Patient Priorities Care provides easier care for older adults

For patients 65 years and older who suffer from multiple chronic conditions like diabetes, high blood pressure or arthritis, worrying about numerous health problems and taking different kinds of medications can become overwhelming.

Patient Priorities Care is a demonstration program that provides a new approach to care for older adults with multiple chronic conditions by focusing on their health goals and values. Published in JAMA Internal Medicine, researchers from the Center for Innovations in Quality, Effectiveness and Safety (IQuESt) at the Michael E. DeBakey VA Medical Center and Baylor College of Medicine led a study that shows how a program like Patient Priorities Care can make healthcare less burdensome for older patients.

“When you’re 80 years old and have six to 10 conditions, you are taking multiple medications and having to see a doctor every few weeks,” said Dr. Aanand Naik, acting chief of geriatric medicine in the Department of Medicine at Baylor College of Medicine and chief of the Implementation Science & Innovation Core at IQuESt and second author of the study. “The way we practice medicine works great for 40 to 50 year olds, but it starts to not work so well when you are 80 and have more problems. That’s really the focus of this work – how do you approach care in a different way and focus on the patient’s priorities.”

Patient Priorities Care is divided into five steps to make sure the patient’s healthcare is in line with their health priorities:

• Exploring what matters most to the patient
• Setting meaningful health goals
• Understanding what the patient is willing and not willing to do to meet their goals
• Communicating about the importance of meeting goals and healthcare preferences
• Adapting current healthcare to the patient’s overall health priorities

“We’re encouraging clinicians to interact with patients in a different way,” said Dr. Lilian Dindo, assistant professor of medicine in the health services research section at Baylor and IQuESt and co-author of the study. “It’s a paradigm shift in what to focus on in a patient encounter. You go from mainly asking the patient about symptoms and diseases to asking more about what they want to get out of their healthcare, what they want their day-to-day life to look like, and how we can help them medically get there.”

The program centers on having patients identify the main activity that is meaningful to them but they are unable to perform because of their health condition, Naik explains. If the patient wishes to focus on meaningful life activities, living independently and walking without dizziness, the program urges patients and physicians to focus on the type of care needed to reach those desired goals.

“If you want to be able to visit your grandkids and play with them for two hours without having a lot of back pain, then that’s the outcome goal that we are trying to accomplish,” Naik said. “Now the care isn’t based on a pain scale, blood pressure number or a glucose number; it’s based on how we can get to this outcome with available healthcare and achieve it on a daily basis.”

The study for Patient Priorities Care included a nonrandomized clinical trial in a large primary care network in Hartford, Conn., where patients with multiple chronic conditions were enrolled into two groups. One group received the Patient Priorities Care approach using a nurse practitioner or a social worker to identify patient priorities, while the other group received usual care from their physician.

Overall, the study showed that the group that received Patient Priorities Care felt less burdened and that their care became more aligned with their health goals, the researchers said.

“We were able to show that we reduced the overall treatment burden, the number of inappropriate medications, focused more on care that the patients want, and that we were able to do this more as a part of their routine medical practice,” Naik said.

“It’s shifting care from ‘what’s the matter with you’ to ‘what matters to you,” Dindo said. “It is starting the discussion with ‘what is the most important thing for you here in your care and what do you want to be able to do more of or have fewer problems with.’”

In addition to Naik and Dindo at Baylor College of Medicine, IQuESt and the Michael E. DeBakey VA Medical Center, the study was also led by Yale University School of Medicine, New York University School of Medicine and American College of Physicians.

See more information about the Patient Priorities Care approach.

See an online curriculum for learning how to implement Patient Priorities Care can be found on the American College of Physicians website.