't know what patients think if you don't ask them."
Of seven tactic teams created in FMAHealth's early days, the Engagement Tactic Team(fmahealth.wpengine.com) was tasked with showing how engaging patients as partners in transforming primary care practices could enhance the patient experience, improve community health and reduce cost.
As part of that effort, a UCSF Center for Excellence in Primary Care work group identified practices that were already doing just that and dubbed those 11 case studies "bright spots." The group's goal was to bring those success stories to light as a means of encouraging other physicians across the country to try patient engagement.
Sharma is part of that work group, along with family physician Kevin Grumbach, M.D.; Beatrice Huang; Rachel Willard-Grace, M.P.H.; and consultant Malachi O'Connor.
It's almost spring 2019, and the California-based team is ready to deliver some outcomes to showcase its work.
For starters, the FMAHealth Board of Directors and UCSF Center for Excellence in Primary Care declared April 4 Patient Engagement Day; a highlight of the day will be a webinar at 11 a.m. PDT hosted by the university and moderated by Sharma.
She will feature certain aspects of her group's research and will present case study findings(cepc.ucsf.edu) from those previously mentioned bright spots.
Register today(ucsf.zoom.us) for the free webinar, and while you're at the Center for Excellence in Primary Care site, be inspired by a video(cepc.ucsf.edu) in which physicians and others share their experiences in engaging patients to improve care.
But readers don't have to wait until April 4 to consider some tips Sharma drafted to help physicians either create a patient engagement council or infuse an existing group with new opportunities. Try out these ideas at your clinic:
- Send periodic emails to your patients to share wellness education and clinic updates.
- Hold a one-time patient engagement day where folks can provide input and receive health education in a town hall-style format.
- Set up a patient advisory council and ask participants to discuss social needs that affect the health of their community.
- Ask your patient advisory council to brainstorm ideas to reduce appointment wait times.
- Invite patient advisers to provide recommendations on branding your clinic.
- Involve the patient advisory council in your strategic plan, mission and vision.
- Include the council in quality improvement (QI) by putting members on QI teams and working groups.
- Consider having patient advisers review aggregate data, run charts and help brainstorm new QI projects.
- Have your advisory council discuss clinic protocols for specific diseases, such as HIV infection and diabetes.
- Ask your patient advisers to shine a light on structural racism and explore how racism in medicine affects health outcomes.
For readers not yet convinced that patient engagement is a topic worth tackling, perhaps one more example will provide the tipping point.
Sharma described a project that took place in her current San Francisco-based clinic. It involved a presentation by residents aimed at improving the rate of physicians using telephone interpreters to communicate with patients whose first language was Spanish.
When residents took the issue to the practice's Spanish-speaking patient advisory council, however, they were surprised by the response.
Patients told the residents that they preferred having doctors talk to them without an interpreter regardless of the docs' "lousy Spanish" because patients trusted their doctors more than any unknown third party on the telephone.
"And so, what was going to be an interpreter project actually became a trust-building project," said Sharma. The patients' feedback challenged the clinic to change how they introduced interpreters to include language about their level of training and their background.
"Patient and caregivers as partners helped define the real problem," said Sharma.
She provided this final takeaway for readers: "The message we've learned from these case studies and interviewing these sites across the country is that it's not a one-size-fits-all process. You can tailor you patient-engagement strategy based on your clinic needs.
"So, in some places it may look like a patient advisory council; in other locations, a practice may only have the bandwidth to recruit a new patient partner to sit on a working group for a particular condition like hypertension. Be creative and do what works for you."
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