Patient Access To Care In The Information Age

The Information Age is now officially a part of the health care conversation. Or vice versa.

In a 2012 national survey by the Pew Research Center’s Internet & American Life Project, it was found that 81% of U.S. adults use the Internet - with 59% seeking out health information online in the past year. Perhaps more importantly, 35% of U.S. adults say they have gone online specifically to try to "figure out what medical condition they or someone else might have". In other words, 35% of U.S. adults are considered "online diagnosers".

Meanwhile, in the year 2013, consumers continue to be faced with issues of access to care. The gatekeeper model continues to regulate a patient's access to care from many health care professionals in many states, including Texas and California.

Toto, we're not in Kansas anymore, and it is definitely not 1950. Now that we are in the Information Age, the model will need to change - and here's why.

Online diagnosis: There are 35% of U.S. adults that will actually make an "online diagnosis" - without any specific "quality control". Patients have ultimately been left to do their own research - and make their own decisions.

Consider the data on "online diagnosers":

- 53% talked with a clinician about what they found online.

- 41% had their condition confirmed by a clinician.

- 35% did not visit a clinician to get a professional opinion.

- 18% say that a medical professional either did not agree or offered a different opinion about the condition.

Increasing demands: In the meantime, the American Medical Association has reported that Texas ranked 47th among all states in 2011 in the number of primary-care doctors per 100,000 residents. In 2009, it was 43rd. A national shortage of 100,000 primary-care doctors is expected by 2020. Oh, and add in the minor problem of a mere 5 million more Texans entering the health care system. And that is only Texas.

We have a problem here - a rather significant access to care problem.`

But there is a solution, one that is readily available to legislators.

If patients have direct access to a broad scope of clinicians, they can then receive care when appropriate, be mentored when appropriate, and referred on when appropriate. With enhanced access to care, they can interact with health care professionals that can then direct them to the proper care within the scope of their training and licensure.

What all of this amounts to is a strange logical fallacy. Gatekeepers do not appear to be terribly concerned about patients doing their own self diagnosis - with no health care training whatsoever! Yet these same gatekeepers are overly concerned about trained and licensed health care professionals - such as advanced nurse practitioners and physical therapists - providing both assessment and treatment to these same patients without a gatekeeper’s oversight. Even if doing so would a) increase access to care, and b) decrease the cost of care.

Patient-Centered Care: I ask the gatekeepers this very simple question: given the current state of patient access to care, and the fact that patients are increasingly using online information for self-diagnosis, which is the better option for patient-centered care:

- Continuing to restrict a patient's access to care by tightening the reins of the gatekeeper model – with many patients simply choosing to settle for their own self-diagnosis alone – or …

- Providing greater patient access to care and effectively creating solutions and guidance in conjunction with the patient's current efforts?

I think we all know the answer to this question. So let’s get on with the solution, shall we?

It's not 1950 anymore. The gatekeeper model may have been appropriate then, but it is highly irrelevant now. It is in dire need of replacement in the Information Age and a knowledge-based society.

Fortunately, legislators can make the choice in support of patient access to care and "patient-centered care" - and patients should demand it.

Photo credits: jo-h