With the four public health insurers generally instructing primary physicians to allocate 10 or 15 minutes to each patient, serious follow-up of the condition of those with potentially serious chronic illnesses may feel shortchanged. But the health funds should be aware that once a patient develops complications, it’s much more expensive to treat them, whether at home or in a hospital.
Now, an Israeli team headed by Prof. Adam Rose from the Braun School of Public Health and Community Medicine at the Hebrew University of Jerusalem’s Faculty of Medicine and Dr. Maram Khazen from the Department of Health Systems Management at the Max Stern Jezreel Valley College in Migdal Ha’emek has published a study analyzing how interdisciplinary teams in primary-care clinics can support patients to visit their doctors on a regular basis or at least consult with them via email, Zoom, WhatsApp, or by phone.
The study was recently published in the Annals of Family Medicine journal titled “Teamwork Among Primary Care Staff to Achieve Regular Follow-Up of Chronic Patients.”
“Regular follow-up visits are critical for managing chronic conditions – yet some primary-care clinics achieve higher visit regularity than others. This study aimed to identify specific strategies used by high-performing clinics to promote consistent follow-up visits for adults with chronic conditions,” says the study.
“Shared decision by the medical staff, the patient, and the family improves the condition of chronic patients,” the Boston-born Rose, who made aliyah in 2019 with his wife and four now-teenaged children, told The Jerusalem Post.
“My research focus is on health systems and health services research, program evaluation, implementation science, and [my] health policy research is focused on optimizing care of chronic conditions in the outpatient setting, assessing and addressing suboptimal prescribing, and quality measurement.
“My prior work has included leading the implementation and evaluation of a multi-year effort to optimize the outpatient management of anticoagulants in the US Veterans Administration system that supports a large number of physician health services researchers who work on improving care.
“Before settling in Israel, I worked at the RAND Corporation, a nonprofit health policy research institute, where I was involved in measuring and improving the quality of care, especially of chronic disease, and understanding and dealing with suboptimal prescribing.”
The present study looked at patients over 40 who suffered from at least one serious chronic disease, including heart failure, emphysema, and type 2 diabetes. “We wanted to contrast more- and less-regular visits (or contact) with the primary care doctor, which is not the same thing as how often one sees the doctor,” Rose explained.
They worked with the smallest health fund – Leumit Health Care Services – which was eager to participate in the study. “We defined a primary care encounter as any time a primary care doctor had the patient’s chart open for five minutes or more, which indicates a meaningful interaction. This means we counted in-person and virtual visits equally but did not consider something like a simple medication renewal.”
Rose continued, “Many patients need encouragement from their personal physician to follow through on the doctor’s recommendations. Some of the clinics have a system in which the personnel meet once weekly to list which no-show patients didn’t come,” noted Rose, who received his MD at the University of Pennsylvania and a master’s degree in health services research at Boston University.
The qualitative research used semi-structured interviews with 15 primary-care physicians, 12 nurses, 15 administrative staff, and four pharmacists from 12 clinics – half with high temporal regularity (patients attending follow-ups relatively evenly spaced in time) and half with low temporal regularity, identifying strategies that helped high-temporal-regularity clinics maintain regular chronic care visits.
Until now, there have been no clear-cut guidelines on the optimal amount of patient visits or contact with one’s doctor. “What’s new here is identifying the characteristics of clinics where there is more or less follow-up and what a clinic has to do to create more regularity. If an insurer wants to build such a system in all of its clinics, we would be glad to advise,” Rose offered.
Comparing Israel’s community health clinics with those in the US, Rose said that becoming a family physician specialist is more common, better paid, and more prestigious here than in America.
“Overall, they do a wonderful job here. Being a doctor is not for everybody, and there are shortages of physicians here as there are abroad. There can be long work hours, but many family doctors here enjoy long-term relationships with their patients.”
The study concluded that “teamwork of staff members in primary-care settings can contribute to more proactive care delivery, with greater potential to prevent long-term complications. The findings suggest that a high-functioning, multidisciplinary care team that focuses on creating the right sorts of interactions and teamwork among members of the staff can contribute to engaging patients more effectively.”
For adult patients with chronic conditions, the advice is often to “see your doctor regularly” because this is thought to promote a more proactive and, therefore, more effective style of healthcare.