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PCCD Theme 1-3 hoorcolleges en werkgroepen
PCCD Theme 1-3 hoorcolleges en werkgroepen
[Meer zien]Voorbeeld 3 van de 19 pagina's
Voorbeeld 3 van de 19 pagina's
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Voorbeeld van de inhoud
Patient Centered Care DeliveryTheme 1 Innovative approaches
Lecture: What is patient-centered care?
Patient centered care: healthcare that establishes a partnership among practitioners, patients and their
families 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. One of the 6
quality domains in 2001. Movement from authority-based care to evidence based medicine leading to
context-based medicine.
Leaders and drivers of their own care delivery. SDM. Health care professionals need to share
power. Patients are not always aware that there are options. Errors due to bad communication.
Most patients believe there is not enough patient centered care. Besides, 48% of patients find it
hard to take an active role in their care, while 94% wants to participate. In Europe almost half of
the population has trouble understanding healthcare information.
11% of medical treatments is proven to be effective. 24% is probably effective. 50% is unknown.
How to organize PCC: the 8 dimensions:
1. Patient preferences: values, preferences, needs, values quality of life. Interaction between
professional and patient.
2. Information and education: decision-aids
3. Access to care: buildings, medication
4. Emotional support: fear, anxiety, impact on lives
5. Family and friends:
6. Coordination of care: teamwork
7. Physical comfort: comfort during a visit to a hospital and in their daily lives
8. Continuity and transition: between different health care settings
PCC in a primary care setting: organizational/health care/patient level. Lack of knowledge, time,
resources.
Conceptual model of PCC The four models of evidence based
and patient centered care
,Outcomes conceptual model of PCC: Clinical outcomes: quality of life and well-being. Organizational
outcomes: job, quality of care, safety.
A moderator is a third variable that affects the direction or strength of the relationship between an
independent and dependent variable (patient condition, expectations).
A mediator explains the mechanism that underlies an observed relationship between an independent
variable and a dependent variable (patient activation, adherence). Why and how is there an effect.
Activate a patient in PCC: SDM, focus on skill-building (especially with long term diseases), education
Literatuur
Rathert
Almost all studies, regardless of methodology, found positive relationships between PCC processes and
patient satisfaction and well-being. This is important for two reasons. First, patient satisfaction with the
care experience has become an important outcome in its own right. Second, some research suggests
that patient well-being and satisfaction may be related to mediating variables, such as adherence and
self-management behaviours.
There was a notable lack of research focused specifically on the dimensions of coordination of care,
emotional support, physical comfort, and continuity and transition. Surprisingly, none of the PCC studies
in this review examined involvement of family. This is particularly notable given that families provide
extensive informal care and play an important role in the patient’s psychosocial context, particularly in
chronic disease and elder care. Some research suggests that patients believe family members are
necessary to enhance patient safety in the hospital and research on end-of-life critical care has found
that the patient and caregiving family members comprise a dynamic “unit” to which providers need to
be sensitive. Coordination of care was only directly examined in two studies and physical comfort was
only examined in one. However, it is notable that the studies in the present review that measured all
dimensions of care did find significant statistical relationships among these dimensions and outcomes.
Finally, although some studies have independently hypothesized moderators or mediators in the PCC–
outcomes relationship, the present study found some consistent variables that appear to play
moderating (patient condition, expectations) or mediating (patient activation, adherenece) roles and
propose these be included in a comprehensive conceptual framework. Important mediators so far
appear to be patient adherence and self-management. Krupat et al.’s (2000) complex moderator–
mediator analysis could be used as a model for future research.
Only one of these studies mentioned any kind of manipulation check. This study found that nurse
enthusiasm for the PCC intervention declined over time because of time constraints, and as well,
patients did not perceive the intervention as strongly over time. Additionally, diffusion of the
intervention could be common, but only one study noted this as a possibility.
Jayadevappa
- Study objective: to evaluate and discuss the interplay of components of patient- centered care by
developing a conceptual model of patient-centered care.
- Results: Though the concept of patient-centered care emerged in the early 50s, it exploded in the health
care research policy arena exponentially in the late nineties. The conceptual model described here can aid
objective and subjective evaluation of patient-centered care. As we strive to improve the quality of care,
patient-centered care can play a pivotal role in this process. This however requires changes in our
healthcare system so as to improve overall quality of care by minimizing wasteful health resource
consumption.
- Conclusions: With healthcare costs projected to continue their rapid increase, the current paradigm of
healthcare is unsustainable. More research is needed to explore the various attributes of patient-centered
care, its acceptability, and comparative effectiveness in the healthcare arena.
, 2 concepts: cultural competence and patient-centered care. Cultural competence sets out to make healthcare
equitable for all, whereas patient-centered care sets out to elevate healthcare quality) many of their
characteristics overlap. Both concepts: 1) understand and are interested in the patient as a unique person; 2) use a
bio-psychosocial model; 3) explore and respect patient beliefs, values, meaning of illness, preferences and needs;
3) build rapport and trust; 4) find common ground; 5) are aware of their own biases/assumptions; 6) maintain and
are able to convey unconditional positive regard; 7) allow the involvement of friends/family when desired; and, 8)
provide information and education tailored to patient’s level of understanding.
Although cultural competence and patient-centered care are two distinct ideas [10], healthcare providers should
seek to incorporate cultural competence into patient-centered care in order to provide healthcare that is both
equitable and of high quality. By doing so, providers would seek to include the following attributes of cultural
competence: 1) understanding the meaning of culture; 2) knowledge about different cultures; 3) appreciation of
diversity; 4) awareness of health disparities and discrimination affecting minority groups; and, 5) effective use of
interpreter services when needed.
Alist of eight core components of patient-centered care that are especially pertaining to underserved populations:
1) welcoming environment; 2) respect for patients’ values and expressed needs; 3) patient empowerment or
“activation”; 4) socio-cultural competence; 5) coordination and integration of care; 6) comfort and support; 7)
access and navigation skills; and, 8) community outreach (28). They also identified following key institutional
structure and process necessary to build patient centered care policies: 1) feedback and measurement; 2)
patient/family measurement; 3) workforce development; 4) leadership; and, 5) involvement in collaborative pilots
The nurse must be able to show a caring presence via communication and other manifestations, approach the
patient as an individual, have the necessary skills and competencies and be able to deviate from established
norms, if necessary. Through this process, the nurse is able to provide effective care, minimize the erosion of
individual (patient) identity, address complexity and broaden the explanatory perspectives of illness
Patient Centered Care
- Clinical Convenience: improvement in patients’ health status, quality of care and increased efficiency of
care, improved recovery, tests less frequent, decreased number of visits, satisfied, signs/symptoms of
improvement, pain control, emotional health. Especially effective communication and continuity of care
are important. Patient engagement and particpation are main factors.
- Patient Reported Outcomes: quality of life, satisfaction, trust, psychological well-being, quality of care.
Revealed preference (individuals choose to discern the best possible option on the basis of their behavior)
or stated preference (use surveys/questions to elicit patients’ preferences for hypothetical options in an
experimental framework).
- Disparity in Care: The factors contributing to health care disparities are race and ethnicity and
socioeconomic status. One way to bridge this gap is to facilitate race-concordant visits. Lower levels of
trust, satisfaction in care, and participation in medical decisions have characterized race-discordant visit.
These visits are longer and more participatory. Language concordance is also an important part of patient
centered communication (possibly solved by professional interpreters).
- Health Care System: Establishment of a patient-centered outcomes research institute through this act was
charged with prioritizing and promoting research that emphasizes the generation of relevant, high-quality
evidence to help physicians and patients make informed decisions about the patient’s healthcare, assist
healthcare delivery systems in providing evidence-based, efficient, and safe healthcare, ensure that
evidence is obtained from ethnically diverse and geographically dispersed communities, and develop
broad prevention and screening strategies that promote health across diverse populations. In a 2020
vision of patient-centered primary care, Davis lists seven essential components: superb access to care;
patient engagement in care; clinical information systems that support high quality care, practice-based
learning, and quality improvement; care coordination; integrated, comprehensive care and smooth
information transfer across a fixed or virtual team of providers; ongoing, routine patient feedback to
practice; and publicly available information
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