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Patient-centered care linked to better outcomes

By Andrew M. Seaman

NEW YORK (Reuters Health) - Patients tend to do better when their doctors pay attention to their individual needs and circumstances, according to a new study.

"In a sense that sounds sort of obvious, but no one has ever showed that before," said Dr. Saul Weiner, the study's lead researcher.

Weiner, a physician and health services researcher at Jesse Brown VA Medical Center and the University of Illinois at Chicago, said doctors are often focused on meeting recommended guidelines, such as prescribing certain medications for a condition like high blood pressure.

"The challenge of healthcare is actually customizing those guidelines to the individual's circumstance and the needs of a patient. For generations people have called that the art of medicine, but the problem with that is it seemed dismissive," he said.

Previous studies had suggested that patient-centered care led to better outcomes, but it was hard to know what doctors were talking about with patients.

Researchers didn't know - for example - whether doctors simply increased patients' medications when their blood pressures crept back up, or if they tried to find out why their current pills stopped working.

Instead of the medication, it could be that the patients could no longer afford their pills, or that they developed dementia and are forgetful.

For the new study, Weiner and his colleagues recruited 139 doctors-in-training, known as residents, from two U.S. Veterans Affairs facilities. The residents agreed to let their patients privately record a future medical visit.

They then recruited 774 patients of those doctors who agreed to secretly tape record one of their future visits by leaving a recorder in their clothing or bag.

The researchers then went through the patients' medical records to see if there were any "red flags" that signaled patients' conditions were deteriorating. For example, if a person's diabetes was no longer under control.

They then listened to the tape recordings to see if the doctors picked up on the "red flags" and tried to address the underlying cause. About 160 of the patients were then tracked for nine months to see if their conditions improved.

Overall, there were 548 "red flags" identified in the patients' medical records, and 208 of them were addressed during the recorded visits.

The researchers found 71 percent of the patients who had their "red flags" addressed by their doctors improved, compared to about 46 percent of those whose doctors didn't get to the underlying cause.

ADDRESSING THE PROBLEM

The study cannot prove that the doctors finding those "red flags" caused their patients to do better, but Dr. Robert Smith, who has researched patient-centered care at Michigan State University in East Lansing, said the results are consistent with previous research.

Smith, who wasn't involved with the new study, said that medical education needs to include patient-centered skills and interviewing practices into its curriculum.

"Doctors are not bad people who are not being patient-centered. It's the fact they're not taught it," he added.

Dr. Lisa Cooper, who co-wrote an editorial accompanying the new study in the Annals of Internal Medicine, told Reuters Health there is also a resource issue.

"I'm always an optimist, but we do have challenges. We have an access problem. We don't have an adequate number of primary care physicians," said Cooper, from the Johns Hopkins University School of Medicine in Baltimore.

Smith, Cooper and Weiner all said patients also shouldn't be afraid to speak up during their visits. But Weiner said the responsibility ultimately falls on the doctor.

"Oftentimes patients don't know what about their context is relevant. If a patient has diminishing cognitive abilities, they're the last person to know their diabetes is going out of control," he said.

"That's why I ultimately think that this is a doctor's job. Not a patient job."

SOURCE: http://bit.ly/Zwi3u5 Annals of Internal Medicine, online April 15, 2013.

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