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Continued: May 8: "Care guides'' show another face of health reform

  • Article by: MAURA LERNER , Star Tribune
  • Last update: August 16, 2013 - 10:26 AM

It’s OK to give educational handouts, talk about controlling blood pressure and help people shop for medications. But “no medical advice.” If a clinical question comes up, they have to check with a nurse or doctor.

“That part, of not overstepping their boundaries, is important,” Adair said. “We just hammer them on that one.”

One day last week, Snyder met with Bob Bourke, 80, who has diabetes and kidney disease.

“So let’s go over how you’re doing with your goals here,” she said. Checking his electronic medical record, she noted that a recent diabetes test was outside the normal range (“It’s a little bit high”). How was he doing with his medications? At one point, Bourke wondered aloud whether a new drug might interact with his old one, and she deflected the question. “Yeah, I don’t know so much about the interactions,” she said. “But if you had a problem, we could certainly talk to [the] doctor.”

Bourke, who lives in Elko New Market, says working with Snyder has given him a better grasp on his condition.

“You know, the doctor is always busy, the nurse is always busy,” he said. But Snyder has more time to explain things. “That’s what’s good about talking to Betsy,” he said.

Sometimes, Adair said, patients reveal things to care guides that they won’t admit to a doctor or nurse. In one case, an elderly patient had high blood pressure, and Adair was struggling to get it under control. “I changed prescriptions, I added doses,” he said, but nothing worked. A care guide discovered the truth. “He wasn’t taking his medicine, but he would never tell us,” Adair said. The care guide, a woman, persuaded the man to start taking the pills, and his blood pressure fell to normal.

“There was something about her ability to get through to him,” Adair said.

Helping patients reach goals

So far, thousands of patients have gone through the program, and Allina’s own research has found that it’s had a dramatic effect. One study, of 2,135 patients, found they were twice as successful as a control group at meeting their “patient care goals,” such as controlling blood pressure, cholesterol, blood pressure. Some 17 percent quit smoking, compared with less than 1 percent of the controls. They were even less likely to end up in the hospital.

The results will be presented Tuesday at a medical meeting in St. Paul sponsored by the Institute for Clinical Systems Improvement.

Dr. Trissa Torres, who studies health-care innovation nationwide, called it a “very exciting program.” As a senior vice president at the Institute for Healthcare Improvement in Cambridge, Mass., she said such programs are transforming medicine all across the country.

Doctors, she said, often assume that patients ignore their advice because they’re uninformed or unmotivated. “In most cases, it’s neither,” she said. The most successful programs, she said, are designed to help the patient help themselves. The key “is being a really good listener, and meeting people where they are,” she said. And that’s where a layperson may have an advantage over a doctor, she said. “We’re trying to build a bridge between the doctor and patient.”

But critics worry that these strategies could do more harm than good. “I just don’t see how in the world that will ever work,” said Linda Hamilton, president of the Minnesota Nurses Association.

Hamilton said the idea of patient guides or navigators is a good one, but only if they have medical expertise. “You’ve got to have somebody who knows how to ask the right questions,” she said. The biggest risk, she said, is that an untrained person will miss something important, “and somebody ends up really in a mess or hospitalized.”

Dr. Robert Geist, a retired Twin Cities urologist, agrees. “They may be smart kids, but they don’t have the sophistication,” he said. “That would worry me a good deal.” In essence, Geist said, “it’s like having a son, a parent, or good friend to speak with about your health.” While there’s nothing wrong with that, he added, “I don’t know anybody who would buy that service.”

But Dr. Dave Thorson, chair of the Minnesota Medical Association, says this kind of program can be valuable.

“Yes, there are risks,” he said. But he said it’s also a way to improve communication with patients. His own practice, in White Bear Lake, is one of many that uses care managers to stay in touch with patients between visits. At this point, he said, there’s no agreement about how much, or how little, training they need. But there’s little doubt that consumers will see more of them in the future.

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  • Betsy Snyder, a care guide for Allina Hospitals and Clinics, visited with a patient in her waiting room office on Thursday at Abbott Northwestern General Medicine Associates in Minneapolis.

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