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OCR for page 239
The Patient Advisory
Council Concept
Milton H. Seifert, Jr.
The Patient Advisory Council (PAC) has been in operation for 8 years in
the private, fee-for-service medical practice of Milton H. Seifert, Jr., M.D.
Members pay $5 per family per year, and the practice contributes some
support for medical activities such as the Annual Health Education Forum.
Other than this, there has been no external funding for the council. The
purpose of the PAC is to achieve health care delivery that is competent,
caring, and appropriate to community needs. It functions to establish a good
working relationship between the practice staff and the patient group.
Membership is open to all members of the practice, which number 4,000
people. There are four meetings annually of the full council, but working
committees meet more frequently, and all meetings are open to anyone in
the practice. The areas of council and practice cooperation are detailed in
Table 1.
This Patient Advisory Council is a major factor in determining the con-
duct of the medical practice. Through a cooperative effort of the practice
staff and the patient group, the services offered are better able to meet the
goals of community oriented primary care as iterated by Drs. Kark and
Abrarnson. This is discussed on an itemized basis below.
A Defined Population: The practice has counted its patients and deter-
mined who are regular patients and who are not. In this study, 75 percent
of the total patients were found to be regular patients. This practice has
served the same area for 52 years.
Availability and Accessibility: The practice provides 24-hour availability
through an arrangement with two other practices in the building, as well
239
OCR for page 240
240
PART II: PRACTICAL APPLICATIONS
TABLE 1 Areas of Council and Practice Cooperation
Council
Practice Staff
A. Organization
1. Membership
2. Treasury
3. Meeting arrangement
4. Recording secretary
B. Accountability
1. Policy development and assessment
~ r' . .
a. services Improvement
3. Support service
C. Patient services
1. Talent bank registry
2. Health education fomm
3. Patient education
D. Liaison
E. Research
Assistance of staff secretary
Assistance of staff secretary
Assistance of physician and whatever staff
is appropriate, e.g., bookkeeper, nurse,
. .
service coorc lnator
Assistance of appropriate staff to acquire
practice version of a patient complaint
Physician, accountant, practice manager,
bookkeeper, and services coordinator at-
tend all meetings of this committee
Referrals provided by staff
Staff assist in program development
Staff assist in developing groups and edu-
cational formats, usually physicians and
nursing staff
Assistance of staff secretary
Staff assistance in refining a research ques-
tion and to aid in issues of human subject
use
as a 24-hour answering service. Council members provide increased acces-
sibility by transporting patients to and from the office. Economic availability
is provided by a self-discount program, a Family Therapy Fund, and an
Annual Forgiveness Day. These programs are under the supervision of the
Support Services Committee of the council.
Epidemiology: Diagnostic data are collected on every patient and have
been since 1974. Various samplings of these data have been done over the
years. The data from these samplings have been compared with published
data from other primary care practices, with the Physician Oriented Disease
Surveillance Program of the Minnesota State Board of Health and also with
the National Ambulatory Medical Care Survey. Our practice compares
favorably to other primary care practices, except in the categories of mental
health and living disorders, where it has a diagnostic rate of 16 percent, as
compared to the usually recorded 3 to 5 percent. These data have been
derived without the aid of a computer.
OCR for page 241
The Patient Advisory Council Concept
241
Programs to Deal With Health Problems: The practice has several programs
to deal with the identified health problems of its patients. These include:
the Well Child Care Program, Marriage Health Education, Parenting, Body
Weight Management Program, Alcohol Education, Social Drinking, Inten-
sive and Maintenance Chemical Dependency Treatment, and Education for
Life Management Skills.
Community Involvement: Decision making is shared in all areas with mem-
bers of the PAC. The practice is accountable to the community through
its Policy Development and Assessment Committee, the Services Improve-
ment Committee (grievances), and the Support Services Committee (fees,
salaries, and practice management). There is also community involvement
through health education and patient-to-patient services.
Clinical Skills: Patient services are delivered by a full-time family phy-
sician, a part-time adjunct physician, a health educator, a living problem
counselor, and the usual supporting practice staff members. This provides
a broad range of clinical skills, which is broadened even further by estab-
lished relationships with various specialists and health resources within the
community. Laboratory and x-ray facilities are available on site.
Comprehensive Care: Comprehensive care in our practice begins with the
study of the diagnostic data. It has been enhanced by adding additional
members to the provider staff, especially in the areas of health education
and counseling. All problems are considered health problems whether they
are physical, mental, emotional, or social.
Team Function: The practice staff has monthly meetings, and one per-
manent agenda item is "Interdependent Functioning." In addition, the prac-
tice staff has developed an Interdependence Protocol. Members of the
practice staff meet with the Support Services Committee of the PAC to
explore problems and share decision making regarding practice management
matters.
Outreach: The practice and the council cooperate in an Annual Health
Education Forum. A prominent speaker or two are invited, and the audience
participates. The council has a Talent Bank Registry, which collects and
collates the skills of various people who are willing to share them with
other patients. The Talent Bank Registry provides patient-to-patient ser-
vices such as babysitting, homemaking, transportation, or physical therapy.
The Liaison Committee of the council provides information about the coun-
cil to interested consumers or providers. Finally, the practice attempts to
identify those patients who are at greater health risk and has procedures
to encourage follow-up on health problems that have already been iden-
tif~ed.
Carative and Rehabilitation Services: There is an integration of the curative
and rehabilitation services, especially through the Talent Bank Registry of
OCR for page 242
242
PART II: PRACTICAL APPLICATIONS
the Patient Advisory Council. Members are available to provide support
for persons with grief reaction, epilepsy, mental illness, chemical depen-
dency, and others. Our program of continuity is designed to provide main-
tenance health services after the acute episode has been treated. Health
maintenance and preventive medicine are stressed at the time of annual
health examinations.
The Patient Advisory Council has played a significant role in this practice.
At their suggestion the medical building was refinanced, which led to a 33
percent decrease in rent. With the help of council members, a new book-
keeping and billing system was installed. This and the development of
improved methods of collecting past due accounts reduced the accounts,
receivable of the practice by 30 percent. The council has also helped to
improve inventory control and practice staff salaries.
The Services Improvement Committee (Grievances) has helped us to
better understand the needs of people. It no doubt reduces the risk of
committing malpractice, and this has been recognized by our professional
liability insurance carrier, who has reduced our malpractice premium by 10
percent because of the participation of the Patient Advisory Council.
There are a number of experiences that could be described to illustrate
the usefulness of the patient-to-patient services. Suffice to say that these
people are providing services that are not available in any other way.
In general, the outcome of the health care system is made up of all the
individual outcomes of each provider/patient relationship. The delivery of
health care services for an individual originates in a single relationship. The
better the relationship of provider and patient, the better will be the di-
agnostic effort and the better the diagnostic effort, the better the therapeutic
effort. Thus, the better the relationship, the better the outcome. The Patient
Advisory Council is simply an extension of that relationship at the com-
munity level. There is always some relationship between a practice staff
and the patient group, but in our case that relationship has been formalized.
The Patient Advisory Council is a concept that provides local account-
ability and therefore local control of the health system. Since this is the
level close to the actual services and their outcomes, the controls should
remain appropriate. A local system under the influence of a Patient Advisory
Council would be more responsive, more practical, more accountable, and
more cost-effective. If the whole system were comprised of local systems
such as this, the attributes mentioned would then accrue tO the system as
a whole.
Representative terms from entire chapter:
practice staff
