A roundtable on patient utility; points of discussion
On Tuesday the 21st September, Friday welcomed senior delegates from across the private and public health sector to our breakfast roundtable on patient utility. By patient utility we simply mean; the pursuit of patient-centred design in healthcare and the consideration of patient experience alongside all other factors of success.
The aim of our ambitious but vital topic was to stimulate discussion on how the different – often isolated - actors in the health landscape; clinicians, patient networks, pharmacy, device makers, pharmaceutical cos, charities, GPs, the government, health providers (both public and private), insurers (where relevant) and technology providers might work closer together in order to deliver outcomes that are truly useful to patients.
Can you meaningfully discuss patient centricity in a clinically centric system?
Despite the title of the event, it was surprisingly difficult to keep the discussion centred around the patient. It was questioned how a clinically centric system could ever become patient centric.
While there are complex and valid reasons why current structures and systems are in place, it was noted that not all reasons are so. Resistance to patient centricity among physicians was discussed, with the idea of patients having access to their own data undesirable for some doctors. It goes against a clinically traditional grain, which will not shift overnight.
The right kind of data at the right time
Naturally, to make anything patient centred it must be backed by data of a scalable mass to point the way. If patient concerns and priorities are to inform the direction of clinical research or an existing service, those priorities need to be fully captured and surfaced. Much like the registry formed by one of our charity attendees. 7 years of longitudinal patient data is helping to shape the way for future research priorities, although there is still more to be done to fully process the data. So far it has helped the Dept of Health assess spending priorities for specialist health centres for people with the condition.
The patient journey
In our discussion we touched on something really important; the idea that a patient’s identity is not static and their attitude to their condition and therefore their treatment is on a constant journey along with them. Patients may relate to others who are in the same stage of treatment or symptoms as they are, more than they relate to others with their condition as a whole.
Are we well?
Partially, this is because one’s attitude to one’s own condition evolves over time. This is not just restricted to people with an existing health condition however; as a society we struggle with the dichotomy of being either healthy or sick and nothing in between. Many people have an uncomfortable relationship with their own health; preferring to ignore a change in health or symptoms for longer than is advisable. This mindset doesn’t lend itself well to a preventative healthcare approach and is a clear factor behind the significant rise in lifestyle related conditions such as type 2 diabetes and heart disease.
Is adherence something more than simply taking your tablets on time?
Is there such a thing as a perfectly adherent patient? Even patients who take a less active role in their care have degrees of activation and engagement, which can be improved by taking a holistic view of adherence. Addressing adherence as a multi-faceted thing from a variety of angles can help a poorly motivated patient become more adherent. From activity and exercise levels - an important part of almost any treatment plan, and arguably a vital component to help patients feel more motivated- emotional and mental wellbeing and the more logistical elements of treatment like stocktaking and ordering medication on time. As their adherence to their treatment ebbs and flows so does the way they identify as ‘healthy’ and ‘sick’ at different points in their lives. Cue the Jekyll and Hyde view of medical adherence.
A patient-centric future?
While there is certainly a long way to go for most healthcare organisations to become patient-centric, we heard many encouraging stories. One organisation reported that every commissioned project in the last six months, has been patient centric. So too, with stories of patient conscious innovation. One charity has helped broker the introduction of remote monitoring and skype clinics for appropriate routine check-ups. Initiatives like this can save both patients and clinicians time and money. We also heard that the government is open for innovation; while it may not be the place where innovation will necessarily happen, it can certainly be the platform which others innovate on.