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Patient-centered doesn’t mean the customer is always right

April 23, 2018

In today’s world of consumerism, treatment centers might struggle to align what patients want from their care with what they actually need for successful treatment and recovery. The challenge then becomes: How can providers ensure they are delivering true patient-centered care?

Above all else, experts say that in order to be patient-centered, providers must first look at the individual in terms of goals and values rather than disorders and diagnoses.

“What patient-centered means is to look at the patient—and the whole patient—not as a menu of a diagnosis but rather who they are as a person,” says Camille Cisneroz, clinical program director at University Park Behavioral Health, Albuquerque. “When someone comes through those doors—let’s say his name is ‘Manny’—that’s who we are looking at. We’re not looking at the alcoholic or opioid addict, or whatever addiction he might have. He’s Manny.”

Experts agree, it’s about trying to make a sincere connection. Cisneroz says treatment centers need to ask questions about the patient’s childhood, pain level, symptoms and who he is as a whole person. From there, diagnosis can be included, but it’s not where to start.

She cites a recent example of a patient who presented with post-traumatic stress disorder (PTSD) and who had tried the recommended eye movement desensitization and reprocessing (EMDR) in the past and found it wasn’t helpful. Instead, she identified with the Narcotics Anonymous Steps and cognitive processing therapy. That combination helped her to better overcome her PTSD rather than the typical treatment, Cisneroz says.

“We have to stop prescribing as if we’re dealing with a menu or a recipe to determine what people need,” she says.

Samantha Arsenault, director of national treatment quality initiatives at the not-for-profit advocacy organization Shatterproof, agrees that treatment is not a one-size-fits-all process. Providing individualized care is not only better for the practice but also helps to improve patient outcomes, she says.

“For instance, a 28-day program is not how to manage addiction, which is a chronic, long-term disease,” she says. “It comes from individual motivation.”

Certainly, if a patient comes in to a treatment center and is given a regimen that doesn’t align with his or her practical goals—perhaps a goal regaining custody of a child or working toward stable employment—the outcome could be unsuccessful or the patient could disengage with treatment entirely.

“Patient-centered care includes goals and objectives and puts patients on the path to achieving those goals,” Arsenault says.

Nuanced objectives

However, Doug Tieman, president and CEO of Caron Treatment Centers, says providers also need to be careful not to buy into the consumerism mentality completely—that is, the concept that customer is always right.

“In many ways, that would be the golden rule,” Tieman says. “But in substance-use disorders, what the patient wants is not always what the patient needs or what is in their best interest.”

For Caron, patient-centered care means providing an individualized clinical program that is developed for each patient in a way that makes patients comfortable in following through with their treatment plans, Tieman says.

“When people have a brain chemistry illness, what you think you want is not necessarily what you need. We need to try to give you what you want and what you need, with a good balance,” he says.

Part of the success in individualized patient-centered care comes from tailoring treatments that fit the patient’s generational cohort and cultural background. For example, younger patients shouldn’t be directed to a paper copy of a 12 Step book if they indicate they are more comfortable with high-tech options, such as apps or online education.

Experts say more digital options are answering the demands of millennials who have essentially grown up with smartphones in their hands. Even something as simple as a meeting-finder app can resonate with a younger patient in recovery.

Tieman says clinicians find it useful to group people together who have similar needs and tailor programming as well as clinician training from there.

“We have gender-, age- and, to some degree, socioeconomic-centered programs. We have therapists who are trained to deal with a particular population,” he says. “The person who’s dealing with the young-adult-male program would use therapies to deal with a population who may not be as keen reading from the ‘Big Book.’”

Fortunately, Tieman says, many new therapeutic modalities have been developed in recent years to help construct a variety of options for treatment programs.

“Whether it’s neurofeedback, mindfulness, EMDR, art therapy or music therapy, there are many other modalities that we can now use,” he says. “Truly patient-centered organizations have a lot of arrows in their quiver and can pull out the right ones for their populations.”

Cisneroz says that while her clients all receive a copy of the 12 Step book upon intake, the program isn’t mandatory if it doesn’t jibe with their road to recovery.

“We have mindfulness; we have SMART Recovery and a lot of experiential options,” she says. “If there’s something they are not adherent to, we replace it individually.”

For example, younger and older patients can be split into smaller groups to participate in programs more in-line with what works for them. Younger groups also are introduced to higher-energy activities during the day, such as a basketball or volleyball games. Meanwhile, older groups might choose walking instead.

Ask the questions

When it comes to objective measurements on whether providers are delivering what patients want, experts say assessment surveys might ask about whether patients feel engaged, listened to, whether they feel goals are being worked on, and if they are in a better place managing their disease than they were a year prior. Sometimes just asking the questions can communicate to a patient that their success matters.

Tieman says his centers make use of patient-satisfaction surveys and family-satisfaction forms. That data is monitored by program and facility to look for trend lines. If something doesn’t meet expectations or if there is an outlier in the comments, the leadership team looks for a way to remediate. Additionally, in order to correct real-time issues, the clinical leadership team is also made available to patients.

“If someone has an issue, we can deal with it immediately,” Tieman says. “It’s part of our culture, and it enhances the environment if we take care of things right away.”

Amenities are nice perks but nothing more

Experts agree the amenities that residential treatment centers offer might seem like a differentiator, but they should never overshadow the quality of the care being delivered. Meals prepared by an on-site chef, leather furniture, high-thread-count linens and swimming pools often promise a degree of comfort that attracts potential patients who are searching online for treatment options.

Shatterproof's Arsenault says there needs to be a balance if luxury amenities are offered. For example, she says that only 30% of specialty addiction-treatment programs in the United States offer even one of the medications to treat opioid-use disorder. Thus, Arsenault says some inpatient treatment centers are not providing a full range of evidence-based treatment, regardless of the look of their facilities.

“That’s an important distinction,” she says. “You need to ensure you are providing good care first and then think about the amenities.”

Tieman says some patients are accustomed to more luxury accommodations if they come from a certain lifestyle, and that’s understandable. However, the expectation that insurance will cover those amenities is unrealistic.

“If someone wants to pay for additional amenities because it’s consistent with their lifestyle and it helps them get through treatment, that needs to be accommodated,” he says.

Alicia Hoisington is a freelance writer based in Ohio.

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