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In addition, the clinic assigned a registered nurse to share each family physician’s office and to work closely with the doctor on patient follow-ups, including calling patients discharged from the hospital to go over their care plans. Plus, the clinic shifted two pharmacists from working mostly on cost control to consulting directly with patients and doctors on drug regimens.
The new study found that the medical home model succeeded in reducing staff dissatisfaction. Only 10 percent of the medical home doctors and staff said they felt burned out, compared with 30 percent of staff members at other Group Health clinics. Dr. Harry Shriver, the chief of staff at the Factoria clinic, used to see 24 patients a day. Under the medical home model, he now sees 12 to 14. He can spend 30 minutes with each patient and accomplish a lot more than before. While he still has a long day, starting at 7:30 a.m. and leaving at 6 p.m., he says he feels he accomplishes more, has better closure with patients, and enjoys his work more.
As to the direct e-mails from patients, Bergman says the fear was that patients would engage in lengthy digital exchanges with the doctors. But that hasn't happened. "Patients know you and respect your time. It's efficient and effective, cuts down visits, and improves satisfaction. And we avoid e-mail ping-pong by getting out of e-mail and phoning the patient or getting them here for a visit."
Thanks to the medical home experiment, Shriver and Bergman, who were feeling burned out and planned to retire, decided to stay on. “We’re feeling rejuvenated,” Bergman says.
Here's a handy check-list of the hallmarks of the patient-centered medical home concept. It's worth comparing with the medical arrangements you now have:
- Patient has a personal relationship with the physician
- Extended office hours
- Open scheduling for same-day appointments
- Electronic medical record
- Proactive tracking of patients’ conditions and preventive care needs
- Comprehensive services and coordination of all types of care
- Doctors and other medical professionals work as a team with the patient
- Evidence-based clinical decisionmaking, with computerized support tools
- Patients have direct phone and e-mail access to doctors and staff
- Patients can make appointments, refill prescriptions, and check lab results via the doctor’s office Web site
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