In February 2023, Dr Kaumudi launched a CaReMe clinic at Aartham Multi Super Speciality Hospital in Ahmedabad, India. We sat down with her to find out how the transition went and how the integrated system is improving quality of care.
Q1: How did you and your colleagues find the transition to an integrated, multidisciplinary model of care?
In India, it’s very easy for a patient to get a cross-speciality consult when they come to us, so we didn’t have to go out of our way to integrate all the specialities. We already had multiple specialities under one roof and because getting appointments for patients is also easy, the transition was pretty smooth. Right now we’re putting the information in the iCaReMe registry, which is an extra step that’s making us more conscious of how we are treating the patients.
We have a dedicated person from our clinical research team who helps us to put in all the data into the registry as it is a time consuming for the doctors.
Q2: What are some of the positive outcomes of establishing the CaReMe clinic?
Because we put everything in the system (iCaReMe Registry), we are more consciously making decisions and this automatically improves patient care. There is also a lot of knowledge sharing between the doctors, which wasn’t happening before. If I was seeing a patient and prescribing diabetic medication, it was the other doctor’s responsibility to look at his renal function, or the third doctor’s responsibility to look at his cardiac function… But now, because there is interaction and because of the monthly meetings, we share experiences and have a better understanding of each other’s perspectives. And that obviously positively impacts patient care. I also hope that all the data we are collecting will help us to publish something in the future.
Q3: What were some of the main challenges you’ve faced so far?
As I mentioned, the work increases because you need someone to dedicate time to putting in the data. Another challenge is that we sometimes lose our patients during the follow-up period. The protocol requires us to do follow-ups and repeat tests over the course of several months, but patients sometimes stop coming and we cannot exactly go to their houses. In India, there are many, many private clinics, so the patient may stop coming to you or start going to another doctor, just as other doctors’ patients may come to us.
Some patients don’t come because they’re feeling fine and will only bother to see a doctor when their disease starts affecting their day-to-day activities. The overall education level is a little lower in India than it is in the western world, and patients don’t always realize that their conditions could get worse if they aren’t monitored regularly. So, what happens is a patient will only come back to you after a year or two, when he or she is really sick and hasn’t taken care of their health. Sometimes they also don’t come to save money. This is what happens in a country like India.
Another challenge is that I need to keep reminding my colleagues to send their patients to me, even if they don’t have any comorbidities or complications, so that I can enrol them in the CaReMe programme. This could be prevented by training all participating doctors when you launch a new CaReMe clinic – or at least having one general meeting for the core team – so that everyone is familiar with the project, the team and their responsibilities. A few initial meetings would help everyone understand who’s who and how the system works, and it might be wise to appoint one person as the leader in each centre.
Q4: How is it currently going? Have any anecdotal feedback from colleagues or patients?
So far, so good! We haven’t had any major problems, but don’t really have any anecdotal feedback. I would say, however, that the elderly patients are particularly happy because they don’t have so many separate appointments. When elderly patients have two three issues– say, a renal problem, a metabolic problem and a cardiac problem – they are the ones who struggle a lot, because of their age and because they have to go to multiple appointments. When they know that their doctors are going to discuss their case amongst themselves, they feel a little bit more confident. They’re often living alone and coming to consultations alone, so they get a little nervous and can be confused at times regarding what they need to do. So, when they know that all the doctors are working together, they feel happier and more confident. This makes a big difference in terms of patient experience. As for patient outcomes, an integrated, multidisciplinary model of care will benefit all age groups.
Q5: What are your aspirations and hopes for the clinic going forward?
We are planning to add more patients to the registry, starting with the more stable patients and then moving onto the patients with more comorbidities and greater health concerns. It was easier to start with the patients with fewer complications while we were getting used to the system, especially since we end up losing patients during the follow-up period. Now that we are okay with the system, we can be more confident about it and start taking in the ones who are really sick.
We hope to make this whole system central to the way we work. It’s the ideal way of working, if you think about it from a patient’s perspective. We also hope to continue the regular interactions with our colleagues and discussing the patients together, rather than working on separate parts of the problem. The system allows us to be more active in our patients’ treatment, and I look forward to seeing how that affects their care. Finally, I hope we are able to inspire people around us and the other clinics that we have here. Maybe they won’t register formally, but they can still follow something similar and this will benefit the patients.
