COMMENTARY
Appathurai Balamurugan , MD , DrPH , MPH
Patient-Centered Care
Appathurai Balamurugan , MD , DrPH , MPH
We are all familiar with patientcentered care , but sometimes we may not realize where our patient ’ s center lies . Patients do not live in a vacuum , and for many , their family is central to their well-being . In our daily clinical practice , we often see patients who are accompanied by someone during their visit . This someone could be a family member or a friend . A common misconception is that they are merely there to assist with transportation for the clinic visit . That may be true at times , but many times it is not the case . Several of our patients seek a family member ’ s support or a friend ’ s support to do tasks such as home blood pressure or blood glucose monitoring , medication assistance , One might offer family group or appointment scheduling . Patients education sessions on chronic may also seek help with making decisions and coping with symptoms disease management with care managers during evenings or and stress due to their condition . weekends when the family Identifying this family member who members can attend along plays a central role in the patient ’ s with the patient . care and engaging them in said care would be an important step . Engaging family members to support individuals with chronic diseases such as diabetes , hypertension , and other cardiovascular diseases has been shown to result in better outcomes . Family can be a vital source of continuity and care coordination across episodes and settings of care .
There are clinical practice models that connect patients and their families to clinical , public health , and community support to help them manage their condition better . These models can guide family members in setting goals for supporting patient self-care behaviors ; train family members in supportive communication techniques ; and provide families with tools and infrastructure to assist in monitoring clinical symptoms and medications . In supporting self-management , family members may facilitate , remind , motivate , and partner in behavior change . This can begin by including the family member in the patient ’ s care plan . This puts some accountability both on the patient and the family member . This can be elaborated with skills training for family members on checking blood pressure or blood glucose or by training family members in education strategies such as teach-back method . One might offer family group education sessions on chronic disease management with care managers during evenings or weekends when the family members can attend along with the patient . One can connect patients and family members with community resources such as county cooperative extension services that offer cooking demonstrations , grocery shopping tours , and yoga / exercise sessions .
A toolkit for making decisions about whether to involve a family member or friend in a patient ’ s care can be found in the U . S . Department of Health and Human Services document , “ Decision Guide Consumer Centered Family Consultation ” ( access at https :// www . integration . samhsa . gov / about-us / Decision _ Guide _ CCFC . pdf ). This toolkit offers a step-by-step guide to providers to assess and engage a family member in a patient ’ s care . Additional resources including the Six Steps to Creating a Culture of Person and Family Engagement in Health Care can be found through the Patient-Centered Primary Care Collaborative website ( https :// www . pcpcc . org / sites / default / files / resources / PCPCC- % 20Planetree % 20 PFE % 20Culture % 20Change % 20Toolkit % 20050517 . pdf ).
Enlisting and empowering patients and their family member as partners in care requires leadership support from the provider and the health system that the provider and practice fits in . Engaging family members in care of the patients would facilitate shared decision-making , cultural awareness , and compassionate interactions . Staff training to engage family members in care will be quintessential . Finally , a core group of patients and family members could be recruited to serve as an advisory board for the practice . The group would provide feedback on current practices , areas needing improvement , and new initiatives . This will be a step in the right direction towards creating medical neighborhoods .
The views expressed in this commentary are that of the author , and not necessarily those of the Arkansas Department of Health .
198 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY VOLUME 114