A question continues to surface...Who should have a Shared Care Plan?
Our natural tendency and focus as caregivers has so far been to go for the most complicated patients first...the multi-diagnoses, poly-med folks, who are frail and least able to accurately and consistently communicate their mass of information to their horde of health care professionals. Indeed, for one of our clinics here in the Pursuing Perfection Project, almost their entire population fits this description. Another clinic has an abundance of patients who are non-English speaking and, in many cases not literate in any language, so communication around healthcare issues is a special challenge.
Shared care plans for these folks are clearly necessary, and require one on one conversation and explanation to complete and maintain. These patients and their caregivers can see the value, appreciate the interaction, and can feel the safety the document creates. However, this also presents a challenge of resources, the manpower, time and reimbursement for a care model which allows these conversations to occur.
As we strive to encourage self-management for the 'walking well' folks with earlier stages of chronic disease, and pre-cursor conditions to those diseases, we face a different challenge. Articulating the value of the conversations, goal-setting, and documentation of the much smaller number of conditions and medications is essential. Yet both caregivers and patients can feel it 'isn't necessary'.
I know I need a shared care plan. I consider myself a healthy person, and an activated patient with inside knowledge and comfort with the medical 'system'. I only have three meds, two for hypertension and one for mild asthma. I have tried other meds for the hypertension which cause reactions. My chart reflected that I was still on one of those discontinued meds though I stopped it after a single dose. I like most everyone else, have a Primary Care Doc, a Specialist, a Dentist, and Opthalmologist, and a Pharmacist. They can all prescribe things that could have an interaction with the others, or healthcare conditions. I've been in the Emergency Department and forgotten to mention the inhaler. I might someday be hospitalized for a car accident and need my ongoing maintenance meds. So, I carry my paper shared care plan with me.
