Thursday, May 26, 2011

Keeping patients at home - Redesigning care delivery

The innovative telehealth programs described in this Globe and Mail article resonated with me this week as we continue to work on similar issues in our urology practice, namely, what is the best way and location to deliver patient care.

The article mentions programs in BC and Ontario where patients with heart disease monitor their own symptoms and vital signs, submit the data via phone or computer, and have regular follow-up by automated phone call.  Of course, all this is in addition to access to traditional, "live" care providers.  The classic model of care for these patients would be to travel to a large centre where specialist care congregates, and then have professionals do all the work.  The telehealth model delivers care in patients' homes, and engages them in their own healthcare.  It saves travel time, stress and expense.  While this delivery model wouldn't suit everyone, the patients interviewed for the article were very pleased with the programs.

In our urology practice, we're (once again) experiencing capacity challenges.  The combination of an impending retirement and several urologists working half-time (I'm a guilty party!), along with changes in OR time allocation, means our patients are waiting longer for consultation appointments.  As part of the Sask Surgical Initiative, our department has been given additional operating room time so we can complete surgeries for people who have been waiting a long time (many over 12 months).  However, as more of us are in the OR, it means that fewer are available to see new patients in the office. 

We're reviewing several aspects of our office care delivery to see how we can be more effective.  We've had success previously with trying to deliver care "closer to home".  We've had success previously with an alternate way of informing men about vasectomy reversal surgery.  We found that men referred to us regarding vasectomy reversal weren't actually asking for the surgery, but were using the office visit as a way to get information about the procedure, its success rate, costs and complications.  We developed an information package about the surgery, and when we received a referral, we send the man and his referring physician that package.  We invite the man to arrange an appointment with us if he has any further questions, or if he is convinced that he wants the surgery.  In the trial period, 2 out of 22 men arranged appointments.  The other 20 men were saved a trip to our office.

We want to identify other situations that can be managed in a similar way.  It may involve information sent to patients, or to family physicians to support them delivering care in their own practice.  This week, two of us reviewed several weeks of office visits to identify common reasons for urologic referral that we think could be managed by the primary care practitioner, for example, uncomplicated bladder infections, scrotal cysts, and enlarged prostates.  We've identified a few likely conditions and will develop information packages regarding investigation and management.  Importantly, we plan to discuss these packages with referring physicians to see what information is helpful for them, and to identify any other issues around the referral (e.g. patient "demands" specialist opinion, no local facilities for testing).

We hope to identify situations where the patient's needs can be met closer to home, by the provider with whom they already have a relationship.

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