Direct Care: how's it working?
So far, our current healthcare model which meets the needs of a growing headache center is working better than any insured system that I have worked in previously! One of the greatest aspects of this model is the ability to field patient messages and provide hands-on care “in the moment.” The majority of migraines cause severe pain, which in and of itself may impair cognitive (thinking) abilities. Migraines are also linked to a phenomenon referred to as “mental fog” that can add to the difficulty in thinking clearly. Sometimes despite outlining and printing out a plan of action for acute headache management, there can be questions at the time of a migraine attack. A recent study showed that headache medicine patients messaged their care providers more than in any other neurology subspecialty grouping of patients.
In the established healthcare system, a patient will often see their provider and then follow up a few weeks or months later. Turn-around for calls may take several days – sometimes from a partner or someone else in the group who is not directly involved in the patient’s care. In my previous work experiences, I wondered if my staff relayed messages to me promptly about patients in the midst of headache – my expectation was for phone lines and messages to be checked several times per day. Often patients were frustrated by all the hoops that they had to jump through to get to me: calling the front office, waiting for forever only to leave a message for the nurse who may or may not relay things right away. Alternatively, they could message via a patient portal. Those communications, however, were not “real time” and required either a nurse or physician to manually check them - - someone would have to sit at their desk constantly refreshing the screen. Since this is not practical for the physician who might be seeing other patients in clinic or making rounds at the hospital, they also ended up being checked by a nurse who would then be expected to sort through and relay them to the physician as appropriate.
Direct care allows for a direct line of communication with your care provider. As a physician, I personally love this! My patients are amazing and I want to be there for them! We both sign a mutual respect agreement on their first visit which goes over expectations of direct physician access on both ends. I will do everything I can to help the patient, while the patient understands that I’m human too and there are some boundaries. Aside from messages when I am seeing other patients or unable to get to my phone, I am readily accessible via text and email. If needed, we also can arrange for a phone call or telemedicine visit. You can reach me like you would a relative or friend, with similar access and limitations.
Having real-time communication with patients allows me to advise and make changes in the moment. I don’t have to wait 6 to 12 weeks and wonder if therapy worked, or if patients were able to follow the protocol. This helps the patient get questions answered quickly about next steps in the midst of an attack but also helps me to keep a pulse on how the headache management plan we agreed on is working. All this, in turn, helps to shape and tweak overall treatment to provide the best care possible.