This post was authored by Suzanne Hughes, RN, MSN, clinical education project director for the Preventive Cardiovascular Nurses Association, and a member of the ACC’s CV Team Section.

The focus on patient-centered care in medicine has come a long way and over the years, all members of the cardiovascular care team have played an increasingly important role.

A survey from earlier this year from the Preventive Cardiovascular Nurses Association (PCNA) asked members of the cardiovascular care team how much time they spend with their patients during an initial visit. Nearly 25 percent responded that they spend more than an hour; most spend between 20 and 60 minutes. Further, even among those respondents who are not themselves prescribers, many make treatment recommendations, and play a key role in assuring that patients persist with long-term therapy.  

However, approaching a patient as a partner, truly listening to their concerns, and championing their interests takes practice. Historically both physicians and nurses assumed more of a paternalistic, and sometimes authoritarian approach.

An important component of patient-centered care is a team-based environment, and ACC survey data have shown that adopting a team-based system of care leads to increased efficiency, improved quality of care, and increased patient satisfaction. Team-based care providers are more likely to implement patient education. Consequently, the three pillars of the Triple Aim – better health and better care at a lower cost – are moved forward with team-based care.

There are several dimensions to implementing a patient-centered health care system:

• Interpersonal, or how we relate to our patients includes listening, trusting, showing empathic communications, and including the families in the discussion. Get to know the patient as a whole person and think about the patient as an expert on what is important to him or her. It is important to remember that the actions of anyone on the care team can influence the patient, from the minute they walk into the waiting room.

• Clinical, or how is care provided from a clinical perspective is fundamentally important. This includes use of decision support tools, coordination and continuity to make sure we are making sure the clinician can efficiently access information, and types of encounters like group visits or telehealth. Reimbursement structures also need to support the different models of care delivery.

• Structural, or how systems are organized includes building an environment that is welcoming, accommodates the clinicians, patients and their families. Make sure the signage is patient-friendly and easy to use. Also, make sure the information technology infrastructure supports patient-centeredness.

We are asking patients to participate in their care more than ever before. This requires ensuring that patients are equipped to participate in their own care and providing clear information.  We need to use “plain language” so that patients understand what is said to them, and we need to take the extra step with “teach-back” to confirm that patients understand important information.  Issues around health literacy are particularly important when communicating with older patients, as the ability to understand complex health information decreases as we age.

In order to establish standards about the content, reading level, and tone of patient-facing materials, PCNA has developed a style guide; all professional societies continue to work diligently to have patient materials that communicate effectively. ACC’s CardioSmart website follows many of these guidelines and provides tools and interactive features to help with patient-centeredness.

Charles Safran, MD, once said that “[patient] participation will lead to better medical outcomes at lower costs with dramatically higher patient and customer satisfaction.” I wholeheartedly agree.

This blog post is part of a special series on the topic of patient engagement.

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