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Exam summary PCCD: lectures
Compact summary from the PCCD lectures. I passed this course with a 7,8!
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Voorbeeld 3 van de 24 pagina's
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Voorbeeld van de inhoud
Lectures Patient Centred Care DeliveryLecture 1: Introduction to PCCD
Patient-centred care is respectful and responsive to patient preferences, needs and values. It is an
approach that adopts the patients perspectives and assures that patient values guide clinical
decisions.
Everybody seems to agree on the importance of patient-centred care. But the question is: is patient-
centred care easy to deliver? This is an more complicated question to answer. Most healthcare
organisations argue that they focus on patient-centred care, not only on a caring level but also on an
organisational level. For example: patients involved with decision making within an organization. But
these examples of participation in an organisational level are quite rare, most patients feel that they
are not taken serious by healthcare organisations/professionals.
While 94% wants to participate, 48% of Dutch patients find it hard to take an active role in their care
delivery. Even 22% finds it extremely hard to participate. What is the issue here? Several studies have
shown, for example, that professionals do not always attempt to involve patients in all the decision
making processes. Sometimes patients are not even aware that there is something to choose.
Healthcare professionals need to share their power/knowledge with patients.
So how come that everybody claims to be patient-centred and wants to be patient-centred, but the
reality shows a different picture? For example obstacles in decision making processes are
experienced by healthcare professionals in which patients are not always supported to set their own
goals. Many healthcare professionals struggle with effective communication. This is just one example
of a study, there are many more studies who point out why PCCD is difficult.
In Europe almost half of the population (47%) has trouble understanding healthcare information.
In the Netherlands this is 33%. Maybe more important: many caregivers are not aware of this. Most
patients simply listen and try to figure it out by themself. This gives caregivers the impression that
the patients did understand them. There are several groups that found it harder to understand
healthcare information like older people, people with a low health status and people with a low
SES.
Main message: patient centered care is hard; we know it works but are clueless to what it looks
like. If care is more patient centered, it will record better outcomes: organizational and patient.
There are many different interventions in the literature that aim to be patient centered, but they’re
all very different. So what makes care patient centred or not? The first thing is that is important is
being respectful and taking decisions together so: shared decisions making. But patient centered
care is more than that. As a patient you may already feel patient centeredness when you enter the
health care facility. You experience a good/bad atmosphere, nice waiting rooms, friendly people who
know you as a person etc. Patient centeredness consists of different dimensions.
Which interventions are most effective, where should we invest our money in to improve patient
centeredness in healthcare? Evidence based on over 3000 medical interventions/treatments: only
11% of treatment is proven to be effective, 24% is probably effective and 50% is unknown. These
results are from hospital settings, in other settings we know even less about the effect of
interventions. So there is a lack of evidence for interventions, but we also lack evidence of what
patient centered care should look like for patient with multimorbidity. This group is mostly exclude
for researches.
,For example: a study showed that it takes 48 hours longer to diagnose a low educated person with a
heart attack. We are aware of differences among subgroups of patients, but we do not effectively
tailor our care to this. People who are lower educated also live shorter and in a poorer health than
people who are higher educated. So care delivery is complex, and more and more we realize that
context matters.
We see a movement from: authority based care evidenced based medicine context based
medicine.
Context based medicine: unravels what care should entail for different patient populations.
SPF-theory will be explained in week 3
Nowadays healthcare seems to be more focussed on the physical well-being instead of the overall
well-being. But we also have another part to get to overall well-being: social well-being. Healthcare is
not really focussed on that part. Research shows that investing in both physical and social well-being
leads to better outcomes. So there is a challenge of investing social well-being in healthcare.
Patient centered care (PCC) is a popular topic to improve healthcare
PCC = healthcare that establishes a partnership among practitioners, patients, and their families
(when appropriate) to ensure that decisions respect patients’ wants, needs and preferences and that
patients have the education and support they need to make decisions and participate in their own
care.
How to organize PCC?
There are eight dimensions of patient centered care. Investing in these dimensions will result in
better outcomes for organisations and for patients:
1. Patient preferences: interaction between healthcare professional and patient. Patients
should be supported to set and achieve their own treatment goals, to improve the quality of
life of the patients.
2. Access to care: healthcare should be accessible to all patients. Think about: financial
accessibility, acceptable waiting times, but also the buildings should be accessible for
wheelchairs etc.
3. Emotional support: emotional aspects of a disease like fear, anxiety about a treatment or
about the future etc. it is important to take that seriously and address that.
4. Physical comfort: two sided. On the one hand it is important to address the clinical aspects
of the disease, pain management, supporting patient with their daily living needs like
sleeping well etc. But on the other hand it is also important that the physical comfort within
an organisation is addressed like comfortable waiting rooms, privacy etc.
5. Family and friends: it is important to involve relatives in care, in the decisions regarding the
patients care. Healthcare professionals should pay attention to their questions and needs.
6. Information and education: PCC is all about putting patients in charge of their own care, but
patients need to be informed of their own care to be in charge. So information should be
, provided and adjusted to the level of the patients. Good communication is the key. You can
also think about the use of decision aids.
7. Transition and continuity: all healthcare disciplines and settings that are involved in the
healthcare about one patient. It’s important that the information is transferred from one
healthcare professional/organisation to another. Transition programs are set up to smoothen
this transition.
8. Coordination of care: is all about the team within one organisation that is involved for the
patient. That is the main differences between transition of care and coordination of care. For
coordination of care it is important that all professionals are well informed of the patients
situation.
If you want to work patient-centered, you need to improve on all levels to improve your patient-
centeredness.
PCC in a primary care setting
Example: study about patients with multi-morbidity in primary care setting. The results were actually
pretty good, the average score was pretty high. But there are some barriers: time, money and patient
characteristics. There is not always enough time or money to improve. But also the characteristics of
patients are so different, not every patient has the same values. These differences makes it really
hard for healthcare professionals to determine what patients need.
Take home massage: patient-centered care pays off! 2
Model I: Rathert, 2013: conceptual model.
In the previous video we discussed the eight dimensions of patient-centered care. According to the
systematic review off Rathert, organising care according to these eight dimensions will result in
better organisational and patient outcomes. That is also depicted in here conceptual model.
On the left: the eight dimensions of patient-centered care, the process.
Process leads to outcomes, but there are also some moderators and mediators that can influence
how process leads to outcomes.
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