Thursday, 16 April 2015

Re-Imagining Care at Home


Last night, Jim went over to Nick's to watch the hockey game, leaving me free to watch my choice of television shows with dinner on my lap.  I went straight to PBS and found 'Rx: The Quiet Revolution', a documentary film on healthcare transformation in America.  I was particularly interested because recently, I worked on a committee looking at home and community care in Ontario.  Our report was titled 'Bringing Care Home' and many of the challenges we discussed were similar to those examined in the film.  Here's a description of the documentary from the PBS website: 



A staggering 50 percent of American adults suffer from a chronic disease such as diabetes, heart disease, obesity and arthritis — and one in four has two or more chronic health conditions. In Rx: The Quiet Revolution, you’ll travel across America to discover a quiet revolution happening in medicine. From Maine to Mississippi, Alaska to California, see physicians, nurses and other healthcare professionals placing the patient at the center of their practice — transforming the way medical care is delivered while lowering costs and improving outcomes.

Rx: The Quiet Revolution peels away the clinical barriers to 'knowing' patients and instead proposes a relationship-based model involving house calls, real conversations and even hand-holding.  The NUKA model of care from Anchorage, Alaska, is profiled in the film as an innovative example of improved patient outcomes together with health economic benefits.  Dr. Douglas Eby, the pioneer of NUKA says positive change resulted from clinicians developing and deepening 'friendly, professional' relationships with patients or 'customer-owners of care', as they are called in Anchorage.  I've been a fan of NUKA for years and have written about it in my book and here, in my blog.  

Although there are many, many good and hopeful messages in this film, there is one aspect that is glaringly absent - the role of family in community care.  We all need the changes depicted in Rx: The Quiet Revolution.  We need compassionate doctors who take time to talk because we need them to understand what our illness means to us.   We need doctors to make house calls when can cannot get to their offices.  And we need medical professionals to work in inter-disciplinary teams so that chronic illness can be treated in the community.   But there is a vital message missing in this film - patients (even when they are called 'customer-owners') do not live in a vacuum.  They survive at home with the help and support of friends and family who are integral in the circle of care and key to enabling the wellbeing of their loved one.  

From 'Bringing Care Home': 

When services are provided in an individual’s home, other family members, including the extended family, friends and neighbours, are often involved in providing care. The residents of Ontario told us that they want the family to be the ‘client’ and the planning and delivery of care to be truly client and family-centered. Although policy makers and providers have long supported the principle of family-centered care, home and community care continues to look more like it is focused on what the providers want, rather than on the needs and preferences of clients and families. 

Too bad that the creators of Rx: The Quiet Revolution did not include the family in their vision of community health care transformation.
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