Do you remember the age-old era of the 1970s-80s, when there was the concept of a ‘family doctor’? This person would be aware of all health-related concerns of all family members. He /She would also remember the family’s past medical history and follow up accordingly. This ensured trust building and continuity of healthcare.
Continuity of healthcare services is vital to improve overall health and patient satisfaction. With an increase in super-specialization and the blooming of a fragmented privatized health system in India, this concept of the family doctor got lost. The health system is fragmented because the communication between different doctors who see a patient is usually minimal or missing. Health records may be incomplete, and the onus to maintain the health records of a patient is on them, rather than on the health system. Imagine a patient goes to clinic A, gets referred to hospital B, and gets admitted. Six months later, he goes to hospital C but has lost all records from centres A and B. This is problematic, and our health system does not offer easy solutions to maintaining the continuity of healthcare.
Especially among the rural population, continuity is a challenge. Patient records are either lost or are incomplete. The literacy rate in rural Solapur is around 70%, and even the literate are comfortable with the local language, Marathi. Medical reports, which are in English, feel like jargon to most people. While the Government of India has rolled out the Ayushman Bharat Digital Mission, which aims at creating a unified health interface through individual ABHA (Ayushman Bharat Health Account) numbers, implementation of the same is far from universal.
A small section of doctors is reviving this concept through their formal training in Family Medicine, and we are happy that our Executive Director will soon be completing her post-graduate diploma in Family Medicine from Christian Medical College, Vellore, among the top three medical colleges in India. This is in addition to her MD in Community Medicine from the same college. Our Founder Director, an MD in Obstetrics and Gynaecology, with over 35 years’ experience, has invested in software that ensures that all patient records are captured and stored digitally. This enables our team to attempt to maintain continuity of care from our end. For example, if a woman comes to us with multiple medical ‘files,’ we record all details on our software. Of course, when and if this woman goes to another doctor in a different place, that doctor does not have access to our records. But we attempt communication with local and other allied health doctors whom our patients go to, so that we can provide comprehensive healthcare to people here. We follow up with people to check how they are doing, if their symptoms have subsided, if our management has worked, if there is anything more we can do, to check what the specialist advised when there was a referral, so on and so forth.
At our non-profit, we want to ensure three types of continuity in care: in our relationship with the women, in the medical management of their problems, and information exchange. In 2018, the World Health Organization published a guideline on enabling continuity of care as a part of its integrated people-centered services Framework. Our team will refer to this document to improve continuity of care for people in rural Solapur.
While the journey will be challenging, we are already seeing the rewards of following up with people. Receiving a ‘I’m doing fine now, consulting with you helped,’ on a follow-up phone call, is highly satisfying!
