A 'real puzzle': the views of patients with epilepsy about the organisation of care

BACKGROUND: Little is known about how individuals who have a diagnosis of epilepsy have experienced healthcare services or their views about how they should best be organised to meet their ongoing needs. METHODS: Focus group interviews. Individuals with epilepsy were identified in 5 practices in Wales: 90 were invited, 40 confirmed attendance and 19 individuals attended interviews in 5 groups of size 6, 5, 4, 3 and 1 (Table 2). Inclusion criteria: individuals with a confirmed diagnosis of epilepsy, aged between 18–65. The exclusion criteria were learning disability or an inability to travel to interview locations. RESULTS: The individuals in these group interviews were not 'epilepsy activists' yet they remained critical in extended discussions about the services encountered during their patient careers, wanting more information and advice about how to adapt to problems, particularly after initial diagnosis, more involvement in decision making, rapid access to expertise, preferably local, and improved communication between clinicians. A central concern was the tendency for concerns to be silenced, either overtly, or covertly by perceived haste, so that they felt marginalised, despite their own claims to own expert personal knowledge. CONCLUSIONS: Users of existing services for epilepsy are critical of current systems, especially the lack of attention given to providing information, psychosocial support and the wishes of patients to participate in decision making. Any reorganisation of services for individuals with epilepsy should take into account these perceived problems as well as try to reconcile the tension between the distant and difficult to access expertise of specialists and the local but unconfident support of generalists. The potential benefit of harnessing information technology to allow better liaison should be investigated

Primary Care Survival Skills in an Age of Reform

The Triple Aim - improved outcomes/quality of care, improved patient experience, and reduced cost - is driving health care reform in Minnesota and nationally. Minnesota is among those states moving quickly to new payment models that reward practices for meeting these three goals and is gradually reducing payments based only on increased volume of services. Primary care is growing into a new leadership role to meet these new demands while managing the reality that full funding for population based care is developing more slowly than the rhetoric. There are many encouraging signs, including an expanding interest in primary care medical careers, increased examples of highly functional interdisciplinary teams and increased attention to the social determinants of health that interfere with improved patient outcomes. This plenary presentation will review key, basic steps regarding how we engage our providers and staff to move forward on this agenda. We must reframe the future and engage our teams in new ways to create new standard work flows to help patients avoid the emergency room and hospital. Who do we need as teammates to create these more effective teams? How can we more fully integrate behavioral health and medical services? How can we fund these teams? Learning Objectives – Upon completion of this activity, participants will be able to: • Discuss the pivotal role of primary care under health care reform. • Identify ways to engage providers and staff in necessary changes to fill the expanded role of primary care

Primary Care Survival Skills in an Age of Reform

The Triple Aim - improved outcomes/quality of care, improved patient experience, and reduced cost - is driving health care reform in Minnesota and nationally. Minnesota is among those states moving quickly to new payment models that reward practices for meeting these three goals and is gradually reducing payments based only on increased volume of services. Primary care is growing into a new leadership role to meet these new demands while managing the reality that full funding for population based care is developing more slowly than the rhetoric. There are many encouraging signs, including an expanding interest in primary care medical careers, increased examples of highly functional interdisciplinary teams and increased attention to the social determinants of health that interfere with improved patient outcomes. This plenary presentation will review key, basic steps regarding how we engage our providers and staff to move forward on this agenda. We must reframe the future and engage our teams in new ways to create new standard work flows to help patients avoid the emergency room and hospital. Who do we need as teammates to create these more effective teams? How can we more fully integrate behavioral health and medical services? How can we fund these teams? Learning Objectives – Upon completion of this activity, participants will be able to: • Discuss the pivotal role of primary care under health care reform. • Identify ways to engage providers and staff in necessary changes to fill the expanded role of primary care