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Summary Week 5. Patients' context - KNOWLEDGE CLIP, LECTURE, WORKGROUP
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2023-2024, Block 1 GW4002MV. Patient Centered Care DeliveryTHEME 5
Patients’ context in PCCD
The persistence of socioeconomic inequalities in health, even in the highly developed ‘welfare states’ of
Western Europe, is one of the great disappointments of public health. Health inequalities have not only
persisted while welfare states were being built up, but on some measures have even widened, and are
not smaller in European countries with more generous welfare arrangements. Poor health, chronic
diseases, and functional limitations also are much more prevalent among some immigrant populations
and people with low socioeconomic status. Self-management abilities and health behaviours, such as
smoking, eating habits, and physical activity, play a crucial role in these health problems and differ
between immigrants and natives and people with high or low socioeconomic status. Sociocultural
differences make it especially difficult for healthcare organisations to reach these groups effectively.
Higher educated patients and those with better self-efficacy and/or self-management abilities receive
better care. During this theme, empirical findings and theories on persisting health inequalities and the
need for diversity in care delivery are presented. In addition, attention will be given to the Social
Production Function theory on how to produce well-being, self-management abilities to maintain well-
being and their implications for PCCD and quality of care.
In addition, to gain insight into chronically ill people's self-management and their related needs for self-
management support it is important that you read the summary of the dissertation of Van Houtum
(2016): Houtum, L. van (2016). Self-management and support needs of chronically ill people. NIVEL:
Utrecht, pages 186-193 (summary).
__________________________________________________________________________________________________________________
Targets for theme 5:
Students can explain how the patient's context/characteristics (e.g., socioeconomic status, background)
can influence the effectiveness of care delivery, with the help of theories and empirical evidence;
Students can defend that diversity in care delivery is need to improve patient outcomes and enhance
PCCD;
Students can analyze differences in the achievement of well-being (and their instrumental goals) among
groups of people;
Students can translate (cultural and socioeconomic) differences among people in interventions to
reduce health inequalities;
Students understand the narrow focus of current care delivery (such as the Chronic Care Model) and
what is needed to effectively improve overall well-being.
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,2023-2024, Block 1 GW4002MV. Patient Centered Care Delivery
Inhoud
Knowledge clips................................................................................................................................................3
Knowledge clip 5. Patients’ context matters.................................................................................................3
Lecture 5. In-dept discussion and Q&A 29 sept..............................................................................................10
Example 1: Preferences for long-term care services...............................................................................10
Example 2. Multi-morbidity patients’ well-being needs and PCC in primary care setting.......................11
Example of an exam question (about self-management)........................................................................12
Questions and topics for discussion........................................................................................................12
Workgroup meeting........................................................................................................................................14
Homework assignment...............................................................................................................................14
Example patients for discussion:.............................................................................................................15
Case study on inequalities in child mortality..............................................................................................16
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, 2023-2024, Block 1 GW4002MV. Patient Centered Care Delivery
Knowledge clips
Knowledge clip 5. Patients’ context matters
The WHO figure shows increases in regional and global
life expectancy. Life expectancy has increased most in
less-developed regions, especially in Africa. Life
expectancy at birth grows rapidly and infant mortality
declines sharply, narrowing the gap between rich and
poor countries.
In the Netherlands, life expectancy has also increased
significantly for all groups (low and high educated). However,
large differences between the groups exist (high educated men
live 7 years longer than low educated men & high educated
women live 5 years longer than low educated women, etc.).
In the EU, even though life expectancy improved for all social economic groups, life expectancy inequalities
have not narrowed despite efforts to
reduce them. Relative differences even
became greater (especially Eastern
European men have lower life
expectancy).
Developing policies and interventions
that effectively target the
determinants of inequalities in health
is an urgent priority for public health
research. Lifestyle related risk factors
have an important role in pre-matured
death in high income countries and
appear to contribute to the
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