Breaking News
January 15, 2019 - AHA: New Cholesterol Guidelines Put Ethnicity in the Spotlight
January 15, 2019 - Different brain areas linked to smoking and drinking
January 15, 2019 - Henry Marsh shares insights into neurosurgery and more at Dean’s Lecture Series
January 15, 2019 - Want to Live Longer? For Just 30 Minutes a Day, Do Anything Else But Sit
January 15, 2019 - The Current issue of “The view from here” is concerned with Targets
January 15, 2019 - Plain packaging sparked tobacco price rises, new study finds
January 15, 2019 - Sedentary lifestyles can be unhealthy, physical activity can lower risk
January 15, 2019 - Gut microbiome may help prevent development of cow’s milk allergy
January 15, 2019 - Lesbian, gay and bisexual individuals more likely to suffer severe substance use disorders
January 15, 2019 - New England Journal of Medicine Publishes Positive Results of the Pivotal Trial of Cablivi (caplacizumab) for Rare Blood Clotting Disorder
January 15, 2019 - Levels of inflammatory marker (CRP) linked to housing type and tenure
January 15, 2019 - Three gifts I’m glad I gave myself in 2018
January 15, 2019 - Columbia’s Pediatrics Department Names New Vice Chairs, Expands Leadership
January 15, 2019 - US FDA Accepts Regulatory Submissions for Review of Tafamidis to Treat Transthyretin Amyloid Cardiomyopathy
January 15, 2019 - Staying fit can cut your risk of heart attack by half
January 15, 2019 - Vitamin D supplements are of no gain to those over 70, study shows
January 15, 2019 - Scientists create comprehensive new method to predict breast cancer risk
January 15, 2019 - Research shows connection between social media use and impaired risky decision-making
January 15, 2019 - FDA Approves Expanded Use of Adacel (Tdap) Vaccine for Repeat Vaccination
January 15, 2019 - Treating spinal pain with replacement discs made of ‘engineered living tissue’ moves closer to reality
January 15, 2019 - Providers Walk ‘Fine Line’ Between Informing And Scaring Immigrant Patients
January 15, 2019 - Outcomes Poorer for Medicaid Beneficiaries With STEMI
January 15, 2019 - Decorative Products on Foods Can Be Unsafe
January 15, 2019 - A dream of sustainable surgery in Uganda
January 15, 2019 - Study shows how herpes viruses and tumors have learned to manipulate the same ancient RNA
January 15, 2019 - Common Heart, Diabetes Meds May Help Ease Mental Illness
January 15, 2019 - Stress and trauma in earliest years linked to reduced hippocampal volume in adolescence
January 15, 2019 - Scientists identify endogenous activator of sigma-1 receptors in human cells
January 15, 2019 - MAR treatments unlikely to be cause of premature or low birth weight babies
January 15, 2019 - Parental CPTSD increases transmission of trauma to offspring of Tutsi genocide survivors
January 15, 2019 - High-fat diets shown to increase blood pressure
January 15, 2019 - New institute for food safety to be established in Netherlands
January 15, 2019 - Keele University researchers receive £2.4 million grant to help reduce overprescribing of opioids
January 15, 2019 - Synthetic compound reverses mutant p53 aggregate accumulation, study shows
January 15, 2019 - First elder care robot tested in a WSU smart home apartment
January 15, 2019 - Oxford researchers explore relationship between technology use and adolescent mental health
January 15, 2019 - From microbiome research to healthier and sustainable foods
January 15, 2019 - How coaching moms and dads improves infants’ language skills
January 15, 2019 - Precision health approach tapped to identify causes of poverty
January 14, 2019 - DNA origami can accurately measure how antibodies interact with several antigens
January 14, 2019 - Researchers identify multiple new subtypes of most common childhood cancer
January 14, 2019 - Total Fertility Rates Vary by State
January 14, 2019 - Elevated blood lead level in early childhood associated with increased risk of academic problems in school-aged children
January 14, 2019 - Superior technique identified that can block CRISPR gene editing
January 14, 2019 - Turning breast cancer cells into fat cells prevents the formation of metastases
January 14, 2019 - Review examines what influences HIV-positive patients to stay on antiretroviral drugs in Africa
January 14, 2019 - Identifying genetic factors that lead to squamous cell carcinoma
January 14, 2019 - Virtual video visits can replace office visits without compromising quality of care
January 14, 2019 - Health Highlights: Jan. 10, 2019
January 14, 2019 - Scientists uncover how protein clumps damage cells in Parkinson’s
January 14, 2019 - Physician-scientist’s “indomitable spirit” prevails over personal adversity
January 14, 2019 - King’s researchers receive £1.25 million to investigate fatal eating disorder
January 14, 2019 - UCR researchers uncover how plants sense temperature
January 14, 2019 - Scientists find link between colitis and colon cancer
January 14, 2019 - New skin patch provides long-acting contraceptive protection
January 14, 2019 - Asparagine synthetase deficiency – Genetics Home Reference
January 14, 2019 - Improved stem cell approach could aid fight against Parkinson’s
January 14, 2019 - New class of sleeping pill preserves ability to wake in response to danger signals
January 14, 2019 - Cancer patients are four times more likely to commit suicide
January 14, 2019 - The human brain works in reverse order to retrieve memories
January 14, 2019 - Simple tips can lead to better food choices
January 14, 2019 - Meth’s Resurgence Spotlights Lack Of Meds To Combat The Addiction
January 14, 2019 - TARA Biosystems and Insilico Medicine collaborate to discover novel therapies for cardiac disease
January 14, 2019 - Early life stress in mice affects their offspring behavior
January 14, 2019 - Depression Tied to Worse Asthma Outcomes in Urban Teens
January 14, 2019 - Santa calorie counting
January 14, 2019 - Opiod prescriptions for pet dogs misused by their masters
January 14, 2019 - People with ASD could be better at recognizing regret and relief in others finds study
January 14, 2019 - Conducting ChIP-Seq with Low Cell Numbers
January 14, 2019 - Study explores support and social networks of family carers of people with dementia
January 14, 2019 - At Risk for an Opioid OD? There’s an App for That
January 14, 2019 - Single national electronic health record will help improve care in Canadian hospitals
January 14, 2019 - Study unearths Britain’s first speech therapists
January 14, 2019 - Study reveals nuances of racial inequalities in breast cancer prevention
January 14, 2019 - Air pollution can raise the risk of miscarriage among women finds study
January 14, 2019 - An extra meal a day cuts deaths by half in elderly with hip fractures
January 14, 2019 - Researchers report vision-based neurotransmitter events for the first time
January 14, 2019 - Pharmacists could significantly reduce ED crowdedness
January 14, 2019 - PTSD linked with cardiovascular disease and cancer, study shows
January 14, 2019 - New analytic model can accurately predict patients at risk of developing PTSD
Engaging with “high-need” patients outside the clinic

Engaging with “high-need” patients outside the clinic

image_pdfDownload PDFimage_print

Beyond the doctor’s office, treatment completion, appointment follow up and other at-home care largely depends on the patient.

That, says Donna Zulman, MD, assistant professor of medicine at Stanford, can pose a challenge, especially when working with “high-need” patients who wrestle with chronic illnesses, socioeconomic challenges or other obstacles that limit their access to health care.

In a recent paper, Zulman and colleagues dug into some of the reasons that high-need patients may not actively participate in their own care, as well as the strategies that break from typical models of outpatient care to help these patients.

Zulman and I recently discussed the findings of the paper, which was published in the Journal of General Internal Medicine.

What is a high-need patient?

The term ‘high-need’ refers to a group of patients who typically have complex medical, social or behavioral challenges and account for disproportionate health care spending — sometimes described as the 5 percent of patients who account for 50 percent of health care spending in this country. This population includes patients with advanced illnesses or disabilities, older adults with frailty and patients with multiple chronic conditions.

What barriers prevent high-need patients from completing outpatient programs?

…The most common structural issue was care fragmentation across health systems. Many high-need patients receive care from multiple physicians, clinics and social services in different settings.

At an individual level, challenges like financial insecurity, mental illness and substance use, physical symptoms and limitations, and a lack of social support were extremely common. One thing that stood out was the prevalence of socio-behavioral factors that pose major challenges for patients, including distrust of the health care system, transportation challenges, housing instability and other issues relating to the neighborhood and social environment.

How can outpatient programs successfully engage high-need patients?

First, the most [successful] teams included staff from diverse disciplines — such as a physician, nurse, social worker and psychologist — which increased the likelihood that someone on the team had the necessary expertise to address the patient’s needs.

Including team members who had a shared experience with patients, whether that referred to roots in the same city, language concordance or a history of homelessness, was also described as helpful…

We heard all sorts of interesting stories about program staff who found time to visit patients in their homes, take them fishing, stand with them in line at the DMV and even go out in search of a prosthetic leg. These time-intensive and intimate activities were seen as pivotal moments that led to trusting relationships.

Programs require adequate time and resources to build relationships with patients, and they need to have the autonomy to address patients’ needs on their own terms.

Photo by Josh Appel

Tagged with:

About author

Related Articles