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Summary Patient Centered Care Delivery
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Summary of the Patient Centered Care Delivery lectures and working groups
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PATIENT CENTERED CARE DELIVERYTHEME 1 - PCCD
Targets:
- Students can analyze important theories and conceptual models concerning PCCD.
- Students understand various models of PCC and know when to use them.
- Students can explain the (lack of) effectiveness of PCC initiatives.
- Students can apply important dimensions of PCC.
- Students can analyze innovative programs that incorporate PCCD.
Acht dimensies van persoonsgerichte zorg
1. Voorkeuren van patiënten: meer dan alleen voor de ziekte
2. Informatie en voorlichting: volledige en begrijpelijke informatie over alle aspecten
3. Toegang tot zorg: fysiek, financieel
4. Lichamelijk comfort
5. Emotionele ondersteuning
6. Betrokkenheid familie en vrienden
7. Coördinatie van zorg: tussen zorgverleners
8. Continuïteit en transitie: tussen zorginstellingen
,MODELLEN RATHERT & JAYADEVAPPA
Article Rathert – Patient-Centered Care and Outcomes: A Systematic Review of the Literature
De 8 dimensies hebben invloed op de uitkomst die afhankelijk zijn van de moderators en mediators. De
moderator kan bepalen hoe sterk het effect is op de uitkomsten.
Article Jayadevappa - Patient Centered Care - A Conceptual Model and Review of the State of the Art
Het is een uitgebreider model waarbij meerdere factoren die van invloed zijn op PCC. Er is meer aandacht
voor zorgmedewerkers, de patiënt zelf, kosten. De acht dimensies komen hierbij minder naar voren. De
uitkomsten zijn concreter gemaakt dan het model van Rathert.
De eigenschappen van de patiënten, provider characteristics en kosten zijn moderators voor de
uitkomsten. Dit model gaat meer over de context. Model van Rathert meer over de inhoud.
De kosten moeten geminimaliseerd worden voor PCC. De uitkomsten gemaximaliseerd.
‘Thus, patient-centered care model integrates (1) understanding the patient and the illness, (2) arriving at
mutual understanding regarding illness management and therapeutic alliance, (3) providing valued
information, (4) enhancing hospital, doctor and patient relationship; and (5) sensitivity about resource
allocation and cost.’
EVIDENCE BASED & PATIENT CENTERED CARE
1. Either or model: een van de twee principes kan worden toegepast,
geen overlap
2. Integrated model: er is wel overlap waardoor EBPCC ontstaat
3. Continuum model: op een schaal kan je aangeven welk principe
meer van toepassing is
4. Cyclical model: evidence based heft invloed op patient centered en
andersom, het volgt elkaar op en verbetert elkaar
, THEME 2 – SHARED DECISION MAKING (SDM)
Targets:
- Students have an understanding of SDM.
- Students can argue pros and cons of SDM compared to other medical decision-making models.
- Students can explain the (limited) applicability of SDM.
- Students can argue the difficulties of putting SDM into practice.
- Students understand the current (international) patients' rights protection and its underlying
principles.
Discuss, debate and decide together with the patient
WHAT
Shared Decision Making: a decision-making model on a continuum between two extremes
- Paternalism: professional decides everything
- Consumerism (informed choice): patient decides everything
Shared Decision Making
1. Choice talk: exchange of information between patient and doctor with medical and personal
information included
2. Option talk: possible options and outcomes are discussed and considered by patient and doctor
3. Decision talk: doctor and patient reach consensus about what needs to be done
WHY
Ethicists: SDM increases autonomy
Economists: SDM increases cost effectiveness
Epidemiologists: patients desire to be informed and involved in the treatment
Clinicians: involvement of patients improves the treatment relationship with better outcomes as result
Possible objections:
- Options may harm those patients who are having difficulties in decision making. Options may result in
a growing awareness of missed opportunities.
- Patients may find it difficult to appreciate outcomes because of their inability to foresee how they
themselves will adapt to outcomes.
- Choice and having a say raise expectations. Disappointment and dissatisfaction lie ahead when clinical
realities fail to meet expectations.
WHEN
S(M)DM is widely propagated but rarely practiced in everyday health care. Sometimes good explanations can
be offered for this phenomenon (dominant doctors, docile patients, lack of time, stress, lack of skills,
communication problems, etc.). However, it is also likely that not every situation lends itself to S(M)DM.
S(M)DM seems more appropriate for some patient groups and less for others.
- More:
o For relatively healthy patients (for example prevention consults).
o For patients with active coping abilities.
o For patients with chronic conditions.
- Less:
o For elderly patients.
o For less educated patients.
o For patients with acute or very severe somatic problems.
o For patients who have to take minor decisions (minimally invasive treatment, low risks, high
degree of certainty as regards outcome).
o For patients with mental health problems
- Or: S(M)DM seems especially appropriate in certain circumstances, i.e. in situations where
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