Patient advocacy

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Patient advocacy is an area of lay specialization in health care concerned with Advocacy of patients, survivors and carers. Typical Advocacy activities are : patient rights, matter of privacy, confidentiality or informed consent, patient representation, awareness building, support and education of patients, survivors and their carers. Patient advocates give a voice to patients, survivors and their carers on different health care related (public) fora : towards the public, to the political and regulatory world, towards health care providers (hospitals, insurers, pharmaceutical companies etc.), to organisations of health care professionals, to the education al world and last but not least to the medical and pharmaceutical research community.

Patient Advocacy in its current form finds its origins in the early days of Cancer Research and treatment, in the 1950-ies. It's part of the notion of Total Care a term coined by dr. Sidney Farber (1951) a Harvard physician and cancer researcher, referring to the treatment of children suffering from leukemia where "the cancer clinician treated the family as a whole".[1] The concept of Total Care, subordinated clinical investigation to patient welfare ... "clinical investigation in the field of cancer may be carried out only as part of the total care of the patient" (Farber et al.,1956).[2] Cancer patients are usually not in a position to take an assertive stance, and even less in the 50-ies, clinicians recruited patients for tests and suspicion reigned at the NIH as researchers had to convince doctors and patients they weren't experimenting on people. In order to properly represent the patients in this medico-legal and ethical discussion Patient Advocacy came into being as a way to make the voice of the patient heard.[3]

Support role of patient advocacy[edit]

Patient advocacy activities often start as an offshoot activity from patient support groups or are the primary role of patient interest groups. Their activities include for a large part support activities such as educating patients and carers to cope with the effects their disease. Patients and survivors suffer from the direct effect or the consequences their disease has on their quality of life. Family and especially family carers of patients and survivors go through difficult phases of adaptation of their daily routine and lifestyle in order to accommodate the disease. The financial impact of ill health on the whole family is not be underestimated, the psychological effects of those changes has a very large impact.

Support activities may include specialised nursing help to assist family carers to cope with the medical care of patient or the survivor, cooperative purchases of health care materials, getting financial support for families, the choosing and use of health insurance plans, coping and preventing families from disappearing totally into poverty, securing dietary support for patients or survivors. Other support activities of the patient advocacy are the establishment of a network of contacts in the public sector (political and regulatory), in the public and private health insurance, in the sector of medical service providers, with medical practitioners and with pharmaceutical and medical research in order to provide the patients with help about care and management of their disease, where and how to obtain diagnosis, second opinion and needed care, to help cover all the financial aspects and support family carers.

Many patient advocacy organizations have formed, in recent years, to help patients navigate the U.S. medical system by teaching them medical navigation strategies: tools or practices that help patients to overcome typical road blocks within the health care system. However, medical navigation is no longer the only support role that medical advocacy groups tackle. Increasingly, patient advocacy support roles are broadening to help patients cope with the mental, social, and emotional affects of medical problems outside of the hospital and will often focus on strategies for increasing quality of life for patients.[4]

Education role of patient advocacy[edit]

Both the patient / survivor of a disease as his carers often are in need of education beyond physical rehabilitation of the patient/survivor to learn about his disease, the aftermath of the disease, the patients limitations and the limits of care family members can provide, to learn to live with the disease and come to terms with the restraints put on his life(style), education of carers to cope with daily care of the patient/survivor (like injections) or with long term effects (for instance to cope with epilepsy seizures or with hyper or hypoglycemia in diabetespatients).

The role of education in patient advocacy is particularly beneficial for medically complex patients (defined by Lynsie Buteyn at Bridges to Patient Empowerment, as patients that have a rare disorder or one or more conditions that affects multiple systems in the body). Buteyn (a pioneer in patient advocacy) has asserted the need for patient education by individuals and organizations to increasingly address the needs of chronically or complexly ill patients by helping to teach them strategies for managing their disease(s) and other aspects of their life that have been impacted by chronic illness because of the propensity, in the current medical system, for medically complex patients to get “lost” in the system due to the complexity of their conditions, and the challenge to communicate health information between a larger number of care providers. Further, medically complex and chronically ill patients often need the most time with their care providers, but too often, end up not being able to get this time due to time limitations imposed by our current medical system.[5]

In the United States, most states have established within their government structures an office of patient advocacy or similar function.

More broadly, patient advocacy can include groups that develop policies and legislation to improve systems or processes for patients, such as the Alzheimer's Association, the British Diabetic Association, and the American Cancer Society. Such patient advocacy organizations are characteristically non-profit and focus on one aspect of health care or a specific disease, generally also conducting fundraising and awareness campaigns and producing healthcare literature and information services. These organizations normally do not engage in the provision of clinical support or the conduct of liaison between patient and provider.

The patient advocate may be an individual or an organization. The terms patient advocate and patient advocacy can refer both to individual advocates providing services that organizations also provide, and to organizations whose functions extend to individual patients. There are also governmental agencies that study and ensure compliance with government regulations including financial aid. Some patient advocates work for the institutions that are directly responsible for the patient’s care.

An individual patient advocate typically acts as liaison between a patient and their health care provider. By professional background, individual patient advocates have often been case managers in the field of social work whose specialty is navigating the bureaucracy of large health plans or government-provided services, or former doctors, nurses or other trained health care professionals who have re-focused on helping patients in their decision-making. Patient advocacy services can also include transition assistance to older patients moving into assisted living and nursing homes, or such mundane but essential tasks as transportation, bill tracking, and payment assistance. There is currently no accredited certification or licensing for patient advocacy in the United States, the United Kingdom, or thus far in any other country. Many colleges and universities offer educational opportunities for students wishing to provide patient advocacy services.[6] These range from weekend workshops, to online webinars, to year-long certificate programs. Patient advocates are individually responsible for self-education concerning the general business of medicine, HMO rules, and local institutional changes to compliance articulation and implementation, as well as following relevant legislative changes.

Individual patient advocate[edit]

A patient advocate may be present for health care appointments and alert the health care provider to patient compliance issues. He or she may separately assist the health care provider and support staff with potential issues and communication. The patient advocate is responsible for maintaining communication with the patient and health care provider to help ensure patient understanding of procedures. By reducing unnecessary anxiety and fear and increasing patient compliance, this can result in a higher incidence of successful treatment. Generally, a patient advocacy contract that includes a release of medical information must be placed with each healthcare facility. A power of attorney for healthcare may be required by some institutions for a patient advocate to exchange confidential information.

The patient advocate may provide medical literature and research services to the patient, family, or health care provider. The patient advocate may also assist with family communication on issues arising from illness and injury. This may include further referral for care and support for both patients and families. The patient advocate has a responsibility for awareness of compliance, appropriateness, and coordination of care for the patient, such as oversight for potentially conflicting treatment modalities and medications. The patient advocate can ensure that questions about the appropriateness of treatment are promptly discussed with the patient's care provider, and that all treatments and concerns are promptly entered into the patient's health care record. The patient advocate is also responsible for reviewing the patient's health care record for correctness and explaining it to the patient. Creation and maintenance of an electronic log for the patient that is available on disk to health care providers is another responsibility of the patient advocate, which may be of great benefit in subsequent urgent situations.

The patient advocate can also assist in resolving disputes between patients and their health care provider, as well as engaging in communications on behalf of the patient in the case of employment issues, engaging with the employer to achieve a mutually beneficial solution for the employer and the individual employee. Where applicable compliance standards are not met, the patient advocate may conduct liaison with corporate oversight, government agencies, or legal professionals to further negotiate such issues on behalf of the patient and family.

It is the duty of a patient advocate to maintain patient privacy in compliance with local and national laws, treating all patient and family information as privileged and protected. This includes ensuring that health care provider communications are treated as highly confidential and privileged, whether or not those communications are specific to the patient, and that permissions to disclose information are negotiated carefully. It is also the duty of the patient advocate to follow any referrals for medical, financial, legal, administrative or other personnel to assure that the patient is always kept safe and well informed, never abandoned or misled during the process.

Patient advocacy professional membership groups[edit]

There are organizations, generally non-profit, that focus on specific diseases or aspects of health care. In such health advocacy organizations, patient advocates may sit on investigative and advisory panels to ensure that ongoing projects and those being considered for funding will directly impact patients' lives, improving delivery of care and support for tertiary care. Patient advocates may also sit on finance boards to analyze cost containment and act as proponents for best practices, advocating better protection for provider and patient.

Some health benefit or employee assistance plans include patient advocacy services offered by third-party patient advocacy companies. Depending on the scope of services included, members or employees can get assistance with scheduling, quality review, care management, and bill negotiation or mediation for the portion of the bills that are the patient's responsibility. Such services are typically available to plan members or employees at little to no additional charge. A benefit of this type of arrangement is that independent third-party firms have fewer conflicts when advocating for members or employees as compared to advocates who are employees of health care providers or insurers.

The National Patient Advocate Foundation[7] is a non-profit organization in the United States dedicated to improving access to, and reimbursement for, high-quality healthcare through regulatory and legislative reform at the state and federal levels. Its companion Patient Advocate Foundation provides professional case management services to individuals.

The Alliance of Professional Health Advocates [8] is a membership organization for private, professional patient advocates, and those who are exploring the possibility of becoming private advocates. It provides business support such as legal, insurance and marketing. It is also the foundation of AdvoConnection [9] the largest and most comprehensive directory of private advocates available to patients and caregivers.

Education in patient advocacy[edit]

As of summer 2012, approximately 19 organizations and universities offer coursework specific to patient advocacy. These opportunities range from weekend workshops, to webinars, to year-long certificate programs, and one master's program in Health Advocacy at Sarah Lawrence College.[10] The interprofessional Center for Patient Partnerships (CPP) at UW-Madison offers three certificates in Consumer Health Advocacy.[11]

Founded in 2000, the Center for Patient Partnerships began offering two graduate certificates in 2008: the “Graduate” certificate in which graduate students pair with their graduate/professional studies in various disciplines (e.g. law, social work, nursing), and the “Capstone” certificate, in which post-baccalaureate students enroll before entering graduate/professional school (e.g. public health, medicine, public policy, health administration). Beginning fall 2012, CPP offers a noncredit Professional certificate. CPP's learning experience is grounded in service learning; students learn by providing advocacy to patients with life-threatening and serious illness.[12] Consumer Health Advocacy certificate students gain fluencies in patients’ experiences in the health care system and the interplay between individual and system level advocacy. The book chapter “Educating for Health Advocacy in Settings of Higher Education” describes CPP's pedagogy and curriculum.[13]

Admitted students may enroll for graduate credit or noncredit, and pursue the program either on-campus, online, or in a blended format. Graduates of the Consumer Health Advocacy Program incorporate the patient-centered perspective and advocacy principles into their work in the healthcare, non-profit, and government sectors. Alumni work at such places as: the Centers for Disease Control, the Food and Drug Administration, Veterans Affairs, Wisconsin Judicare, After Breast Cancer Diagnosis, various hospital systems, and private law firms.

Patient advocacy awards[edit]

In 2011, the H. Kenneth Schueler Patient Advocacy Compass Award [1] was established in honor of one of the first advocates to establish a private practice in patient advocacy. The award recognizes excellence in private practice including the use of best practices, community outreach, support of the profession and professional ethics.

Organizations and governmental agencies[edit]

In the United States, state governmental units have established ombudsmen to investigate and respond to patient complaints and to provide other consumer services. In New York, for example, the Office of Patient Advocacy[14] within the New York State Office of Alcoholism and Substance Abuse Services (OASAS)[15] promotes high-quality care in OASAS-certified programs by protecting patient rights and ensuring that services are delivered consistent with regulations and expected standards. This office helps people in treatment, or their families, by answering questions and addressing problems that cannot be resolved by the programs themselves. It also advises health care professionals about issues concerning patient rights, treatment services and accepted standards. Likewise, in California, the Office of the Patient Advocate (OPA), an independent state office established in July 2000 in conjunction with the Department of Managed Health Care, is responsible for the creation and distribution of educational materials for consumers, public outreach, evaluation and ranking of health care service plans, collaboration with patient assistance programs, and policy development for government health regulation. Such state government offices may also be responsible for intervening in disputes within the legal and insurance systems and in disciplinary actions against health care professionals. Some hospitals, health insurance companies, and other health care organizations also employ people specifically to assume the role of patient advocate. Within hospitals, the person may have the title of Ombudsman or Patient Representative.

Nursing and patient advocacy[edit]

Health care workers such as nurses, social workers who are in close contact with the patient often identify themselves with the role of patient advocate. However, there are clearly (potential) conflicts of interest between their assumed advocacy role and their actual role of care practitioners and their position as a care providers employee in such situations.

Nonetheless, the American Nurses Association (ANA) includes advocacy in its definition of nursing, which it describes as "the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations."[16]

Advocacy in nursing finds its theoretical basis in nursing ethics. For instance, the ANA's Code of Ethics for Nurses includes language relating to patient advocacy:

  • The nurse's primary commitment is to the patient, whether an individual, family, group, or community.
  • The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.[17]

The stance the ANA defends is commendable, and beyond any doubt nurses are - within the confines of a medical care situation (whether it's in a hospital or similar setting or in residential care at home) - the patients advocate in the interaction between patient nurse and physician. In that respect the Code of Ethics should be read as an incentive for nurses to exercise control over the care, and defend the best possible quality of life for the patient. However in the larger world of medical care for patients and survivors and different medical interests, the nurses and other professional carers are a separate group with their particular interests, that differ from the interests of patients and their family carers, but also from other medical practitioners, from their employers ( the service providers) or from insurance, research and commercial interests in the subject matter of care for patients and survivors of diseases and suffers chronic medical conditions.

See also[edit]

References[edit]

  1. ^ quoted from Cancer on trial, Keating and Cambrosio, University of Chicago Press, 2012, p81
  2. ^ quoted from Cancer on trial, Keating and Cambrosio, University of Chicago Press, 2012, p81
  3. ^ Cancer on trial, Keating and Cambrosio, University of Chicago Press, 2012, p80-83
  4. ^ http://bridgestopatientempowerment.org
  5. ^ http://bridgestopatientempowerment.org/about/
  6. ^ http://HealthAdvocatePrograms.com
  7. ^ National Patient Advocate Foundation
  8. ^ The Alliance of Professional Health Advocates
  9. ^ AdvoConnection
  10. ^ http://healthadvocateprograms.com/masterlist.htm
  11. ^ http://www.patientpartnerships.org/certificate/
  12. ^ http://www.patientpartnerships.org/advocacy/
  13. ^ M. Hurst, M. E. Gaines, R. N. Grob, S. Davis (2008). J. Earp, E. French, M. Gilkey, ed. Patient Advocacy for Health Care Quality: Strategies for Achieving Patient-Centered Care. Jones and Bartlett Publishers, Inc. 
  14. ^ http://www.oasas.ny.gov/pa/index.cfm
  15. ^ http://www.oasas.ny.gov
  16. ^ ANA, making patient advocacy a fundamental part of nursing. Nursing's Social Policy Statement, Second Edition, 2003, p. 6 & Nursing: Scope and Standards of Practice, 2004, p. 7.
  17. ^ ANA. "Code of Ethics for Nurses - Provisions". Retrieved 2010-06-08. 

External links[edit]