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Featuring Hilltown Community Health Center

This is one in a series of stories about strategies primary care practices are using to increase patient engagement. MHQP is in a unique position to learn about structural programs and innovative practices that help empower patients to be active in their own care, as we have recently completed a first-of-its-kind statewide study of patient engagement activities in primary care practices in Massachusetts with the support of CRICO.

One of the promising ideas that emerged in survey responses is pre-visit planning.

Clinicians have limited time with each patient and it should be focused on the patient, not on paperwork. By having other team members do some prep work in advance of the appointment, the practice can optimize the time clinicians spend with patients and the providers can fully focus their attention on the patient’s needs. It’s a great way to make face-to-face interactions more efficient, be respectful of the patient’s time, and help build the relationship between the provider and the patient.

At first glance, it seems counter-intuitive to spend time on a patient in advance of his or her visit. But this is time well spent. Practices report that, while the process requires entirely new workflow patterns for many staff members, they also report that it results in significant rewards for providers and patients alike.

There are many ways to implement pre-visit planning. Some practices reach out to patients 1-2 weeks before the scheduled appointment to make sure the team is up-to-date on criticial issues and logisitics, and then has time to follow-up on any specialty appointments the patient has had since their last visit. In other practices, the team simply reviews patient files a day or two in advance of the primary care appointment to identify and urgent issues and make sure everything is ready for the appointment.

Here are some thoughts from Eliza Lake, CEO at Hilltown Community Health Center, a network of community health centers in rural Western Massachusetts, which has successfully implemented one approach to pre-visit planning in its organization:

“We do pre-visit planning before every patient comes in. Each of our clinical teams does it in their own way, but the general idea is the medical assistant and the PCP get together to review the patient a few days before the actual appointment. They talk about the issues they believe the patient is struggling with, the topics they need to be sure to raise with the patient, and things they need to do in advance to make the visit as productive as possible. The medical assistant then gets as much of the pre-work done as they can within their scope. By the time the patient arrives, the medical assistant already has a sense of the screening tests the patient needs to have done, where they stand with their mammogram or their cervical cancer screening, etc. Everything is lined up before the patient walks in the door and the PCP can immediately get right to the heart of the matter with the patient.

We’ve been doing pre-visit planning for long enough now that it’s part of our standard process. It’s just what we do. I’m not sure people would know what a visit would look like without it. It’s a very important piece of how we ensure our patients are getting what they need and that they build relationships with their provider. As a rural community health center, we see a vulnerable patient population with very complex needs, and we try to meet all of those needs. Our patients have many social determinants of health that are contributing to their health status, including poverty, food insecurity, housing, etc. So, it’s important for us to understand the full picture because there could be a lot of things going on with somebody – and if you don’t know them well, you could potentially miss something and not address it.”

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