As American Heart Month wrapped up, we had the opportunity to sit down with Dr. Sharonne Hayes, founder of the Women’s Heart Clinic at Mayo Clinic in Rochester, MN and a Scientific Advisory Council member for WomenHeart, a member of the MACC Task Force. Here are her insightful answers.
1. MACC Task Force: How would you describe the current situation with regards to care coordination for women with heart disease?
Dr. Sharonne Hayes: Unfortunately, we don’t really have a health care ‘system’ that supports care coordination for women with heart disease. Electronic health records (EHRs) and, often, health care providers, don’t regularly talk to one another. Being cared for in an integrated care system like our practice at Mayo Clinic can facilitate care coordination; providers and patients both have access to their EHRs – I can easily see the pattern of care a woman has had – what’s happened during her visits with her primary care doctor, OB-GYN, gastroenterologist, rheumatologist, etc. Even with the most integrated ‘system’, there are barriers we haven’t overcome, and outside of an integrated environment – which is where the vast majority of patients receive care – it’s an even bigger challenge. It can be downright un-coordinated. We providers don’t necessarily talk to one another, and the timely and effective ‘push’ of information to each other that would be helpful to the patient, can be logistically challenging.
2. MACC: Are there differences relating to care coordination for women vs men?
Dr. Hayes: As far as women specifically, there are some important clinical issues that lead women to have a different experience than men. Some challenges with care coordination occur because women with heart disease have more medical problems and more providers than men – and having more physicians means you are dealing with more doctors who don’t communicate with each other. In some ways it’s better for older women than younger – older women typically have insurance and most have moved on from their OB-GYN and are seeing an internist as their primary care provider, whereas younger women with heart disease often still consider their OB-GYN to be their primary care provider. Those practices may have less experience with cardiac issues and may have a narrower range of preventive services for women at risk for heart disease.
A difference that’s gender-based rather than clinical is that many more women are caregivers than men. If you are Medicare age, you may be caring for two generations – women in their 60’s are often the ‘sandwich’ generation – they may be caring for their children or grandchildren, and also caring for an elderly parent. Medicare-age women are also more likely to be widowed, living alone, or under the poverty level. All of this means she might be much more likely to show up for a parent’s or child’s appointment but cancel or reschedule her own. She is the care coordinator for her whole family.
3. MACC: What type of approach should women with cardiovascular disease take to improve their health care coordination?
Dr. Hayes: First, I’m a huge believer in second opinions – women are much more reticent to leave their doctor and seek a second opinion, especially for something as potentially serious as heart disease. And, if possible, they should work with their own doctor to obtain one. That’s the best way to make sure she gets the most benefit from that opinion and her care isn’t fragmented further. It’s important for women to be comfortable seeking a second opinion – to make sure a diagnosis is right, a treatment is the best option for them – and that her doctor is aware of that too.
Secondly, don’t be afraid to advocate for your own health and to be your own care coordinator. I always tell women they may have to step up to ensure they fully understand their health situation, their treatment options, and prescriptions – they have to be proactive and a self-advocate when it comes to their own care. And it’s always a good idea to bring a friend to a doctor’s visit who can be a second set of ears for you.
4. MACC: Where do you see the most significant gaps in care for older women living with heart disease?
Dr. Hayes: Women have more co-morbidities than men. When they go to their 20-minute appointment, they usually can’t get through all of those things. The reality is that the average cardiologist in a busy private practice doesn’t want to hear a whole lot about the things that don’t seem directly related to the heart. But my female patient’s painful knees may have a huge impact on her cardiac health if it keeps her from exercising – it’s so important for one of her providers to make sure her diabetes or joint pain are well controlled, and whether she can get up the stairs to her pharmacist’s office to pick up the medications she needs – it all works together.
5. MACC: What examples of programs or strategies come to mind that have allowed women with heart disease to improve their care and outcomes?
Dr. Hayes: Well, certainly WomenHeart comes to mind – it has given women a support network that serves as a surrogate coordinator, equips them with the resources, knowledge, and questions to use to challenge and better understand a doctor, get more information, and to push back if necessary. If a doctor doesn’t ask you what you are going to do for your heart between now and the next visit, WomenHeart can arm you with the questions you need to ask that doctor – “What can I do for my heart before I see you again?” And it provides you with the tools and resources to follow through on the actions that will help your heart.
6. MACC: What could Medicare do to improve care for women with heart disease?
Dr. Hayes: First, study or provide competitive funding to study both optimal ways to coordinate care and the impact of reimbursement of coordination of care on patient outcomes. I don’t know that there’s a best model to use out there to help patients – and women specifically – coordinate their care, but it would be great if we could identify and then implement one. Secondly, the lack of a consistent, available, and interoperable EHR is a major problem – and it’s so important to teach patients to take advantage of patient portals such as MyChart so they can keep their own EHR and pull it up on their tablets or laptops when they visit their doctors. The activated patient can do that – take control of their own health record and share it with their doctor. And when they travel, it’s also important for them to take that record with them. I realize that’s not an easy thing to make happen, especially with the Medicare population, but it is so important.