ACC Urges Shift to Patient-Centered Care


It’s time for cardiologists to pay more attention to patients’ needs and to advocate for patient-centered care with insurers and policy makers, according to a new health policy statement from the American College of Cardiology.

The statement outlines a new treatment paradigm of shared decision making with patients, and a systemic approach to care that, for the first time, urges creation of patient-centered medical homes led by cardiovascular specialists.

Dr. Mary Norine Walsh

"In true patient-centered care, the focus is on the patient, not on the disease," Dr. Mary Norine Walsh, chair of the ACC’s patient-centered care committee, said in an interview. "Beyond knowing the technical aspects of the disease, we need to do a better job of understanding patients’ perception of their disease and their goals and life experience, so we can together chart a course for how we are going to manage the disease," said Dr. Walsh, medical director of the heart failure and cardiac transplantation programs at St. Vincent Indianapolis Hospital.

The bottom line is, physicians need to communicate better with patients, at a level that takes into account their health literacy, and patients need to be more actively engaged in their own care, according to the policy statement, which was published in the Journal of the American College of Cardiology (2012, May 14:doi:10.1016/j.jacc.2012.03.016).

"As clinicians, we have been taught for many years to give patients orders and expect things to happen," said Dr. Alfred A. Bove, professor emeritus, Temple University, Philadelphia, and vice chair of the patient-centered care committee, in a statement. "But when it comes to the day-to-day management of chronic conditions like heart disease, we have to empower patients to be actively involved in their own care. We won’t be effective unless we move toward a patient-centered approach. This initiative is intended to help us get there."

The statement is not designed to tell physicians how to manage their practices, said Dr. Walsh. It’s a call to payers and policy makers to help give physicians the tools they need to move to patient-centered care, she said. "The onus is not on the doctors here," said Dr. Walsh.

However, it does urge physicians to start thinking about educating patients in a variety of ways, including pamphlets, online programs, community events, and group education sessions. The statement estimates that 89 million American adults – one-third the population – are not literate enough, health-wise, to follow through on recommendations for tests and treatments and self-monitoring. Educational content should also be tailored to patients’ individual health situations and needs.

The next step should be to create easy-to-use decision aids for patients – so they are no longer passive recipients of recommendations for care – and self-management programs, including web portals, so that patients also engage in monitoring chronic conditions. Such portals are currently rare but will likely be required for physicians who want to qualify under stage 2 of the meaningful use criteria for Medicare’s electronic health record incentive program.

Dr. Walsh admitted that, even in her practice, she relies on outdated technology – giving patients a printed-out grid for monitoring their blood pressure – that is not ideal for engaging them in their own care. But for starters, she says, the ACC has a portal of sorts, the CardioSmart website, which offers patients some decision aids and information about various conditions and tests and treatments in lay-friendly language.

The ACC is also hoping to make inroads with the idea that cardiovascular specialists can lead medical homes, for certain patients. "We know that not every cardiologist will be a home for every patient," said Dr. Walsh. But for transplant patients, those with ventricular assist devices or congenital heart disease, the primary physician is a cardiologist or a surgeon, she said.

The specialist-led medical home will not operate to the exclusion of the traditional medical home; it will be one of many models, said Dr. Walsh.

The policy statement envisions a care team "to manage patients with advanced cardiac disease across the continuum of care from the stable outpatient environment to the level of intensive in-hospital care without changing care teams." Such a team would be directed by cardiologists with advanced training in cardiovascular disease management and include nurse practitioners, pharmacists, educators, and technologists with expertise in echocardiography, myocardial perfusion imaging, and other advanced imaging.

Overall, the policy statement "clearly puts a stake in the ground as far as what we as a professional society feel is important," said Dr. Walsh, who added that she expected that the statement will be used to educate physicians and payers and be taken to all of its discussions on Capitol Hill.


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