Forum Replies Created
-
Posts
-
The US cannot import nor export systems because the complexity of its own healthcare system, the disparities in processes and diagnostic procedures, as well as its unique population as Barry mentioned above.
Question #1: Describe the three most important characteristics to you in selecting your own care provider and if ‘Prescription for the Future’ has impacted these and why
The most important characteristic in selecting a care provider are area of expertise, patience with patients and the will to help. Prescriptions for the Future impacted these somehow; the book helped me in framing the “how”. A quick example is when asking for the availability of protocols or pathways for the management of common illnesses, this shows the level of expertise of the care giver.
The article is clear on a point: the sources of healthcare financing is very different when you compare high income countries like the US with LMIC. 40% of healthcare costs comes from social health insurances while this is almost inexistent in low and LMIC countries who finance almost 50% of healthcare from the pocket of patients or private pre-paid plans. So, for me, the use of social health insurances MUST be included as a substantial and a sustainable source for financing healthcare on developing countries as those who need healthcare in these countries can’t afford it.
High income countries like the US would benefit from strong community health systems like in Rwanda, who are really in contact with the population and strengthen the primary healthcare services of these nations.
Barry
Thank you for sharing your experience on virtual care delivery in the covid-19 pandemic. We did the same amid the pandemic and this really reduced the costs of patients, especially considering the context in our setting where you need to advance costs even if you have a health insurance. Virtual care is really part of our architecture today and we expanded this to NCDs like diabetes and hypertension.Question #1: Describe any specific healthcare process and the potential for virtual medicine to improve quality and reduce cost. Provide supporting evidence and address potential problems with this approach.
The process of monitoring and evaluating chronic medical conditions like diabetes and hypertension can be efficiently done virtually with the aim of reducing the cost.
In sub-saharan Africa, most persons suffering from chronic cardiometabolic factors like hypertension and diabetes must pay from their pockets the costs for transportation to the medical facility monitoring them and responsible for the renewal of medicines they must be continuously taking.
In Cameroon, when we had newly diagnosed patients with these chronic medical conditions, we would make a thorough initial assessment and investigation, which could even require 2 days of consultations. We would always include a specialist in this initial review without charging the patient. Specialists relevant to NCDs (like cardiologists, nephrologists, internists, etc.) were always in the hospital following a schedule, as they would support the diabetic clinic throughout the week while seeing outpatients.
After that initial review, patients are managed and would come every month at the diabetic clinic. This is where virtual medicine would be of great potential.
Virtual care would reduce transportation costs as well as costs linked to specialists’ consultations and investigations.
These prescriptions could be issued virtually if we invest in quality time to educate these patients how to take care of their treatment (both nonpharmacological and medicines they are taking for their treatment) as well as measure and record blood pressure and glycemia (just to name these).
Diabetic patients could then come every quarterly (4 times a year rather than 12 times a year) to have HbA1c measured, while patients with hypertension could come every 4 months (3 times a year, rather than 12 times).
Further reduction in costs would be made as this model would avoid unnecessary visits to the readily available (but not free costs) specialists, who always request long lists of investigations.
Question #2: Is “all healthcare local”? Agree or disagree and provide one supporting argument for both positions.
I disagree that all healthcare is local. We purchase equipment, supplies and even expertise from foreign countries. However, in the mind of patients, I think they may assume healthcare is “local”, since they would always consult the local medical facility that is near their homes/communities.
Thank you so much Suzanne for reading through and for your kind words. Much appreciated. I realise there was a typo when I dropped by reply to your contributions. I meant to type a “WOOOOOW”.
While the available data does not seem to support the change politicians would want to male (the agenda of politicians may not always match data. This change could be aimed at demonstrating other issues…), I agree with Suzanne that the study design may pose a couple of challenges as its “denominators” may not be representative of the scope of the problem. Most of healthcare spending comes from inpatient care. So making a study design to inform health spending from outpatient care seems to me inappropriate. Also, people from companies were included in the study and we could see that they didn’t really use the tool much.
Can we make an informed decision based on these???
The main barrier to price transparency is that healthcare providers are not willing to share the prices, costs of their services or how to invoice patients, even in an outpatient setting. Additionally, we could see from the employees studied in these 2 large companies, offering a price
transparency tool was not associated with lower health care spending. The tool was used by only a small percentage of eligible employees. hence, the available evidence does not seem to support this political move.Wood, Suzanne thank you for sharing this story and experience.
These are unnoticed behavioural needs of persons whom we see everyday, for whom we trust we doing the best (as we take care of their sick kids), while in fact the prolonged illness takes a toll on their mental health.
Thankyou for raising that,Question #2: What health and wellness problems might a behavioral health provider address and how could co-locating with physicians improve care quality? Provide a specific example of success.
Behavioral health services cover a wide range of healthcare services for the treatment of mental, emotional, or chemical dependency disorders. These specialists can be pertinent in addressing issues like:
– Depression
– Obesity in children and adults
– Smoking cessation
– Post-traumatic stress disorders, including gender-based violence
– Adults with opioid use disorders
– Children with behavioral sleep disorders
– Complementary care of persons who are homeless, as well as migrants, refugees and internally displaced.
– Binge eating disorders
– Etc.Having behavioral health providers co-locating with primary care physicians eases the holistic approach of care delivered to patients, especially for some patients who may have diseases with unnoticed behavioral disorders. When they are co-locating, experts could:
– collaborate without having to see the patient (especially in the context where these specialties are not well known and there is fear, stigma or discrimination associated to consulting a behavioral specialist). E.g. In our clinic in Accra, be have a counselor who is available to see staff/family members that might be in need. It is very common that I raise issues (under confidential cover of course, especially if patients have not given their consent) like asking an opinion about symptoms you see and you are not convinced it could be addressed by a behavioral specialist.
– Collaborate through the same medical records. E.g. I have a patient I follow who has hypertension, and this arises in a context of recurring stress at the workplace and hypertension in the family. Having the counselor and I keep track of our records in the EMR allows us to be quickly aware of how he improves stress levels.At home, we usually struggle with our kids. We have a squad of 3 strong and vibrant young boys (13, 11 and 7 years old). I have many examples I could use from my experience as a parent to demonstrate Chapter 10’s lesson about doing things because you see your peers do them.
What comes to my mind is when we initiated the habit everyone must clean his/her plate, cutlery, and glasses after dinner. In the evening, we are all tired, and we want the kids to develop the habit of keeping the place all clean. Implementing this change at first simply didn’t work: We, the parents, would always be hustling, chasing the kids to do cleanup. It was very usual to come and see dumped dishes in the kitchen sink. Until we found a strategy: we convinced the elder brother to wash his items. He was then boasting about his behavior among his peers (brothers), saying he can wash dishes like the parents instructed, and that the 2 others could not. We didn’t have to work on that change anymore: every boy was eager to get the work done to boast about being able to do it.I agree with you Suzanne: the decrease in bill collections, bankruptcies, and large unpredictable medical expenses are pertinent incentives to investing for a widespread health insurance coverage. Personal finances are not thought in school, and people usually fall off track when it comes to understanding and properly using money.
An argument in favour of the repeal of he Affordable Care Act is that the expansion of insurance has demonstrated a change in health outcomes like mortality rate. In other words, expanding health insurance has not shown a net reduction in mortality rate. The supportive evidence to this is from Kronick R. (Health insurance coverage and mortality revisited. Health Serv Res 2009; 44: 1211-31) and Wilper AP, Woolhandler S, Lasser KE, McCormick D, Bor DH, Himmelstein DU. (Health insurance and mortality in US adults. Am J Public Health 2009; 99: 2289-95).
An argument AGAINST the repeal of the Act according to Sommers BD, Maylone B, Blendon RJ, Orav EJ, Epstein AM. (Three-year impacts of the Affordable Care Act: improved medical care and health among low-income adults) is an overall improvement in the management of chronic medical conditions.There is steady increase in the incidence and prevalence of chronic medical conditions and having tools to help in getting better outcomes is key in our era.
BARRY:
I agree that hypertension management is also worth considering shared decision-making. There is so much we would be missing if we don’t put the patient in the loop of the decision-making process.SUZANNE:
In my context, mothers come from other facilities (less equipped, sometimes help[ posts where they delivered and the teams were hoping the baby would be okay) for neonatal care, we we have an urgent need to move in the diagnostic processes and do what all what we can do for not further delaying starting antibiotics. Also, infections may really go fast. As such, providing consent for a LP is really what we need as you pointed out. Another point is that when the culture is positive, we would proceed with 21 days of IV antibiotics even if the cerebrospinal fluid examination returns normal.
So I agree with Barry: this is a difficult conversation.
The diagnostic processes need to be clarified and the parents need to give their informed consent at all stages of the management and care delivery. However, involving them in the decision-making pattern may delay care, and this too is problematic
