Age-Friendly Outpatient and Specialist Care for Older People in Viet Nam: Building Safer, More Accessible and Coordinated Care from Appointment to Follow-Up

AGE-FRIENDLY CARE QUALITY · INTEGRATED CARE & CARE TRANSITIONS

Last reviewed: October 2026

An older woman in Viet Nam has appointments with two hospital specialists on the same morning. She has been told to arrive early, but the journey takes more than an hour, and walking long distances has become difficult. After registration, she moves between waiting areas, consultation rooms and the laboratory. By the time she sees the second doctor, she is tired and has difficulty remembering everything discussed during the first consultation.

Both specialists provide appropriate advice for the conditions they are treating. However, when she returns home, she is uncertain whether one of her existing medicines should be continued. She also has a laboratory result that will become available several days later but does not know who will review it or whether another appointment is necessary.

In another family, an older man misses a specialist appointment because his daughter, who normally helps him arrange transportation and manage hospital registration, cannot accompany him. He can make decisions about his health but finds online booking difficult and has trouble reading information on his phone. The appointment is eventually rescheduled, although the delay adds to his family's concerns.

Neither situation necessarily involves a major clinical error. Yet both reveal weaknesses that can affect the safety, accessibility and continuity of outpatient care.

For older people, an outpatient visit is rarely limited to the time spent with a doctor. It may involve arranging transportation, navigating a large facility, waiting for several services, understanding medical information, coordinating treatment from different specialists and carrying out instructions after returning home. Difficulties at any of these stages can prevent otherwise appropriate clinical care from achieving its intended benefit.

As Viet Nam responds to population aging, outpatient departments and specialist clinics have an opportunity to become more responsive to these needs. Many older people live with multiple chronic conditions and receive care from several providers over time. Others require assistance with mobility, communication or administrative procedures, even when they remain capable of managing many aspects of daily life independently.

Making outpatient care age-friendly does not necessarily require establishing a separate geriatric clinic or introducing a new assessment for every older patient. It requires understanding how the existing service works from the patient's perspective and identifying where its processes create avoidable barriers, confusion or safety risks.

The central question is therefore: How can outpatient and specialist services redesign the patient journey to make care safer, more accessible and better coordinated for older people?

Answering this question means examining the entire pathway, from appointment scheduling and preparation to registration, consultation, investigations, treatment planning, referrals and follow-up. The objective is to ensure that each stage supports the next, rather than leaving older people and their families responsible for connecting fragmented services on their own.

Age-Friendly Outpatient Care Is a Service-Delivery Challenge

Outpatient services are often organized around departments, professional schedules and separate administrative processes. Patients register, wait, receive a consultation, undergo investigations and return for further review when needed.

This arrangement can work reasonably well for someone who is mobile, familiar with the healthcare system and able to understand and remember instructions. It may be more difficult for an older person who uses a walking aid, has hearing impairment, needs several consultations or depends on someone else for transportation.

The problem is not simply that older patients require more time. Different aspects of the service may create difficulties that accumulate over the course of a visit. An early appointment can require a long journey during busy traffic. Registration may involve multiple counters, while laboratory investigations may be located far from consultation rooms. A patient may spend several hours waiting without knowing whether the next step requires another queue or a return to the original clinic.

These difficulties affect more than convenience. Physical exhaustion may make communication harder. Confusing instructions can lead to missed investigations or follow-up appointments. Poor coordination between specialties may leave important clinical questions unresolved.

The Institute for Healthcare Improvement (IHI) provides a useful international reference through its Age-Friendly Health Systems: Guide to Using the 4Ms in the Care of Older Adults in Ambulatory Care Practices, published in 2026.

The guide emphasizes understanding existing workflows, identifying how age-friendly care is already delivered, adapting processes, assigning responsibilities, measuring performance and sustaining improvement. Its approach is particularly relevant because it encourages healthcare organizations to build on existing activities rather than establish a separate system whenever an older person attends for care.

The 4Ms framework—What Matters, Medication, Mentation and Mobility—provides a foundation for age-friendly care. However, translating these principles into outpatient practice requires decisions about who obtains relevant information, when it is reviewed, how clinicians respond and whether important actions are completed.

For example, knowing that an older person has difficulty walking becomes useful when it influences arrangements for reaching the consultation room, attending investigations and returning home. Identifying a medication concern matters when an appropriately qualified professional reviews it and communicates the resulting plan.

The World Health Organization's second edition of the Integrated Care for Older People (ICOPE) handbook, published in 2025, also emphasizes personalized assessment, care planning and implementation within primary care and community settings.

These approaches are complementary, but neither should be treated as a mandatory Vietnamese accreditation standard for outpatient clinics. They offer principles and implementation guidance that healthcare organizations can consider within their own legal, professional and operational context.

The important lesson is that age-friendly outpatient care should be visible in how a service operates, not only in the frameworks it has adopted or the training its personnel have attended.

Viet Nam's Legal Framework Provides Important Foundations for Age-Friendly Outpatient Care

Outpatient and specialist services in Viet Nam operate within the country's legal framework for medical examination and treatment.

The Law on Medical Examination and Treatment No. 15/2023/QH15, effective from 1 January 2024, establishes relevant patient rights, professional responsibilities and requirements for healthcare delivery.

Article 9 addresses the right to receive information and explanations about health conditions, examination and treatment methods, available services, service prices and guidance concerning self-monitoring and care. Article 10 addresses respect for patients, protection of privacy and freedom from discrimination or mistreatment. Article 11 concerns the right to choose examination and treatment methods after receiving appropriate information, subject to the exceptions established by law.

Article 12 provides for access to medical record information and explanations of healthcare costs in accordance with applicable requirements.

These provisions are relevant throughout an outpatient encounter. They support the expectation that an older person should receive respectful treatment, understand the proposed care and have access to information needed to make informed decisions.

The legal provisions concerning priority in medical examination and treatment require particular attention.

Article 12 of the Law on Older Persons No. 39/2009/QH12 establishes priority in examination for people aged 80 years or older, subject to specified exceptions. However, the newer Law on Medical Examination and Treatment No. 15/2023/QH15 provides a broader applicable priority framework.

Specifically, Clause 2 of Article 3 of the 2023 Law establishes priority in medical examination and treatment for patients in emergency conditions, children younger than six years, pregnant women, people with severe or particularly severe disabilities, people aged 75 years or older, and people with meritorious service to the revolution, in a manner appropriate to the characteristics of the healthcare facility.

Healthcare organizations should therefore take account of the provision concerning people aged 75 years or older when designing outpatient priority arrangements.

This does not mean that every person aged 60 years or older automatically receives the same queue priority, nor should chronological age override the immediate clinical needs of emergency patients.

Priority arrangements should be transparent, consistent with applicable law and integrated into an appropriate process for identifying patients who require more urgent clinical attention. The operational details may differ between facilities, but personnel and patients should be able to understand how the arrangements work.

Government Decree No. 96/2023/NĐ-CP, together with applicable amendments, provides detailed requirements concerning the organization, licensing and operation of medical examination and treatment facilities. Hospitals, general clinics, specialist clinics and other authorized providers must operate within their applicable organizational and professional scope.

Age-friendly improvements do not create additional clinical authority. Administrative and support personnel may assist patients with registration, navigation and communication according to their roles, while professional assessment, diagnosis and treatment remain within the lawful scope of qualified healthcare practitioners.

Accessibility also has a regulatory dimension.

Circular No. 06/2024/TT-BXD, effective from 1 February 2025, promulgates QCVN 10:2024/BXD, the National Technical Regulation on Construction Works Ensuring Accessibility. The regulation establishes technical requirements for construction works and activities within its scope, including relevant healthcare buildings.

Healthcare organizations should verify the requirements applicable to their facilities, particularly when planning construction, renovation or modifications. Operational assistance may reduce accessibility barriers, but it should not be presented as a substitute for applicable construction and accessibility obligations.

Circular No. 51/2024/TT-BYT, effective from 1 March 2025, provides another relevant foundation by regulating social work activities in medical examination and treatment facilities.

These activities may support patient reception, information, guidance, psychosocial assistance and coordination with other services according to the regulation and the facility's organizational arrangements.

This creates opportunities to strengthen patient navigation and support. However, it does not automatically require every facility to provide an identical individualized navigation program or authorize social work personnel to make clinical decisions beyond their lawful responsibilities.

Together, these legal provisions provide a foundation for respectful, accessible and accountable care. The operational challenge is to translate them into arrangements that work consistently during everyday outpatient practice.

Appointment Scheduling Is the First Step in the Care Pathway

The outpatient journey begins before the patient arrives.

Appointment systems influence when older people travel, how long they wait, whether family assistance is available and whether the clinical team has the information needed for the consultation.

An appointment process designed mainly for administrative efficiency may not adequately consider these circumstances.

For example, an older person may need several investigations and a specialist review during the same hospital visit. Scheduling these activities without considering their sequence can lead to repeated travel between departments or unnecessary waiting.

Another patient may rely on a relative who is available only at certain times. A rigid appointment arrangement may make attendance difficult even when the person is willing to receive care.

A more responsive system should provide clear information about the appointment date, location, expected preparation and any documents or previous results the patient should bring.

Where clinically appropriate and operationally feasible, appointments and investigations can be coordinated to reduce unnecessary journeys or repeated visits.

However, grouping several services into one day is not always the best option. Some older people may become exhausted by long visits, while certain investigations require preparation or cannot be completed together.

Scheduling should therefore consider both the clinical sequence and the patient's practical circumstances. A service may need to offer different arrangements depending on the complexity of the visit, available resources and the patient's ability to attend.

The system also needs a reliable way to identify when an appointment request involves a potentially urgent clinical concern. Administrative personnel should know how to direct such information to an appropriately qualified professional rather than independently judge whether symptoms are medically urgent.

Digital booking can improve convenience for some patients, but it should not become the only practical route to care where doing so would create avoidable barriers.

Some older people use smartphones confidently. Others may have limited digital literacy, difficulty reading small text, unreliable internet access or a preference for telephone or in-person communication.

An age-friendly outpatient service should consider accessible alternatives rather than assume that one appointment system will work equally well for everyone.

Reminders can also be useful when designed appropriately. A message sent shortly before an appointment may reduce confusion about the date, time or location. However, the service needs to consider whether the patient can access that communication channel and whether personal information is being shared lawfully.

The objective is to help patients reach the appropriate service at a suitable time, with enough information to prepare and without avoidable administrative difficulties.

Preparing Before the Visit Can Make the Consultation More Useful

A well-organized outpatient service should help older people arrive with the information needed for clinical assessment.

For patients attending several specialists, this may include previous clinical summaries, recent investigations, information about current medications and relevant changes in health or functioning.

The preparation process does not need to become another comprehensive geriatric assessment. Its purpose is to make the planned consultation more effective.

A short previsit reminder may explain what documents are needed, whether any preparation is required and where assistance can be requested.

Some patients may benefit from being encouraged to prepare their main questions before attending.

An older person may be more concerned about increasing difficulty walking than a laboratory value that has changed slightly. Another may want to understand whether a new treatment will interfere with everyday activities or require additional visits.

When these concerns are identified early, the consultation can address what matters to the patient alongside the clinical reason for referral.

Information about current medications is particularly important when care involves multiple specialists. The patient may bring an updated medication list, prescriptions or medication packaging where appropriate. The receiving clinical team can then determine what requires verification or professional review.

However, collecting medication information should not be confused with authorizing administrative staff to reconcile prescriptions or make treatment decisions independently.

Preparation must also be proportionate. Asking every older patient to complete lengthy questionnaires or upload extensive medical records may increase workload without improving care.

The appropriate approach depends on the reason for the appointment, the complexity of the patient's needs and the resources available.

A brief, clearly explained preparation process is often more useful than an elaborate system that patients find difficult to complete.

Accessibility Begins at the Entrance, Not the Consultation Room

A clinic cannot be considered accessible simply because a consultation room is located on the ground floor or an elevator is available.

The patient's journey begins at the entrance to the facility, including the drop-off area, pathways, registration counters, waiting rooms, toilets, laboratories and other service locations.

An older person who uses a wheelchair may have difficulty entering a building because of a poorly designed ramp. Someone with reduced vision may struggle with steps, floor-level changes or unclear signs. A patient who walks slowly may need opportunities to rest between distant departments.

These are practical issues of service design.

Accessible routes, suitable seating, adequate lighting, clear signage and usable toilets can make a substantial difference. The physical environment should be assessed according to the people expected to use it, while taking account of applicable Vietnamese technical requirements.

The World Health Organization's World Report on Ageing and Health recognizes the importance of accessible health facilities and transportation in supporting older people's use of healthcare services.

However, infrastructure alone is insufficient.

A building may meet relevant physical specifications while remaining difficult to navigate because instructions are confusing, service locations frequently change or personnel cannot provide assistance when needed.

The reception process should therefore help patients understand where to go and what will happen next.

A person who cannot hear an electronic queue announcement may need an alternative way to receive the information. Someone with limited literacy or visual impairment may benefit from clearer directions or appropriate assistance.

Where several departments are located in different buildings or on different floors, the organization should consider how patients obtain directions and whether those who need assistance can reach the next service safely.

Such arrangements should preserve dignity and independence. Not every older person requires accompaniment or intensive assistance, and staff should not assume that age alone makes a patient unable to navigate the service.

The goal is to make appropriate help available without unnecessarily taking control away from the individual.

Waiting Time Is Both a Service Experience and a Safety Consideration

Waiting is a normal part of many outpatient services, but its consequences can be different for older people with limited stamina, mobility difficulties or complex health needs.

A prolonged wait may cause discomfort or exhaustion. Someone who needs assistance using the toilet may become distressed if the waiting area is far from accessible facilities. Another person may need to eat or take medication according to an existing plan, while a delayed investigation may affect those arrangements.

Not every prolonged wait creates a clinical risk, but waiting conditions should be considered as part of overall service quality.

An age-friendly clinic should understand how patients move through registration, consultation, investigations, payment and departure, including where delays occur.

Simply measuring the time from registration to the first consultation may overlook substantial waiting later in the visit.

For patients requiring several services, the relevant experience may be the total time spent at the facility and the number of separate waiting periods.

Clear communication can reduce uncertainty. Patients should know where they are expected to wait, whether an investigation will take place before or after the consultation and how they will be informed when it is their turn.

When delays become substantial, providing updated information may help patients and families make practical decisions.

The service should also have arrangements for recognizing when someone becomes acutely unwell while waiting. Reception staff and other nonclinical personnel need to know how to obtain prompt clinical assistance rather than independently assess or dismiss concerning symptoms.

Clinical urgency and legally established priority should be incorporated into queue management through appropriate processes. These responsibilities should not depend solely on informal judgments by staff at registration counters.

Reducing unnecessary waiting can improve the patient experience, but faster throughput should not become the only objective. Rushing consultations or investigations may create different risks.

The more useful goal is to organize a predictable, accessible and clinically appropriate flow of care.

Communication During the Consultation Must Support Understanding and Choice

An older person's ability to benefit from a consultation depends partly on whether the clinical information is understood.

This can be challenging when consultations involve several conditions, technical explanations, multiple medication changes or decisions requiring follow-up.

Hearing impairment, visual difficulties, cognitive changes, fatigue or limited familiarity with medical terminology may create additional barriers.

Clinicians should communicate directly with the older person whenever possible, even when a family member accompanies them.

A relative may provide valuable information, but the presence of a caregiver does not automatically mean that the patient is unable to understand or participate in decisions.

The consultation should allow sufficient opportunity to establish the patient's concerns, explain relevant findings and discuss clinically reasonable options.

Clear language is particularly important when describing a new diagnosis, proposed treatment or the implications of an investigation.

The Agency for Healthcare Research and Quality's Health Literacy Universal Precautions Toolkit, third edition, published in 2024, provides a useful international reference. It emphasizes making healthcare information understandable, simplifying navigation and checking that patients can act on instructions.

One practical approach is teach-back, in which the clinician or another appropriate team member asks the patient to explain the agreed plan in their own words.

The purpose is to check whether the explanation was effective, not to test the patient's intelligence or memory.

For example, after a medication change, the team may ask the patient to explain which medicine will be taken differently and when the change should begin.

If the response reveals uncertainty, the explanation can be clarified before the patient leaves.

Communication should also reflect individual needs. Written instructions may need suitable print size or formatting. Someone with hearing impairment may benefit from a quieter setting and face-to-face communication. Patients who are tired may need the most important information presented clearly and reinforced at the end of the visit.

For more complex decisions, clinicians may need to explain the expected benefits, possible risks and practical implications of different options. The older person should have a meaningful opportunity to ask questions and express preferences.

The objective is not simply to transfer information from clinician to patient. It is to support an informed decision and a practical understanding of what happens next.

Specialist Coordination Should Prevent Patients From Becoming the Only Link Between Providers

Many older people receive care from more than one specialty.

A patient with cardiovascular disease, diabetes, kidney impairment and mobility difficulties may attend several clinics, sometimes within the same hospital and sometimes at different facilities.

Each specialist has legitimate responsibilities within their field. However, decisions made in one consultation can influence treatment in another.

A medication change may affect a condition managed by a different specialist. A new investigation may duplicate a recent test, although repeat testing can also be clinically justified when circumstances have changed. One clinician may recommend follow-up at an interval that conflicts with another appointment.

The problem is not necessarily the number of specialists involved. It is the absence of a dependable process for connecting relevant information and resolving conflicting instructions.

An age-friendly outpatient service should therefore clarify which clinical information needs to be available across consultations and who is responsible for addressing important inconsistencies.

Where relevant and lawfully accessible, an up-to-date medication record, recent investigations and treatment summaries can support better decisions.

The responsibility for reviewing and changing treatment must remain with appropriately qualified healthcare professionals.

A clinic coordinator or administrative navigator may help patients obtain appointments and transmit authorized information, but that role should not be confused with clinical authority to reconcile conflicting treatment recommendations.

When a significant disagreement or uncertainty is identified, the responsible clinicians may need to communicate directly or arrange an appropriate professional review.

Some patients benefit from having an identifiable clinician or service responsible for coordinating their broader care. However, this arrangement cannot be assumed to exist uniformly across all Vietnamese healthcare facilities.

Where no formal coordinating clinician is assigned, the service still needs a practical process for determining who will address an unresolved issue.

For example, if an investigation ordered by one specialist identifies a concern relevant to another specialty, the clinician responsible for the result should have a clear process for determining and communicating the next action.

This becomes particularly important when a patient receives care from several organizations. Information may not be available through a shared electronic system, and clinicians may need to rely on appropriate clinical summaries, records supplied by the patient or lawful communication between providers.

A referral should not be considered complete merely because a referral form has been issued. The important question is whether the patient can access the receiving service and whether clinically significant information reaches the appropriate professional.

The purpose of specialist coordination is to preserve the value of specialized expertise while reducing the risk that older people and their families must interpret and reconcile complex medical instructions on their own.

Investigations and Referrals Need Clear Responsibility for Completion

Outpatient encounters often generate actions that continue after the patient leaves the consultation room.

A clinician may order laboratory tests, imaging, another specialist opinion or a follow-up assessment. Some results are available immediately, while others become available only after the patient has returned home.

These activities create a continuity risk when the responsible person or process is unclear.

A laboratory result may be abnormal, but the patient may not know whether further contact is necessary. A referral may be recommended, yet no appointment is arranged. A requested investigation may never be completed because the patient misunderstood where to go or could not return to the facility.

These problems cannot be solved simply by giving patients more documents.

An outpatient service should determine who is responsible for reviewing pending results, communicating clinically significant findings and taking appropriate action.

This responsibility must remain within the relevant professional and organizational arrangements, including the clinical significance of the result.

A practical tracking process may help identify investigations that are incomplete, results awaiting review and referrals for which further action is required.

Not every result needs the same response interval or communication method. The urgency should be determined by an appropriate healthcare professional.

Where results require prompt action, the service needs a dependable way to contact the patient and confirm that the necessary next step has been arranged.

Where a referral is made, the service should distinguish between issuing the referral and completing the intended clinical handoff.

Administrative personnel may support appointment arrangements and tracking, while qualified professionals remain responsible for clinical interpretation and decisions.

For older people who depend on family assistance or face transportation difficulties, referral arrangements may need additional coordination to be workable.

An important implementation question is what happens when the usual process fails. If a patient cannot be reached, a critical result is not acknowledged or a clinically necessary referral remains incomplete, personnel need to know who is responsible for reviewing the unresolved issue and deciding on further action.

This does not mean that every routine result or referral requires intensive tracking. The level of oversight should reflect clinical risk, professional responsibilities and available resources.

A diagnostic test or specialist referral should not be considered a completed care process merely because it has been ordered or documented. The service needs an appropriate arrangement for reviewing its outcome and addressing any clinically necessary next action.

This principle is particularly important in high-volume outpatient settings where clinical responsibility can become fragmented across separate departments and visits.

The End of the Visit Should Produce One Understandable Plan

An outpatient visit should conclude with a clear understanding of what has been decided and what the patient needs to do next.

This may appear straightforward, but it becomes more difficult when several investigations, treatments or referrals are involved.

The older person may receive a new prescription, changes to existing medication, instructions for an investigation and an appointment with another specialist. If these instructions are provided separately, the patient may leave without understanding how they fit together.

A useful end-of-visit process should bring the important decisions into a coherent plan.

The plan should explain the main clinical findings in understandable language, the agreed treatment, relevant medication instructions, required investigations, follow-up arrangements and circumstances requiring earlier professional attention.

Where several specialists are involved, the patient should know which recommendations apply and whom to contact if instructions appear inconsistent.

The plan should also reflect the person's ability to carry it out.

An older patient may understand the treatment but have difficulty obtaining medication, traveling for repeated investigations or arranging a follow-up appointment. These barriers should be recognized before assuming the plan is feasible.

When family support is necessary, the service should establish whether the patient wishes relevant information to be shared and whether the caregiver can provide the assistance expected.

Written information can reinforce the discussion, but it should not replace an explanation that the patient can understand.

Teach-back or another suitable communication approach may help establish whether the essential instructions are clear.

The plan should also identify any pending issues. If a test result is not yet available, the patient needs to know how it will be reviewed and how they will be informed when further action is required.

For patients with multiple appointments or referrals, a clear explanation of the sequence can be valuable. They should understand which actions are expected first, which can be arranged later and whether another clinician or service is responsible for completing a particular step.

The objective is not to create a lengthy document. It is to provide a practical account of the visit that helps the patient, caregiver and future clinicians understand what has been agreed.

Follow-Up Should Be Designed as Part of Care, Not Left to Chance

Continuity does not end when the patient leaves the clinic.

Some older people require routine review, while others need follow-up because of treatment changes, pending investigations or concerns identified during the consultation.

A follow-up process should reflect clinical priorities, the patient's preferences and the practical arrangements needed to complete the plan.

The AHRQ Health Literacy Universal Precautions Toolkit provides guidance on follow-up responsibilities, including deciding why follow-up is required, who should perform it and which communication method is suitable.

A scheduled telephone call may be appropriate for clarifying instructions or checking whether a referral has been arranged. Other situations require a face-to-face consultation or clinical assessment.

The choice should be based on the purpose of follow-up and the clinical condition, not simply on administrative convenience.

A clinic should also distinguish between planned routine contact and the need for urgent assessment when new symptoms develop.

Patients need to know which concerns can wait until the next appointment and which require earlier medical attention. Potentially serious symptoms should not be managed through routine appointment messages when an urgent or emergency response is appropriate.

Where follow-up is arranged digitally, the service should consider whether the patient actually uses the communication channel.

Sending a message does not establish that the person has received, understood or acted on it. Patients may prefer a phone call, paper instructions or communication through an authorized caregiver.

A useful follow-up system should also identify appointments or referrals that have not been completed when follow-up is clinically important.

However, such tracking needs to be proportionate to the service's responsibilities and resources. Not every missed appointment justifies the same intervention, and the clinic should not assume that every patient needs intensive follow-up.

The aim is to prevent clinically significant issues from being lost while respecting patient choice and using available resources appropriately.

Patient Navigation, Family Support and Digital Access Need Clear Boundaries

Older people may need assistance with different parts of the outpatient journey without needing help with every aspect of care.

Someone may be able to discuss treatment independently but require assistance with registration. Another may navigate the facility but struggle to understand complex written instructions. A third may need transportation support but manage appointments and medication without difficulty.

An age-friendly service should recognize these differences rather than apply the same assistance model to everyone.

Patient navigation can include helping people locate departments, understand administrative steps, arrange appointments or reach the appropriate support service.

Hospital social work may contribute to addressing relevant psychosocial and practical needs under Circular No. 51/2024/TT-BYT and the facility's arrangements.

However, navigation services should not be assumed to include clinical decision-making, comprehensive case management or financial assistance for every patient.

Responsibilities need to remain clear. Administrative personnel can explain how to access services. Social work personnel can provide assistance within their professional and organizational role. Clinical advice must come from appropriately authorized healthcare professionals.

Family involvement can make care more manageable, particularly when an older person needs support with transportation or remembering appointments.

However, family participation should not automatically replace the patient's preferences or decision-making rights.

The service should communicate directly with the older person whenever possible and share information with relatives according to applicable legal requirements and the individual's wishes.

Digital services create additional opportunities and risks.

Online appointments, electronic records, electronic prescriptions and patient portals may help coordinate care. Yet poorly designed systems can create new barriers for people with limited digital literacy, visual impairment or inconsistent access to smartphones and the internet.

A clinic should therefore evaluate whether its technology makes care easier for older people or merely shifts administrative work from the provider to patients and their families.

The Law on Personal Data Protection No. 91/2025/QH15, effective from 1 January 2026, and Government Decree No. 356/2025/NĐ-CP provide important requirements governing personal data processing in Viet Nam.

Outpatient providers must consider these obligations when collecting appointment information, maintaining clinical records, using communication applications or sharing information between services.

The responsibilities depend on the actual data processing arrangements and applicable legal provisions. Convenience does not remove the obligation to protect personal information.

The practical objective is to make support available while preserving privacy, autonomy and the ability to participate in care.

Building an Age-Friendly Outpatient Workflow Requires Clear Responsibilities

An age-friendly outpatient service depends on the coordination of clinical and nonclinical personnel.

Reception staff, administrative teams, nurses, doctors, pharmacists, social workers and other personnel may all influence whether an older person's visit proceeds safely and efficiently.

Their responsibilities are different, but their work is connected.

A registration problem may prevent a patient from reaching the appropriate consultation. A delay in arranging investigations may disrupt the clinical plan. A misunderstanding at the end of the visit may undo much of the value of an otherwise appropriate encounter.

For this reason, outpatient improvement should examine the entire pathway rather than assign responsibility for age-friendly care to one clinician or department.

A practical workflow should establish who responds when an older person needs help scheduling an appointment, who identifies accessibility barriers during registration and who can obtain clinical assistance when a patient becomes unwell while waiting.

It should also clarify who is responsible for communicating important treatment changes, tracking clinically significant pending results and arranging follow-up when required.

The objective is not to create a new position for every task. Existing personnel may already perform many of these activities.

IHI's 2026 ambulatory care guide emphasizes examining current practice before introducing new processes. It encourages teams to identify what is already working, adapt existing workflows and determine how recommended actions can occur reliably.

This is particularly relevant to Vietnamese hospitals and clinics where additional personnel or technology may not be immediately available.

A clinic may already have a patient assistance desk, social work personnel, an electronic registration system or a nurse-led consultation preparation process. The improvement opportunity may involve connecting these resources more effectively rather than establishing an entirely new service.

Clear ownership is essential.

If nobody is responsible for reviewing whether an important referral was completed, the existence of a referral system alone may not prevent problems. If different staff assume that someone else has explained a medication change, the patient may leave without a clear understanding.

The workflow should therefore connect each significant step with an identifiable role, a communication process and a way to recognize when the intended action has not occurred.

A Vietnamese Hospital Can Begin With One Outpatient Service

Introducing age-friendly outpatient care across an entire hospital may be difficult, particularly in facilities with high patient volumes, multiple specialties and complex administrative processes.

A more feasible starting point is one outpatient department or specialist service with a substantial number of older patients.

For example, a hospital could begin with a general internal medicine clinic or a specialist clinic caring for older people with multiple chronic conditions.

The project should begin by understanding the current patient journey.

The team can follow the process from appointment scheduling to arrival, registration, waiting, consultation, investigations, payment and departure. It should also examine what happens after the patient leaves, including pending results, referrals and follow-up appointments.

Observing the process from the perspective of an older patient or caregiver may reveal problems that are not visible in departmental performance reports.

A clinic may appear efficient because consultations are completed quickly, while patients spend substantial time moving between service areas or waiting for investigations.

The team should also speak with older people and caregivers about their experiences. They may identify confusing signage, difficulties with online appointments, unclear medication instructions or the need for better communication about delays.

These findings can help select a manageable number of improvements.

One clinic might begin by improving appointment information and access to assistance at registration. Another might focus on coordination between consultation and laboratory services. A third may identify a need for clearer end-of-visit instructions and responsibility for pending test results.

The chosen changes should match the problems observed.

Hospital leadership should designate appropriate operational and clinical leads, with participation from personnel responsible for relevant stages of the pathway. Including older patients or family caregivers in the improvement process can also help the team identify barriers that staff may overlook.

Clinical decisions must remain with authorized healthcare professionals, while administrative and service improvements should have clear organizational ownership.

The team should agree on how the new process will work, what staff need to know and how problems will be reported.

A small pilot can then test whether the arrangements are practical during normal clinic operations.

For example, the team may discover that asking patients to provide information before a visit is useful for some people but creates difficulties for those with limited digital access. It may find that one check-in assistance point is sufficient during quieter periods but overwhelmed when several clinics begin at the same time.

These observations should guide adjustments rather than lead to automatic expansion of an untested process.

The first goal is to establish a workflow that personnel can perform consistently and patients can actually use.

Measuring Outpatient Quality Requires Following the Whole Patient Journey

Outpatient services often measure appointment volumes, consultation numbers, waiting times and patient satisfaction.

These indicators provide useful information, but they do not necessarily show whether the service works well for older people with different needs.

A clinic may have high satisfaction scores while some patients with mobility limitations find it difficult to attend. Another may reduce consultation waiting time but create delays in investigations or follow-up.

A meaningful quality approach should therefore consider access, reliability, safety, coordination and the patient's ability to understand and carry out the care plan.

Appointment access is one area for evaluation. The service may examine whether patients can book and change appointments through appropriate channels, whether assistance is available when needed and whether practical barriers contribute to missed visits.

The experience of attending the facility is another. Measures may include total visit duration, waiting at different stages, difficulties navigating the building and whether patients receive appropriate assistance.

These findings should be interpreted in relation to clinical complexity and the services required. A longer visit may be appropriate when a patient needs extensive assessment or several investigations.

Communication can also be evaluated. Patients may be asked whether they understand the treatment plan, know what actions are required and can identify whom to contact with questions.

Where appropriate, services may review whether important medication changes were clearly documented and communicated.

Coordination measures can include completion of clinically necessary referrals, review of pending investigation results and follow-up on unresolved issues.

Patient experience remains important, but satisfaction alone should not be treated as proof of clinical safety.

Older people may value respectful communication, opportunities to ask questions, clear instructions and confidence that different clinicians are working from consistent information.

Equity should also be considered.

A service that performs well for patients using digital appointment systems may still disadvantage those without smartphones. Similarly, facilities may be accessible to relatively independent older people but difficult for patients requiring mobility assistance.

Reviewing results across relevant patient groups can help identify barriers that average performance measures conceal.

A small initial set of indicators may be more useful than an extensive dashboard that staff cannot maintain.

These measures are proposed areas for local quality improvement. They should not be presented as a nationally mandated Vietnamese age-friendly outpatient accreditation indicator set or as identical to the recognition requirements of IHI.

IHI's Cross-Setting Measurement Guidance for Spread of the 4Ms, published in February 2025, and the AHRQ health literacy toolkit may support the design of local measures. However, their indicators should be adapted thoughtfully and interpreted according to the service's actual responsibilities, rather than reproduced as universal requirements.

The purpose of measurement is to determine whether changes make care more accessible, understandable, coordinated and safe for the people using the service.

Improving the Patient Journey Without Making Care More Complicated

An age-friendly outpatient model should simplify the experience of receiving care rather than introduce new procedures that create additional burdens.

Some improvements may require physical adaptations or investment in information systems. Others may involve changes to existing workflows, clearer communication or better coordination between departments.

The distinction matters because resources are limited and not every problem requires new technology or a specialist team.

A hospital may improve navigation by providing clearer directions and appropriate assistance. It may reduce unnecessary visits by coordinating selected investigations. It may strengthen continuity by assigning responsibility for reviewing pending results.

These changes need to be evaluated in practice.

A process that works during a small pilot may become difficult when patient volumes increase. A new appointment system may reduce waiting for some people while creating barriers for others. A coordination process may improve documentation but fail if the responsible clinician does not have sufficient time or access to information.

Regular review should therefore consider both intended benefits and unintended consequences.

Staff need opportunities to explain when procedures are difficult to perform, and older people should be able to report barriers without fearing that their concerns will be dismissed.

The improvement process should examine why a problem occurs rather than assume that more instructions or training will always solve it.

Sometimes the issue is unclear responsibility. Sometimes it is the physical layout, scheduling arrangement, unavailable clinical information or mismatch between staffing and patient demand.

A sustainable outpatient model responds to these operational realities while maintaining patient rights and professional standards.

Different Vietnamese healthcare organizations may develop different solutions. A large specialist hospital may have the resources for dedicated patient navigation and integrated scheduling, while a smaller clinic may rely on simpler coordination and communication arrangements.

Variation in service design is reasonable when it reflects local needs and resources. What should remain consistent is the commitment to making care accessible, clinically appropriate, understandable and coordinated.

From Individual Consultations to a Reliable Outpatient Care Pathway

For many older people, outpatient services are the part of the healthcare system they encounter most frequently.

A consultation may last only a short time, but its consequences extend into everyday life. The patient must understand the treatment, obtain medicines, complete investigations, attend follow-up appointments and manage care alongside other responsibilities.

When these activities are poorly connected, older people and families may struggle even when each individual consultation is clinically appropriate.

An age-friendly outpatient approach recognizes that the experience of care begins before arrival and continues after the patient returns home.

Appointment systems need to be accessible. Facilities and waiting arrangements must reflect different physical and communication needs. Consultations should support informed decisions, while specialist care requires reliable exchange of relevant information.

Investigations and referrals need accountable follow-through. End-of-visit instructions should be understandable, and follow-up arrangements should be realistic.

These expectations do not mean that every older person needs a comprehensive geriatric assessment or a dedicated care coordinator. The level of assistance should reflect individual needs and the capabilities of the service.

For Vietnamese hospitals and clinics, the opportunity lies in organizing existing resources and responsibilities so that important steps work together rather than operate as separate administrative and clinical activities.

The central question remains: How can outpatient and specialist services redesign the patient journey to make care safer, more accessible and better coordinated for older people?

The answer is to treat outpatient care as a continuous service pathway, with clear responsibilities before, during and after the consultation, rather than as a collection of individual appointments.

High-quality age-friendly outpatient care is not defined only by the expertise of the clinician or the number of patients seen. It also depends on whether older people can reach the service, participate in decisions, understand the care they receive and complete the next steps safely and with appropriate support.

As Viet Nam's healthcare system responds to population aging, improving these everyday processes offers a practical opportunity to strengthen patient safety, care coordination and healthcare quality across hospital outpatient departments, general clinics and specialist services.

References

1. National Assembly of Viet Nam. Law on Medical Examination and Treatment No. 15/2023/QH15. Adopted 9 January 2023; effective 1 January 2024.

2. Government of Viet Nam. Decree No. 96/2023/NĐ-CP detailing certain provisions of the Law on Medical Examination and Treatment. 30 December 2023, as amended.

3. National Assembly of Viet Nam. Law on Older Persons No. 39/2009/QH12. 23 November 2009, as amended.

4. Ministry of Construction of Viet Nam. Circular No. 06/2024/TT-BXD promulgating QCVN 10:2024/BXD, the National Technical Regulation on Construction Works Ensuring Accessibility. 1 August 2024; effective 1 February 2025.

5. Ministry of Health of Viet Nam. Circular No. 51/2024/TT-BYT regulating social work activities in medical examination and treatment facilities. 31 December 2024; effective 1 March 2025.

6. National Assembly of Viet Nam. Law on Personal Data Protection No. 91/2025/QH15. Adopted 26 June 2025; effective 1 January 2026.

7. Government of Viet Nam. Decree No. 356/2025/NĐ-CP detailing certain provisions and measures for implementing the Law on Personal Data Protection. 31 December 2025; effective 1 January 2026.

8. Institute for Healthcare Improvement. Age-Friendly Health Systems: Guide to Using the 4Ms in the Care of Older Adults in Ambulatory Care Practices. Boston, MA: IHI; 2026.

9. Institute for Healthcare Improvement. Age-Friendly Health Systems: Cross-Setting Measurement Guidance for Spread of the 4Ms. Boston, MA: IHI; February 2025.

10. World Health Organization. Integrated Care for Older People (ICOPE): Guidance for Person-Centred Assessment and Pathways in Primary Care. 2nd edition. Geneva: WHO; 2025.

11. World Health Organization. World Report on Ageing and Health. Geneva: WHO; 2015.

12. Agency for Healthcare Research and Quality. Brach C, editor. AHRQ Health Literacy Universal Precautions Toolkit. 3rd edition. Rockville, MD: AHRQ; March 2024.