Patient advocacy
Encyclopedia
A Patient Advocate acts as a support structure and if legally contracted to do so may act as a liaison between a patient and their Health Care Provider(s). Most health care professionals see themselves as advocates for their patients, however their time and scope are limited by their job function. The Independent Patient Advocate is a vital instrument for both patient and healthcare providers in the optimal delivery of health care.
The terms Patient Advocate and Patient Advocacy have a broad range of usage and may be applied to various subcategories of individual advocates and organizations providing various levels of advocacy. A Healthcare Advocate may provide some of the services that a Patient Advocate provides. The Patient Advocate may be an individual or an organization. Patient Advocacy organizations are often non-profit and focus on one aspect of health care or a specific disease, generally within fundraising and awareness campaigns, including healthcare library literature and information services. These organizations rarely engage in the Patient Advocacy function of clinical support, liaising with patient and provider. There are also governmental agencies that study and ensure compliance with government regulations including financial aid. Some patient advocates work for the institutions that are directly responsible for the patient’s care.
Patient Advocacy is a burgeoning field in the early stages of legislative definition and there is currently no accredited certification curriculum specifically for advocacy. While those engaged directly with the patient during care are typically educated and experienced in the healthcare area of concern, a Patient Advocate need not be in the health care profession and may simply be a concerned citizen, supportive neighbor, friend or family to listen, take notes and help the patient communicate, understand, remember and cope with an often confusing and fearful process.
There is currently no specific training or certification program for individuals calling themselves Patient Advocates. However, there are individuals, organizations and agencies that offer individual patient advocacy services either as volunteers or for a fee. These have been termed professional patient advocates by the Health Advocates Association.
The Patient Advocate may provide medical literature research service to the patient, family, health care provider or research personnel as requested. The Patient Advocate often assists with family communication and issues arising from illness and injury. This may include further referral for care and support for both patients and families, which includes ongoing communication and coordination with all practitioners according to each practitioner's preferred protocol. The Patient Advocate has a responsibility for awareness of compliance, appropriateness and coordination of care for the patient, with initial oversight for potentially conflicting treatment modalities and medications. Questions about the appropriateness of treatment should be promptly discussed with the Patient and Primary Care Provider, with all treatments and concerns promptly entered into the health care record. The health care record should be reviewed for correctness and provided to the patient on an annual basis, or more often if the treatment is intensive, prolonged or with several health care providers. Creation and maintenance of an electronic log for Patient and available by disc to Healthcare Providers is highly desirable as it may be of great benefit in an urgent situation.
The Patient Advocate will assist in resolving issues arising with insurance and household accounting management as well as any home health care and home maintenance issues that arise for the ill or disabled. In the case of employment issues, the Patient Advocate may engage in communication with the employer to negotiate a mutually beneficial solution for the employer and the ill or injured individual.
In the case where compliance standards are not met on either the patient side or in health care delivery or by employer/partner/corporation, the Patient Advocate may be in the position of liaising with corporate oversight, government agencies or legal personnel to further negotiate such issues on behalf of the Patient and family.
It is the duty of a Patient Advocate to maintain patient privacy according to local and national laws, treating all patient and family information as privileged and protected. As well, Health Care Provider communications are treated as highly confidential and privileged, whether or not those communications are specific to the patient. In all cases, permission to disclose information should be negotiated carefully. It is the duty of the Patient Advocate to follow any referrals for medical, financial, legal, administrative or other personnel to assure that the patient is always kept safe and well informed, never abandoned or mislead during the process.
You may be able to find an individual advocate who can help you, for a fee, with all forms of assistance at:
You may be able to ask your benefit plan provider or employer to provide access to a third-party Patient Advocacy service to assist you when needed at:
organizations. In this form, the Patient Advocate may sit on investigative and advisory panels to ensure that ongoing projects and those being considered for funding will directly impact patients' lives, improving delivery of care and support for tertiary care. The Patient Advocate may also sit on finance boards to analyze cost containment and act as a proponent for best practices, advocating better protection for Provider and Patient for the greater good of society. This includes SEC advocacy encouraging investors to continue supporting such progressive change. The Patient Advocate must be actively engaged in self education on the general business of medicine, HMO rules and local institutional changes to compliance articulation and implementation, as well as following relevant legislative changes. Patient Advocates are needed to lobby for a health care system that is realistic for patients and practitioners, not merely beneficial to corporations.
Some health benefit or employee assistance plans include Patient Advocacy services offered by third-party Patient Advocacy companies. Depending on the scope of services included, members or employees can get assistance with everything from scheduling and quality review to care management and bill negotiation or mediation for the portion of the bills that are the patient's responsibility. The primary benefit of having access to these companies is that: (1) their services are available to plan members or employees at little to no additional charge, and (2) as independent third-party companies, they have fewer conflicts when advocating for members or employees as compared to advocates who are employees of health care providers or insurers.
Patient advocacy refers to advocacy at every level for all patients and families: letter writing to media and government as a concerned citizen or lobbyist; facilitating and supporting forums and panels; assisting patient and family in daily activities and health care procedures; speaking on a patient's behalf in order to further their treatment progress; or to protect their rights
and help them learn how to obtain information and services.
For more information, contact the National Patient Advocate Foundation,, You may also find advocates for specific diseases by entering the name of specific disease and add the term 'patient advocate' to your search. For example, a search on "breast cancer advocate" will give toward the top of the results, National Breast Cancer Coalition
Perhaps the largest government agency responsible for health care oversight is the Health Care Financing Administration (HCFA) which is responsible for overseeing compliance with rules of Medicare and Medicaid. The agency works with states to oversee Medicaid compliance. States maintain offices with Ombudsman
who investigate and respond to patient complaints regarding Long-term health facilities that receive money from Medicaid.
companies, and other health care organizations employ people specifically to assume this role. Within hospitals, the person may have the title Ombudsman
or Patient Representative. The role of Patient Advocate is frequently assumed by nurses, social workers, and other health care providers. However, there are clearly potential problems when a professional may be in conflict between the interest of the patient and the interests of the advocates employer.
. The American Nurses Association
(ANA) includes advocacy in its definition of nursing as "the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations."
Advocacy in nursing finds its theoretical basis in nursing ethics
. For instance, the ANA's Code of Ethics for Nurses includes language relating to patient advocacy:
The terms Patient Advocate and Patient Advocacy have a broad range of usage and may be applied to various subcategories of individual advocates and organizations providing various levels of advocacy. A Healthcare Advocate may provide some of the services that a Patient Advocate provides. The Patient Advocate may be an individual or an organization. Patient Advocacy organizations are often non-profit and focus on one aspect of health care or a specific disease, generally within fundraising and awareness campaigns, including healthcare library literature and information services. These organizations rarely engage in the Patient Advocacy function of clinical support, liaising with patient and provider. There are also governmental agencies that study and ensure compliance with government regulations including financial aid. Some patient advocates work for the institutions that are directly responsible for the patient’s care.
Patient Advocacy is a burgeoning field in the early stages of legislative definition and there is currently no accredited certification curriculum specifically for advocacy. While those engaged directly with the patient during care are typically educated and experienced in the healthcare area of concern, a Patient Advocate need not be in the health care profession and may simply be a concerned citizen, supportive neighbor, friend or family to listen, take notes and help the patient communicate, understand, remember and cope with an often confusing and fearful process.
Individual or Personal Patient Advocate
The Patient Advocate may be present for health care appointments and alert the Health Care Provider to Patient compliance issues and separately assist the Health Care Provider and support staff with potential issues and communication. The Patient Advocate will maintain communication with the Patient and Health Care Provider to help ensure patient understanding of procedures, thereby reducing fear and increasing patient compliance, resulting in a higher percentage of successful treatment. Generally, a Patient Advocacy contract with a Release of Medical Information must be placed with each healthcare facility. A Power of Attorney for Healthcare may be required by some institutions for a Patient Advocate to exchange confidential information.There is currently no specific training or certification program for individuals calling themselves Patient Advocates. However, there are individuals, organizations and agencies that offer individual patient advocacy services either as volunteers or for a fee. These have been termed professional patient advocates by the Health Advocates Association.
The Patient Advocate may provide medical literature research service to the patient, family, health care provider or research personnel as requested. The Patient Advocate often assists with family communication and issues arising from illness and injury. This may include further referral for care and support for both patients and families, which includes ongoing communication and coordination with all practitioners according to each practitioner's preferred protocol. The Patient Advocate has a responsibility for awareness of compliance, appropriateness and coordination of care for the patient, with initial oversight for potentially conflicting treatment modalities and medications. Questions about the appropriateness of treatment should be promptly discussed with the Patient and Primary Care Provider, with all treatments and concerns promptly entered into the health care record. The health care record should be reviewed for correctness and provided to the patient on an annual basis, or more often if the treatment is intensive, prolonged or with several health care providers. Creation and maintenance of an electronic log for Patient and available by disc to Healthcare Providers is highly desirable as it may be of great benefit in an urgent situation.
The Patient Advocate will assist in resolving issues arising with insurance and household accounting management as well as any home health care and home maintenance issues that arise for the ill or disabled. In the case of employment issues, the Patient Advocate may engage in communication with the employer to negotiate a mutually beneficial solution for the employer and the ill or injured individual.
In the case where compliance standards are not met on either the patient side or in health care delivery or by employer/partner/corporation, the Patient Advocate may be in the position of liaising with corporate oversight, government agencies or legal personnel to further negotiate such issues on behalf of the Patient and family.
It is the duty of a Patient Advocate to maintain patient privacy according to local and national laws, treating all patient and family information as privileged and protected. As well, Health Care Provider communications are treated as highly confidential and privileged, whether or not those communications are specific to the patient. In all cases, permission to disclose information should be negotiated carefully. It is the duty of the Patient Advocate to follow any referrals for medical, financial, legal, administrative or other personnel to assure that the patient is always kept safe and well informed, never abandoned or mislead during the process.
You may be able to find an individual advocate who can help you, for a fee, with all forms of assistance at:
- Houston Patient Advocacy
- RN Patient Advocates
- AdvoConnection
- Guardian Nurses Healthcare Advocates
- My Nurse First
- Patient Advocate Foundation .
- First Measure Patient Advocates
You may be able to ask your benefit plan provider or employer to provide access to a third-party Patient Advocacy service to assist you when needed at:
- The Karis Group
- Guardian Nurses Healthcare Advocates
- Health AdvocateHealth AdvocateHealth Advocate, Inc. is a national health advocacy, patient advocacy and assistance company, serving more than 6,000 clients and 18 million people and offering a spectrum of services to help employers, employees and consumers navigate the healthcare system and facilitate members’ interactions...
, Inc. - Health Proponent
Patient Advocacy Groups
There are organizations, generally non-profit, that focus on specific diseases or aspects of health care. These are sometimes distinguished from Patient Advocates and referred to as Health AdvocacyHealth Advocacy
Health advocacy encompasses direct service to the individual or family as well as activities that promote health and access to health care in communities and the larger public. Advocates support and promote the rights of the patient in the health care arena, help build capacity to improve...
organizations. In this form, the Patient Advocate may sit on investigative and advisory panels to ensure that ongoing projects and those being considered for funding will directly impact patients' lives, improving delivery of care and support for tertiary care. The Patient Advocate may also sit on finance boards to analyze cost containment and act as a proponent for best practices, advocating better protection for Provider and Patient for the greater good of society. This includes SEC advocacy encouraging investors to continue supporting such progressive change. The Patient Advocate must be actively engaged in self education on the general business of medicine, HMO rules and local institutional changes to compliance articulation and implementation, as well as following relevant legislative changes. Patient Advocates are needed to lobby for a health care system that is realistic for patients and practitioners, not merely beneficial to corporations.
Some health benefit or employee assistance plans include Patient Advocacy services offered by third-party Patient Advocacy companies. Depending on the scope of services included, members or employees can get assistance with everything from scheduling and quality review to care management and bill negotiation or mediation for the portion of the bills that are the patient's responsibility. The primary benefit of having access to these companies is that: (1) their services are available to plan members or employees at little to no additional charge, and (2) as independent third-party companies, they have fewer conflicts when advocating for members or employees as compared to advocates who are employees of health care providers or insurers.
Patient advocacy refers to advocacy at every level for all patients and families: letter writing to media and government as a concerned citizen or lobbyist; facilitating and supporting forums and panels; assisting patient and family in daily activities and health care procedures; speaking on a patient's behalf in order to further their treatment progress; or to protect their rights
Rights
Rights are legal, social, or ethical principles of freedom or entitlement; that is, rights are the fundamental normative rules about what is allowed of people or owed to people, according to some legal system, social convention, or ethical theory...
and help them learn how to obtain information and services.
For more information, contact the National Patient Advocate Foundation,, You may also find advocates for specific diseases by entering the name of specific disease and add the term 'patient advocate' to your search. For example, a search on "breast cancer advocate" will give toward the top of the results, National Breast Cancer Coalition
Governmental Agencies
Agencies responsible for certifying and recertifying health care professionals and health care institutions issue reports on Healthcare Provider associations, affiliations, licensing and disciplinary actions that may be helpful to patients. Most matters are settled within the legal and insurance system prior to any disciplinary action with the exception of nursing.Perhaps the largest government agency responsible for health care oversight is the Health Care Financing Administration (HCFA) which is responsible for overseeing compliance with rules of Medicare and Medicaid. The agency works with states to oversee Medicaid compliance. States maintain offices with Ombudsman
Ombudsman
An ombudsman is a person who acts as a trusted intermediary between an organization and some internal or external constituency while representing not only but mostly the broad scope of constituent interests...
who investigate and respond to patient complaints regarding Long-term health facilities that receive money from Medicaid.
Patient Advocacy Within the Health Care Community
Some hospitals, health insuranceHealth insurance
Health insurance is insurance against the risk of incurring medical expenses among individuals. By estimating the overall risk of health care expenses among a targeted group, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to ensure that money is...
companies, and other health care organizations employ people specifically to assume this role. Within hospitals, the person may have the title Ombudsman
Ombudsman
An ombudsman is a person who acts as a trusted intermediary between an organization and some internal or external constituency while representing not only but mostly the broad scope of constituent interests...
or Patient Representative. The role of Patient Advocate is frequently assumed by nurses, social workers, and other health care providers. However, there are clearly potential problems when a professional may be in conflict between the interest of the patient and the interests of the advocates employer.
Nursing and patient advocacy
Patient advocacy is fundamental to nursingNursing
Nursing is a healthcare profession focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life from conception to death....
. The American Nurses Association
American Nurses Association
The American Nurses Association is a professional organization to advance and protect the profession of nursing. It started in 1896 as the Nurses Associated Alumnae and was renamed the American Nurses Association in 1911...
(ANA) includes advocacy in its definition of nursing as "the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations."
Advocacy in nursing finds its theoretical basis in nursing ethics
Nursing ethics
Nursing ethics is a branch of applied ethics that concerns itself with activities in the field of nursing. Nursing ethics shares many principles with medical ethics, such as beneficence, non-maleficence and respect for autonomy...
. For instance, the ANA's Code of Ethics for Nurses includes language relating to patient advocacy:
- The nurse's primary commitment is to the patient, whether an individual, family, group, or community.
- The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.
See also
- The Professional Patient Advocate Institute
- Patient empowermentPatient empowermentThe patient empowerment concept, a recent outgrowth of the natural health movement, asserts that to be truly healthy, people must bring about changes in their social situations and in the environment that influences their lives, not only in their personal behavior.According to advocates of the...
- Health AdvocacyHealth AdvocacyHealth advocacy encompasses direct service to the individual or family as well as activities that promote health and access to health care in communities and the larger public. Advocates support and promote the rights of the patient in the health care arena, help build capacity to improve...
- OmbudsmanOmbudsmanAn ombudsman is a person who acts as a trusted intermediary between an organization and some internal or external constituency while representing not only but mostly the broad scope of constituent interests...
- Organizational OmbudsmanOrganizational ombudsmanAn organizational ombudsman is a designated neutral or impartial dispute resolution practitioner whose major function is to provide independent, impartial, confidential and informal assistance to managers and employees, clients and/or other stakeholders of a corporation, university,...
- Geriatric care managementGeriatric care managementGeriatric care management is the process of planning and coordinating care of the elderly and others with physical and/or mental impairments to meet their long term care needs, improve their quality of life, and maintain their independence for as long as possible...
Other Links
- National Accadmy of Certified Care Managers http://www.naccm.net/n_1.htm