We’ve often talked about the disconnect between perception of quality of care and measures of actual quality of care. The John A. Hartford Foundation recently released results of a poll of over 1000 adults aged 65 and older (John A. Hartford Foundation 2012). While 97% of respondents were satisfied with the care they got from their primary care physician, responses to specific questions identified serious gaps in care. Many of those gaps impact on health status, patient safety and quality of life.
The poll asked about items of care considered important in geriatric care. For example, at least an annual review of all medications taken is very important, yet 32% of seniors responding stated they had not had such a medciation review in the past 12 months. 60-70% did not recall being asked about falls or fear of falling, depression symptoms, or activities of daily living. Less than 20% were counseled on how to avoid falling.
Of seven geriatrician-recommended services, only 7% received all seven and 76% received fewer than half the services.
Interstingly, over two-thirds of the seniors were unaware that Medicare covers an annual “wellness” visit that has no out-of-pocket expense to them.
Of course, some critics will note that the survey was based upon the patient’s recall and that perhaps some of the services were actually rendered. But you get the idea – we often fail to deliver services that are important in preventing harm to our patients (and could avoid substantial unnecessary costs to our healthcare system).
When we do the “brown bag” visit (where we have our patient bring in all the medicines he/she is taking at home) we cease to be amazed at how many medications we end up taking away. Similarly, while we see many physicians ordering DEXA scans to look for osteoporosis, only a minority of those same physicians actually perform a fall risk assessment on those same patients. Yet many physicians don’t schedule their Medicare patients for that annual wellness visit where such services should take place (and the Medicare reimbursement for such visits is better than for most office visits).
Now that electronic medical records are being adopted in the majority of medical practices, we need to make better use of alerts, reminders, and registries to identify such gaps in care and be proactive in providing these services.
We’re missing a big opportunity to improve health status, prevent untoward events, and save money at the same time. Hopefully, our move towards more accountable care will help close some of these gaps.
John A. Hartford Foundation. John A. Hartford Foundation Public Poll: “How Does It Feel? The Older Adult Health Care Experience” April 23, 2012