This short discussion paper from the Center for the Advancement of Health provides useful, practical guidance for both health care providers and patients on ensuring patient engagement in the implementation of medical home models. A suggested agreement for both providers and patients is included as an appendix:
Sharing Information
1. Patient: Before each medical visit, write down a list of concerns and questions to talk about with your clinician.
Clinician: Ask specifically what the patient’s concerns and questions are for the visit. Respond to concerns and answer questions.
2. Patient: Report accurately on the problem: How long has it been going on? How severe is it? How does it affect you?
Clinician: Provide a safe setting for talking about confidential concerns. Inquire about mental and physical symptoms, any substance use, changes since last visit and progress in previous treatment plan.
3. Patient: Bring a list of all current medications and their doses, including vitamins, supplements and alter native products and be ready to let your clinician know if they are helping you or if you are having any problems with them.
Clinicians: Review the list of medications and how they are working. Make a plan for refills, substitutions and discontinuation.
4. Patient: Before leaving your appointment, ask questions when explanations and next steps are not clear. Clinician: Ask your patients to describe their understanding of what you have talked about and what each of you will be doing next.
5. Patient: Tell your clinician when you get care somewhere else; for example, if you go to the emergency room or see a specialist your clinician didn’t refer you to. Authorize those doctors to share this information with your clinician.
Clinician: Ask the patient about whether he or she has consulted other clinicians. Be sure that medical information is shared with other appropriate providers and institutions.
Shared Decision Making
6. Patient: Ask about and consider information about how different treatments or tests might affect you. Clinicians: Describe the benefits and risks of treatments and tests.
7. Patient: Agree on a care plan with your clinician. Follow-through on referrals for treatment and testing. Track any success or problems with following your care plan.
Clinician: Agree on a care plan with your patient; explain your reasons for advising any treatments and tests. Provide or prescribe sources for additional information and support. Make and record referrals and provide contact information for them. Discuss how you will monitor and revise the plan together.
8. Patient: If you are told that you have a serious illness, ask your clinician to help you get other expert opinions on your condition and care plan before starting treatment.
Clinician: Provide guidance and referral about getting other opinions about serious diagnoses prior to beginning treatment. Meet to talk about what to do if you get different expert opinions.
Responsibility for Care
9. Patient: Fill or refill prescriptions on time. Use medications or devices as directed. Monitor whether they are working and any side effects. Consult with your clinician before you stop taking any prescribed drug or change the way you are taking them, stop any therapy or stop using prescribed devices
Clinician: Use electronic prescribing to make sure that your patient receives the right drugs at the right dose and that any new drugs don’t conflict with the patient’s current medications. Ask the patient about the effectiveness and side-effects of the drugs you previously prescribed.
10. Patient: Discuss with your clinician about whether you should get shots (e.g., flu shots) and tests (e.g., Pap, mammogram and colonoscopy).
Clinician: Discuss your patient’s health and family history; modify standard recommendations for shots, screening and early detection tests as needed. Assist by providing shots and tests or make referrals for screening or early detection.
Ignatius Bau 