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Advice on the management of complex patients

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Primary care physicians who care for complex patients are often challenged with managing their care appropriately. Caring for complex patients involves the need to coordinate with specialty providers, to control the redundancy of tests, reduce the number of avoidable hospital admissions, and to curb costs for the patient and the provider. According to a study report published in the Rand Health Quarterly, “a relatively small proportion of complex patients … incur most of the nation’s health care costs” in the US.

The report, recognizing the challenges faced by primary care physicians in treating complex patients, states that “innovative uses of analytics and health information technology (HIT) may address these challenges.” Analytics, using various types of data, “may help create better risk stratification approaches that more effectively target patients for interventions.” HIT tools “may facilitate communication and improve timely decision making.”

Dr. Clive Fields, president of the Village Family Practice and co-founder/chief medical officer at VillageMD, writes in Physicians Practice that managing complex patients involves thought and planning on the part of the primary care physician. Dr. Fields also cites the need to take advantage of patient data collection and analytics, stating that the successful management of complex patients “involves implementing best practices, using data to identify opportunities for improvement, measuring outcomes, and creating a cycle of continuous improvement.”

Dr. Fields offers some additional advice on complex patient care. Primary care physicians should clearly understand their role in the care of complex patients. When multiple providers are treating the patient, as is usually the case, the primary care provider should take the lead in coordinating that care.

Primary care physicians should also know their patients well to better manage their care. They should be able to answer three questions, Dr. Fields suggests:

  •         Who are my complex patients?
  •         What illnesses and complications do they have?
  •         Where have they been in the healthcare system?

The answers can be easily attained by getting to know the patients more thoroughly as individuals and as part of a population group. Answers can also be found in the data contained in the patients’ electronic health records (EHRs), enabling primary care providers to coordinate and manage the care of their complex patients more efficiently and more effectively.