Top 5 PA policy topics of 2013

Increased primary care demand not evenly distributed
Increased primary care demand not evenly distributed

Washington, D.C. – The Clinical Health Affairs Commission (CHAC) of the American Academy of Physician Assistants (AAPA) identified the five most important policy-specific medical topics at the AAPA's IMPACT 2013.

As in the presentation of the top 5 disease-specific topics, each discussion included a description of the impact of these events on public health, medical technology, and disease diagnosis and treatment.

Incentivizing primary care

The United States spends more on health care than any other country with poorer outcomes, unsustainable costs, unacceptable rates of medical errors, and persistent and worsening health-care disparities. The majority (75%) of  U.S. health costs are spent on management of chronic diseases (e.g., cardiovascular disease, cancer, diabetes). The two most common preventable causes of disease are tobacco use and obesity.

Clinicians are clearly not properly addressing modifiable risk factors of disease. According to Alison Essary, MHPE, PA-C, the first step to remedying this situation is to reframe our educational model and train future providers in the psychological, social, and economic determinants of disease.

Future providers must also be trained in the science and practice of cost-effective, patient-centered, and evidence-based health promotion. A multidisciplinary, team-based approach to health in all specialties and in all settings must be implemented. “Every PA should take some kind of ownership and responsibility for prevention,” advised Essary. As for tips for clinical practice, Essary emphasized motivational interviewing, utilizing community and social support, and encouraging prevention and health promotion.

Improving patient safety

Eliminating medical errors may not be possible, but PAs can certainly play a role in improving patient safety. “The number one cause of why bad things happen in health care is poor communication,” said Kevin Scheur, PA-C, MPH. Patients cared for in medical homes have been shown to experience better communication and fewer medical errors. “Structure begets function,” noted Scheur, “and the system often works against us.”

Basic improvements can dramatically enhance the delivery of care.The Agency for Healthcare Research & Quality (AHRQ) recommends five things patients can do to ensure safer health care. First, patients should be encouraged to ask questions if they have doubts or concerns about their care. Second, patients should be instructed to provide a list of all medications they are currently taking. Third, patients must obtain the results of any test or procedure. Fourth, patients should talk to their provider about which hospital best suits their needs. Finally, patients must fully understand what will happen if they need surgery.

End of life care

Anthony Brenneman, MPAS, PA-C, began his presentation on end of life (EOL) care with some obvious, but sobering, statistics that explain why this is such an important topic in 2013. Less than 10% of people die suddenly; most experience prolonged illness. Up to 90% of Americans have expressed a desire to die at home amongst family and loved ones, but 75% will actually die in a nursing home.

Clinicians need to dispel patient fears and fantasies about death and dying. There are mechanisms for treating physical symptoms and psychological distress associated with dying. Many clinicians are not familiar with the social isolation that surrounds the dying process.

Patients and family members should be warned about social isolation, and clinicians should help them build support systems to deal with this problem. Additional focus should be paid to the individual providing the caregiving. The financial pressures involved can be tremendous, and up to 30% of people will become impoverished by having to provide care to a dying loved one. Breakdowns in coping strategies can be minimized by establishing connections with local hospices or EOL care providers.

A discussion of EOL care can occur at the initial patient presentation. The topic can be revisited at each annual visit. Obvious times to introduce the topic of EOL care are at the initial discussion addressing life support and when transitioning to hospice care.

Engaging the patient in their own care

Patient engagement requires “getting back to the simple stuff,” according to Folusho Ogunfiditimi, DM, MPH, PA-C. Patient and family control of care is vital and relies on a positive relationship with the clinician. Open communication and the sharing of information fosters an environment of trust and respect. Patient engagement results in an understanding of values, beliefs and preferences, all of which have a direct correlation to patient-related outcomes. Engagement also improves organizational care-delivery models as well as patient safety. “We're not just delivering medicine,” remarked Ogunfiditimi, “All we're doing is facilitating health-care resources to the patient.”

The connection between poverty and health

Improved education has been shown to reduce morbidity. “Literacy has a direct correlation to poverty,” noted Mr. Ogunfiditimi, “It is important that we understand the link between poverty and health-care delivery.” Socioeconomic status is a social determinant of health. Social determinants of health are associated with heart disease and stroke. There is also a strong link between social needs and life expectancy.

Up to 76% of physicians believe that payments should be made to patients to cover the costs of such social needs as food, transportation, and shelter. Health-care alone only represents 10% of the contributing factors to life expectancy; social circumstances and environmental exposure represents 60% of contributing factors to life expectancy. According to Ogunfiditimi, one out of every seven prescriptions for social needs should address fitness, nutrition, transportation assistance, adult education and housing.

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