The overlap between the clinical aspects of our health journey and behavior of health team members occurs most often in medication management. Effective medication management depends on empowered, informed patients and caregivers prepared for clinician visits, and engaged clinicians skilled at working with activated patients. This strong relationship of health team members advances patient safety, improves outcomes, and positively impacts life flow and work flow. Patients, caregivers, and clinicians can use tools to improve the effectiveness of medication management. Current methods are often haphazard, disorganized, time consuming, frustrating and are clinician facing, not patient facing.How can we systematically approach the opportunities in medication management and support the various tools available or needed?
The opportunities in patient-centered medication management include:
1) Accurate, up-to-date patient information (Changes in demographics and insurance, comprehensive health team membership);
2) Informed patient (create and maintain medication list and/or read and modify portal information [including OTC], collaborate to set mutual medication goals, able to disclose usage variation, alert to and tracking medication outcome and side effects, voice follow-up questions and concerns for clinician, know where to seek information outside of clinical visit, manage continuity of care among multiple clinicians);
3) Engaged clinician (collaborate to set mutual medication goals, manage patient/caregiver diversity including cognitive challenges, provide links to information outside clinical visit, able to disclose errors, communicates with other clinicians in health team
The team could use tools that help
1) Organize current medications on paper or electronically (patient)
2) Report on usage, outcome, and side effect (patient)
3) Prepare questions in advance of conversation with clinician (patient)
4) Set mutual medication treatment goals (clinician and patient)
5) Manage differing styles of communication about medications (clinician and patient)
6) Seek further information after clinic visit (clinician and patient)
7) Disclosure of errors in prescribing or administering (clinician)
8) Communication with multiple clinicians for continuity and integration of care (clinician)
9) Management of care coordination with multiple clinicians (patient)
10) Integrate tools into life flow (patient) and work flow (clinician)
How will we measure success?
a) Increase in meeting mutual medication treatment goals
b) Increase clinician confidence in communication with patients
c) Increase patient confidence in communication with clinicians
d) Maintain or improve throughput
e) Improved health outcomes (individual and population)
Is this framework accurate? Sufficient?
I would slightly reframe this as requiring an engaged patient (or caregiver) and collaborative clinician. Both parties need to become informed, though often about different things.
One thing missing (or insufficiently stressed) in the framework is recognition that collaborative goal setting (or even the disclosure of patient, caregiver and clinician goals) is a necessary first step that is too rarely attempted.