Lecture 1
Part 1. What is patient-centered care?
Patient-centered care has been on the healthcare agenda for several decades. The adoption of PCC is
supported by a lot of organizations. Many PCC interventions or attributes have been incorporated in
practice today.
IoM identified PCC as one of the important qualities. The IoM recommended strategies and policies
at multiple levels in order to advance patients, in collaboration with professionals. This can be done
by SDM. Patient centered care is respectful and responsive to patient preferences, the needs and
their values. It is a approach that adopts the patients perspective and ensures that patient values
guide all clinical decisions in the care process. There is a lot of interest in PCC. We all seem to agree
on the importance of this concept.
IS PCC EASY TO DELIVER?
This is a more complicated question. It can also entail in involving patients in decision making in the
organization. This is quite rare.
Almost all people want to participate while half of them find it difficult to take an active rol in their
care. People want to participate but experience barriers for engagement. Studies have shown that
professionals do not always attemt to involve patients in the decision making process, for example
professionals tend to not always present all treatment options. Sometimes patients don't know they
can choose or professionals do not present the options neutrally. In this sense patients may
experience their involvement is not wanted. PCC requires healthcare professionals to share power.
Although our system performs well, there is still a lot of diversity on the individual patient level.
How come that everybode claims to be patient-centered but the reality shows a different picture?
HEALTHCARE PROFESSIONALS' VIEW ON PCCD
A study showed that although healthcare professionals attach great importance to patient
preferences and effective coordination, good information and education, they also experience
difficulties in the delivery of PCC. Professionals experience obstacles in decision making processes.
Even though open communication is perceived as very important, many professional struggle with
effective communication.
In Europe half of the population has trouble understanding of healthcare information, they have a
limited health literacy. So, this result is shocking. If you look specifically in the Netherlands we
perform better, but 3/10 patients are unable to use the provided health information. Healthcare
professionals were not fully aware that patients do not understand it. Patients did not tell them.
People with poor health status, with a high use of healthcare services and with a lower SES
experienced above average problems. There is not one type of care for all populations, we need
different types of PCC for different groups.
Patient centered care is hard; we know it works but are clueless to what it looks like. It works
because many studies show improved outcomes with PCC. But results are quite divers. Interventions
focus on access, on communications, several components, one aspect such as care coordinations.
How can we compare the different interventions? What makes care patient-centered?
The first thing is SDM, making decisions together. But PCC is more than that. You can feel it by going
to the organization. People can be nicer, the seats can sit better. If we want to improve different
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,aspects, which interventions should we choose? Which are most effective considering the limited
budget and manpower?
This question is quit difficult. In almost 90% of the interventions we do not know if they are effective.
We lack a lot of evidence. The effectiveness is also not the same for all group of patients. For
example people with a heart attack in first aid. It may take 48 hours longer to diagnose this by a
lower educated patient. We also lack protocols that incorporate differences in the expressions of
complains in different types of patients.
Movement from authority based care in which professionals are central in decision making to
evidence based medicine leading to context based medicine. This is to unravel what care needs to be
delivered for different patients. PCC requires various sources of knowledge.
Part 2. Eight dimensions of PCC
This is the social production function theory. Healthcare aims to ensure the overall well-being. This
consist of physical and social well-being. Nowadays we focus more on physical well-being. But there
is also the other part. Healthcare insufficiently focuses on that part, the social well-being. That is
were PCC comes into play.
PATIENT-CENTERED CARE
PCC is 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. Patient-centered vision on care delivery could be summarized as providing care that the patient
needs in the manner that the patient desires it at the time the patient needs it. Increasingly patients
want increased access to important information, which they need to be an active partner.
HOW TO ORGANIZE PCC?
What kind of characteristics are important for care to be patient-centered? There are eight
dimensions, including respect for patient values, preferences and needs. But also emotional support,
the involvement of family and friends and effective coordination of care. They can also be applied to
other healthcare dimensions. Investing in these dimensions is expected to result in better outcomes
for oganizations and patients.
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, 1. PATIENT PREFERENCES
It is important that professionals understand the patient by taking the time to really get to know the
patient as a person and also to get to know his or her values and preferences. This is about the
interaction between the healthcare professional and the patient. Patient should also be involved in
decisions of care. Patient preferences can also change over time, particularly in patients for who the
health status changes like chronic conditions.
2. ACCES TO CARE
The care should be affordable and accessible for all patients. This refers to waiting times, but also
may include having multiple options for consultations (e-consults). It also includes accessible building
and access to medication (easily request prescriptions).
3. EMOTIONAL SUPPORT
It is important that not only the physical aspects are addressed, but also the emotional aspects. You
can do this by giving attention to for example fear. Or the impact on the daily lives of the patients.
For example being in constant pain and sleepless.
4. PHYSICAL COMFORT
Two-sided. On one hand to address the clinical aspects. Pain should be managed. On the other hand
it is also important that physical comfort in the organization is addressed. For example clean and
comfortable waiting areas.
5. FAMILY AND FRIENDS
The involvement in decisions. Health conditions do not only affect patients, but also family and
friends.
6. INFORMATION AND EDUCATION
The provision of essential information to patients is about providing sufficient information
about all aspects of their care delivery. Patients should be in charge of their own care process.
To foster this, they should receive clear and easy information. To provide good information and
education, open communication is key. This requires professionals to have high quality
communication skills. An example in this are decision aids.
7. TRANSITION AND CONTINUITY
The chain from one care setting to another or from one discipline to another should be as seamless
as possible. So, smooth transitions require the transfer of all relevant patient information. When
multiple healthcare providers all involved, they all need to transfer information regularly.
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, 8. COORDINATION OF CARE
The organizations team of healthcare professionals should be well informed about the healthcare
delivery and this should be well coordinated among these professionals. So, teamwork is essentials.
Healthcare professionals should be well-informed so patients don't need to repeat their story. So,
coordination of care is about the team within one discipline/organization that is involved in the
patient care. An example is having regular team meetings and have a case manager.
PCC IN A PRIMARY CARE SETTING
PCC FOR PATIENTS WITH MULTIMORBIDITY IN THE PRIMARY CARE SETTING
Improvement program in GP practices. The program consited of several interventions to increase
knowledge and implementation on PCC on three levels, organization, healthcare professional and
patient level. There were various patient-centered inverventions.
In the study they assessed whether the program was associated with more positive experience for
patients with multimorbidity. The scores improved after implementation, but not on all level.
EXPERIENCES OF HEALTHCARE PROFESSIONALS WITH PCC IMPROVEMENT
In general professionals express several improvements in different dimensions. Investing in all
dimensions is needed to taylor care delivery to the diverse population of patients with
multimorbidity and to the verious care needs of them. The patients themselves did not experience
significant improvement in all dimensions. Professionals indicated difficulties with the adjust of
information and education and with the provision with adequate support to provision in the needs of
patients. Important barriers were related mostly to a lack of knowledge, skills and also time that is
available for professionals.
VIEWS OF PATIENTS WITH MULTIMORBIDITY
Interviewers could destinct three viewpoints.
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