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Continuous supply

Providing health care to the elderly can be complicated. People often have many different doctors and health professionals in different locations. Traveling and getting around become more difficult as people get older. The drugs covered by the Medicare Prescription Drug Plan in the United States vary between insurance companies and change frequently. Support from a team of healthcare professionals led by a general practitioner or a doctor who specializes in caring for the elderly (geriatrician) is the best way to deal with these complexities.

Continuous care is an ideal in which medical care is provided to one person in a coordinated and uninterrupted manner despite all the complexities in the health care system and despite the involvement of various medical professionals and doctors in different care facilities. In addition, everyone involved in providing medical care to a patient, including the patient, interacts with one another and works together to coordinate medical care and set goals.

Continuous care is not always easy to achieve, however, especially in the US where the healthcare system is complex and fragmented. In the absence of continuous care, patients may not fully understand their health problems and may not know which doctor to turn to if they have problems or questions.

Challenges for Continuous Supply

Continuous care is particularly important for the elderly. Older people tend to have several doctors (a separate specialist for each organ or problem) and therefore switch from one care facility to the next (referred to as a change of care). You can be cared for in various private medical practices, in hospitals, in a rehabilitation clinic and / or in a long-term facility.

Several doctors

Having multiple doctors can disrupt the continuity of medical care for an elderly person. For example, a doctor may not have up-to-date, accurate information about care provided or recommended by another doctor. This doctor may not know the names of the other doctors involved or it may not occur to them to contact them. Information about care can be misinterpreted or misunderstood, especially if the elderly have disorders that affect language, vision, or mental ability (cognition) that make it difficult for them to communicate effectively. Elderly people may mention an important detail to a doctor, but forget to tell other doctors about it.

To ensure that care is continuous (and optimal), all doctors involved need to have complete, current and accurate information about what other doctors have been doing, especially what tests have been done and what medicines have been prescribed. If this information is missing or incorrectly communicated, the following can happen:

  • Diagnostic procedures are unnecessarily repeated.

  • Inappropriate drugs or other treatments are prescribed.

  • Preventive measures are not taken as every doctor assumes that they have already been done by another doctor.

Different doctors can have different opinions about a person's medical care. For example, doctors at the hospital may disagree with a patient's general practitioner when it comes to whether surgery is necessary or whether the patient should go to a nursing home after discharge. The patient and family members may be overwhelmed and confused by the differing opinions of doctors.

Patients who take many prescription drugs, as is often the case with older people, can redeem their prescriptions at different pharmacies (for example at the pharmacy that is closest to the specialist's practice). In this case, not every pharmacist may be aware of all the drugs that the person concerned is currently taking and therefore cannot know if a newly prescribed drug could interact with a current drug.

Various facilities

The change from one supply facility to the next (supply change), such as B. from a hospital to a qualified nursing home increases the likelihood that errors can occur in the care. New medicines may be prescribed in the hospital, which may result in the effects of other medicines in the patient overlapping or in negative interactions. Sometimes the further prescription of medication that is still required is unintentionally forgotten. Even if changes are made to the patient's medicines, those changes may not be communicated to all healthcare professionals and physicians involved, such as the general practitioner.

To avoid such problems, current regulations in the United States require healthcare facilities to reconcile drugs whenever the facility changes and whenever new drugs are prescribed or follow-up prescriptions are issued for current drugs. Medication matching involves comparing the patient's prescribed medication with all medication he / she has taken to ensure that no medication is duplicated or missed. When changing care facilities, older patients or their caregivers must ask the doctors whether the medication has been compared.

If patients are not in a healthcare facility, they and / or their caregiver must match the drugs themselves. Patients should keep a list of both the drugs they are currently taking and the drugs they have previously taken (with a reason for discontinuing the drug). Then, when patients have been examined by a new doctor, admitted to, or discharged from, a hospital or other care facility, they should check whether one of their lists contains the newly prescribed drugs. If one of the following cases is discovered by the person concerned, this should be discussed with the doctor immediately:

  • A double prescription for a medicine he / she is already taking

  • Prescribing a drug that previously had to be discontinued

  • A missing medicine - a medicine that he / she was taking but that is not on the facility's list of current medicines

It is always advisable to make an appointment with your general practitioner shortly after you leave the hospital or other facility (such as a rehab clinic or qualified care facility). Patients should bring the list with their current medication and their packaging to the appointment. The doctor can then review all recommended medications and instructions at the discharge date.

Lots of regulations

There are many regulations in the health system that can affect continuous care. These regulations can be set by the government, insurance companies, or professional organizations for health care professionals and physicians. For example, some insurance companies limit which hospitals patients can go to. Unless he / she also works in this hospital, the general practitioner of the person concerned cannot provide any care there. In addition, many general practitioners no longer provide care in hospitals or rehabilitation clinics. Therefore, in such cases, patients may be cared for by a new doctor who is unfamiliar with their medical history. The person concerned or their supervisor must ensure that all relevant information is provided to the new doctor.

Lack of access to care

Continuous care can be interrupted when patients do not have access to medical care. For example, elderly people could miss a follow-up appointment because they have no means of transport to the doctor's office. They may not see a doctor because they are not insured and cannot afford to pay for medical care themselves.

Further problems

It can happen that a patient forgets or is not aware of a doctor's appointment.

Not all physicians participate in all Medicare managed care programs. Before seeing a new doctor, patients under Medicare managed care programs should verify that that doctor is covered by their program so that there are no unexpected costs.

Strategies to improve continuity

Improving continuous care requires efforts on the part of the health system, on the part of the patients receiving care, and on the part of family members.

Health system

Managed care organizations and some state health insurances coordinate all medical care and thus contribute to continuous care. In addition, the health system has developed various strategies to improve continuous care. Examples:

  • Interdisciplinary care

  • Electronic medical records

Interdisciplinary care

Interdisciplinary care is coordinated care provided by a wide variety of healthcare professionals including doctors, nurses, pharmacists, dietitians, physical therapists, occupational therapists, and social workers. These healthcare professionals make conscious and organized efforts to communicate, cooperate, and reach agreement with one another regarding the care of a patient. Interdisciplinary care is intended to ensure that patients can move safely and easily from one care facility to the next and from one doctor to the next. This is also to ensure that the doctor most qualified for the respective problem provides the care and that no care overlaps. Interdisciplinary care is not available everywhere.

Interdisciplinary care is especially important when the treatment is complex or when there is a change from one care facility to the next. The patients who are likely to get the most benefit are those who are debilitated, who have many medical conditions, who need to see several different doctors, and who experience side effects as a result of drugs.

The healthcare professionals and doctors who care for a particular patient are known as the interdisciplinary team. The care services are coordinated by a doctor - the patient's family doctor or a social worker or care manager.

Sometimes the medical professionals and doctors in an interdisciplinary team do not work together on a regular basis (an ad hoc team). The team comes together to meet the special needs of a particular patient. In other situations there is a permanent team with the same members who usually work together and care for many patients. Some nursing homes, hospitals, and hospice facilities have permanent teams.

Team members discuss treatment plans and inform each other about changes in the patient's health, changes in treatment, and results of tests and examinations. They ensure that the patient's records are up-to-date and that these records are available for the patient at all departments of the health system. Such efforts help ensure that a change of care facility or doctor is carried out more smoothly and with fewer negative effects for the patient. Tests are also less likely to be repeated unnecessarily and less likely to make mistakes or failures in treatment.

The interdisciplinary team also includes the elderly patient and family members or other caregivers being cared for. For effective interdisciplinary care, these people must actively participate in the care and communicate with the medical professionals and doctors in the team.

Elderly Care Manager

Elderly care managers are specialists who ensure that an elderly person receives all the help and care they need. Most elderly care managers are social workers or caregivers. You can be a member of an interdisciplinary team. Elderly care managers can organize the services they need and then oversee them. These care managers can organize, for example, that an outpatient care worker comes home or that an assistant helps with house cleaning and meal preparation. You can locate a pharmacy that delivers medicines to your home or arrange transportation to and from the doctor's office. Elderly care managers are relatively rare.

Electronic health record (EGA)

The EGA contains a patient's health information in digital form. The aim of the records is that all medical professionals and physicians who care for a patient have access to the patient's precise, current, readable and complete data when necessary.

The EGA usually includes demographic and personal information (e.g. age and weight), medical history (including vital signs, prescribed drugs, allergies, and immunization status), test results (from laboratory tests and imaging), and billing information.

The EGA is improving care for the following reasons:

  • The doctors responsible for the care of a person are enabled to exchange information more quickly and easily.

  • Errors and omissions due to a lack of information that would have been important to the doctors are reduced.

  • Repetitions of examinations that have already been carried out are reduced.

  • Treatment delays are reduced.

  • Patients will have access to their medical records and greater participation in their own medical care.

However, there are many different EGA schemes. Healthcare professionals and hospitals often cannot read the records of professionals and hospitals that use a different system. In addition, the data in the EGA system is only as accurate as the data entered by previous medical professionals, and data entry is usually time-consuming. If possible, the data contained in the EGA system should be verified by the patient.

Patients and their care

To help improve the continuity of their care, the elderly or their caregivers can take an active role in their care. For example, they can learn more about what can affect continuity, how the health system works, and what resources are available (such as care managers or social workers) to improve continuous care. A good understanding of their medical conditions and the details of their health insurance can also help.

Active participation starts with communication - i. H. the provision and receipt of information. If the elderly have special health needs or questions, they or their family members should tell their healthcare professionals or doctors. For example, the elderly in the United States often need help determining which drugs are covered by their Medicare prescription drug plan.

Individuals receiving care or their family members need to be proactive in this regard. For example, elderly patients or their caregivers need to develop an ongoing relationship with at least one healthcare professional or doctor, usually a general practitioner, to minimize the problems of having multiple doctors treat the patient. Elderly patients should ensure that the general practitioner is aware of changes in their condition and medicines, especially if a specialist has made a new diagnosis or changed a treatment regimen. You may need to ask a doctor to call and discuss with another doctor to make sure information is communicated clearly and treatment is appropriate.

Active participation also means asking questions about a disease, treatment or other aspect of care. This also includes learning how to prevent illness and taking the appropriate steps to address it.

A healthy lifestyle is part of the active participation of a sick patient. For example, people with high blood pressure can eat a balanced diet to maintain heart health and exercise regularly. Patients can also monitor their health at home. For example, people with high blood pressure can check their blood pressure. People with diabetes can check their blood sugar levels.