Patient Centered Care Delivery
HC.1 - Introduction to PCCD
Part 1: what is patient-centered care (PCC)?
PCC is one of 6 important quality domains in healthcare.
Patients are stimulated in collaboration with their healthcare professionals to be a leader and drivers of
their own care delivery. This can be done by e.g. informed and shared decision making.
PCC is respectful and responsive to pt preferences, needs and values.
Involvement of pt can also be done on (higher) organizational levels. E.g. involved in hiring new
healthcare professionals.
But this is rare.
Research shows that many patients don’t feel like their level of participation in their own care or treatment
is efficient. They often feel that they aren’t taken seriously or not involved enough in shared decision
making.
While 94% wants to participate, 48% of Dutch pt find it hard to take an active role in their care. 22% finds
it extremely hard to participate.
What is the issue? People want to participate, but experience various barriers for their engagement.
Studies show that professionals not always involve pt in decision making processes (e.g. not always
given all treatment options; sometimes pt aren’t even aware that there’s sth to choose). If professionals
present options, they don’t always present them equally neutral.
PCC collaborates with pt instead of acting on their behalf. Health care professionals have to share power
in order to do this.
Even though NL performs well on different rankings about the quality of care, there’s still a lot of diversity
on patient centeredness on each individual pt level.
How come that every institution claims en wants to be pt centered, but the reality shows sth else?
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Study results:
Although professionals health care professionals attach great importance to e.g. pt preferences,
effective coordination of care, good information and education, they also experience difficulties in
the delivery of PCC
o e.g. they experience obstacles in decision making processes
o Pt don’t always get the support they need to set their own treatment rules or voice their
own preferences
Many professionals struggle with effective communication and education
,Patient centered care is highly valued, but the importance of a few points of PCC appear to differ among
health care professionals. And professionals experience barriers to PCCD in practice.
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Study results: health literacy (= the ability of people to make sound decisions concerning health and daily
life) among European citizens
In Europe almost half of the population (47%) has trouble understanding healthcare information.
This means that they have limited health literacy
o There are differences between countries
In NL 3:10 pt were unable to use the health information that was provided
Health professionals aren’t fully aware that pt didn’t understand them correctly. Pt don’t tell and
professionals think the pt understands
Pt that are more vulnerable to have health literacy: poor health status, high use of healthcare
services, low socioeconomic status
Based on this and other studies, we are increasingly aware of the need for diversity in healthcare.
We need different types of PCC for different groups in society.
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PCC is hard. We know it works but are clueless to what it looks like.
A systematic review showed that organizations that score well on PCC also got a better score on pt and
organizational outcomes.
But the interventions in this SR are quite diverse. Some incorporated quality improvements with some
aspects of PCC, while other interventions focus on communication or access to care. Some interventions
are complex and focus on more components, while others only focus on one aspect of care (e.g. care
coordination).
The question that remains: how can we compare all these different interventions that aim to be pt
centered?
What makes care pt centered or not?
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The first thing that’s important is being respectful and taking decisions together (shared decision making).
But PCC is more than this. It’s also a good atmosphere, professionals that work well together etc. that
make a pt feel pt centeredness.
Certain aspects are more important in PCC. E.g. coordination of care, involvement of family and friends,
also considering mental health (besides physical health).
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If we want to improve PCC of care, which interventions should we choose? Which interventions are most
effective considering the limited health care budget and man power we have?
Effectiveness (based on study that looked at > 3000 mostly used medical treatment):
Only 11% of treatments is proven to be effective
24% is probably effective
7% has both positive and negative effects
8% is likely not effective
50% is unknown
This study was done in hospital setting. In primary or community care setting we know even less about
the effects of these interventions (RCT is difficult etc.).
In many trials pt with multicomorbidities are excluded from the trial, because they might contaminate the
research findings.
So we lack a lot of evidence for many of these interventions and know that the effect of these
interventions is not the same for all groups of pt (e.g. takes longer to make a diagnosis with a lower
educated pt than with a higher educated pt).
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In response to this there’s a movement from authority based care (in which professionals are central in
decision making based on their authority), to evidence based medicine (given to everyone based on
best available evidence), leading to context based medicine (which is what care should be for different
pt populations).
PCC needs various kinds of knowledge, including local knowledge, knowledge from pt themselves,
knowledge from context in which pt live (which includes living conditions and preferences of pt).
So professionals need to adjust shared decision-making to fit the preferences of the pt.
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Part 2: eight dimensions of PCC
Social production function (SPF) theory:
Overall well-being consists of physical well-being and social well-being, which in turn consists of
different aspects
Professionals mainly focus on physical well-being, but social well-being is also really important
Investing in social well-being is where PCC comes in to play
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Patient centered care= healthcare that establishes a partnership among practitioners, pt and their
families (when appropriate) to ensure that decisions respect pt wants, needs and preferences and that pt
have the education and support they need to make decisions and participate in their own care
Provided care that pt needs, in the way pt desires it and at the same time the pt needs it.
Increasingly pt wish for access for important information etc. This is necessary to be able to actively
participate in the care process.
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How to organize PCC?
The 8 dimensions of PCC:
1. Pt preferences
2. Information and education
3. Access to care
4. Emotional support
5. Family and friends
6. Coordination of care
7. Physical comfort
8. Continuity and transition
These dimensions show us how we can organize PCC within healthcare organizations.
You can not only improve a few of these dimensions to improve care. You need to improve all of them.
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1. Pt preferences:
Professionals need to understand pt by getting to know the pt and their preferences and values
This is about interaction between professional and pt
Professionals shouldn’t only focus on treatment, but also quality of life
Pt should be involved in decisions and be supported in setting and achieving their own life goals
Pt preferences change over time. Especially in pt with changed health status
o e.g. organizations have a personal care plan in which pt can set their own goals and
which is catered to their needs and preferences
o The goals of pt are often broader than improving health outcomes
2. Access to care:
Healthcare should be affordable and accessible for all pt
This refers to waiting times, multiple options for consults (e.g. e-consults), accessible buildings,
medication, insurance
, 3. Emotional support:
Pay attention to pt fear, depression etc.
Also pay attention to impact of the disease on pt life (more difficult to have many social relations
or a job if you’re constantly tired)
Can refer pt to social support or peer support groups
4. Physical comfort
Not only physical comfort during daily life, but also when they visit health care institutions
e.g. comfortable chairs, respecting privacy
5. Family and friends
e.g. Ronald McDonald houses (so parents can stay physically and emotionally near their sick
child and can feel supported by other parents)
6. Information and education
Need to provide sufficient information about all aspects of their care
Need clear and easy information about their condition to be able to actively participate in their
care
Open communication between professionals and pt is important. For this you need professionals
that are good communicators and that are aware of health illiteracy etc.
e.g. decision aids help pt make the right choice for them. Also make it easier for pt and
professionals to discuss treatment options and improve communication
7. Transition and continuity
Change from one organization or one specialization to another should be as seamless as
possible
Make sure that pt get all the information they need (why they are going, where they are going,
who will be the contact person etc.)
e.g. transition from pediatrics to adult care is still difficult. You can e.g. use a transition
coordinator or the presence of the pediatrician in adult care visits
8. Coordination of care
Professionals should be well informed of PCC and PCC should be well coordinated among these
professionals
Teamwork is essential, so pt e.g. don’t have to repeat the same story over and over again (do
teammeetings etc.)
Can use a case manager that makes sure that all care is coordinated well among health care
professionals
So coordination of care is about the team within one discipline or in one organization that’s
involved in pt care
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PCC in a primary care setting
Program: PCC for pt with multimorbidity in the primary care setting
They made an improvement program to foster the 8 dimensions of PCC and assessed the
experiences of professionals and pt with this program in practice
The program consists of different interventions meant to improve the knowledge and
implementation of PCC on different levels (organizational, healthcare professional and pt level)
o e.g. making an appointment via the internet, reorganizing the consultation structure,
training on health literacy, improving communication between professionals
o Was based on 3 different questions that can be asked to reassure that pt wishes and
needs are taken into account:
What are my options?
What are the advantages and disadvantages of these options?
What does that mean for my situation?
