You will find the word “patient” cited in every version of the Hippocratic Oath. Whether you are a pharmacist or a physician, you begin the journey of dedicating yourself to the betterment of patient outcomes by taking the oath at your commencement. The word “patient” is also prominently mentioned in the varying mission statements of pharmaceutical companies, hospital conglomerates and health insurers. More recently, the increased focus on patients has precipitated the creation of positions such as Chief Patient Officer or Patient Experience Officer – positions which have typically been reserved for medical, pharmacy or science leaders. These and other efforts are putting the patient needs, wants and desires front and center of how legislators and companies think about healthcare. Whether it’s through the 21st Century Cures initiative on Capitol Hill, how pharmaceutical companies discover new medicines, how employers provide healthcare coverage, or how health systems structure patient care, all are rightly focusing attention on the patient.
Still, the question that needs to be raised is whether we are truly listening to the patient and, more importantly, are we providing them with the tools they need to engage in appropriate “self-care.” As Tom Ferguson, MD and founder and editor of the magazine Medical Self Care put it, “Lay people could do even more for themselves if they had better access to currently available health tools, skills, support, and information.” In my view, successful self-care relies on three pillars: A strong patient participation and engagement in treatment decisions and health care policy; robust information sharing with the patient from all healthcare sectors; and access to over-the-counter medicines without unnecessary barriers.
Disconnect between patients and physicians regarding the care being provided is nothing new. Research dating back to the late 1990’s by the National Bureau of Economic Research suggests that patients are not necessarily matched with the treatments they prefer (http://www.nber.org/papers/w6513.pdf). More recently, a survey by Pfizer Inc. demonstrated that the same may be true for employee benefit design. In the Pfizer survey, only 50% of patients suffering from breast cancer versus 98% of human resources administrators felt that they have and are provided good health benefit coverage; indicating that employees do not see that the benefits provided to them are adequate when facing a life threatening disease.
The good news is that systemic change is moving towards patient engagement as demonstrated by the involvement of patients during the Energy and Commerce Committee 21st Century Cures hearings, the development of Clinical Trial Transformation initiative and the launch of the Center for Total Health by Kaiser Permanente.
The bad news is that progress on the second pillar – information sharing – is agonizingly slow. The health care system is still incapable or unwilling to share medical information with the patients they serve. The primarily paper-driven record system is not conducive to providing patients with the information that can help them manage their health. This is why organizations such as Open Notes are implementing systems within the provider community where a patient is able to see information about their care. Whether it is their lab tests, the medications they are on, or selected parts of their medical records, patients are able to have a more thorough understanding of their health. The research so far is promising; in a study published in the British Medical Journal, after 12 months of implementing the Open Notes system, 99% of patients wanted to continue to have access to their notes online and none of the doctors decided to stop the practice. There is absolutely no doubt that an informed patient will have better outcomes as they improve their medication compliance, adapt preventative measures or reduce potential medical errors as they gain access to information critical to self-care.
Another pillar for successful self-care is access to over-the-counter (OTC) medicines which oftentimes are the best remedy to keeping patients healthy and out of the physician’s office, and to reducing healthcare costs. Every dollar spent on an OTC nonprescription product saves the healthcare system $6-7, which adds up to a sizable $102 billion in annual savings. However, instead of allowing more access to OTC medicines, policy makers have recently erected barriers that curtail their usage. For example, in 2011, Section 9003 of the Affordable Care Act established a new uniform standard for medical expenses whereby health flexible spending arrangements (health FSAs) and health reimbursement arrangements (HRAs) are only allowed to reimburse the cost of over-the-counter medicines if they are purchased with a prescription. In other words, the law mandates that the patient needs to get a prescription from a physician through an office visit, the very thing that OTC access was meant to avoid.
More importantly, in support of access to OTC’s, half a dozen states have passed resolutions to recognize the importance of improving awareness of self-care and consumer empowerment through the development of new nonprescription medicines and the appropriate switch of certain prescription medicines to nonprescription. This is a critical acknowledgement that over-the-counter medicines can greatly improve and reduce costs to the public health system, while encouraging consumers, healthcare practitioners, policymakers, and regulators to communicate the benefits of self-care.
As healthcare professionals, we ultimately want what is best for the patient. We want tools that help the patient get better faster, be more productive and enjoy an exceptional quality of life. It is not enough to recite the word “patient” in oaths and include it in mission statements and job descriptions; we need to listen and engage with patients in shared decision-making by providing them access to information and self-care tools such as over-the-counter medicines.