Barbara Tofani: The United States Underestimated the Need for Care Coordination

Care has become very complex and it isn’t enough to just give patients information and hope they can process it on their own, said Barbara Tofani, RN, MSN, NEA-BC, administrative director of the Hunterdon Regional Cancer Center.

Why is care coordination in the United States not at the level it should be? Why do we still have so much to improve in this area?

I think we need to improve because I think we really underestimated the need for care coordination. And patients are being hit with so much information and there was a time that we thought if we just gave them the information they’d be great, and now what we’re realizing is that we’ve given them so much information it’s almost the equivalent of giving them no information at all. Because they just can’t read it, they can’t process it, they can’t deal with it. I think we underestimated that problem.

It used to be that patients were kind of a captive audience for us—at least in oncology. They came into the hospital, we gave their treatment or they came into the outpatient centers, the private practices, and we gave them their treatment and they went on their way. Now, easily half of the patients are getting oral chemotherapy agents—we’re just writing a script for them and we’re sending them home, and really nobody has been paying attention to: can they afford it, are they taking it, are they taking the medication correctly, how are they dealing with the side effects, do they even know what side effects to be looking for?

I think the care has become very complex. We thought the solution was going to be just educate them, and we’re finding that’s not been the solution at all. It’s almost like we’re back to square 1 again. And we’ve really got to start all over and figure out how to get patients the right resources and the right attention at the right time in the right doses, for want of a better way to put it.
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