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Summary PCCD: lectures, workgroups and literature
Summary PCCD: lectures, workgroups and literature
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Summary Patient Centred Care DeliveryWeek 1
1.1 Lecture Patient centred care delivery
Person centred care: the person as a whole is central, instead of the patient where is only looked at
the illness or problems of that person.
● Shared-decision making
● Respect for the patient(s opinion)
● Information provision to the patient
1. Patient preferences
Treat them with dignity and respect, setting goals and stimulate the patient to reach them.
2. Information and education
Patient is in charge of their own care; thus, they have to know everything about their care. The
information should be perfectly suitable for the patient and understandable (taking f.e. their
education level and language into account).
3. Access to care
Don’t have to wait too long to receive care, also access to services, and that it is easy for people in
f.e. wheelchairs to go to the doctor (so more physically).
4. Physical comfort
The effects of having an illness, shortage of breath with a COPD patient f.e. The patient should be
helped to feel comfort. Also, clean waiting rooms, nice chairs, and privacy.
5. Emotional support
Anxiety and depression; f.e. chronic diseases often go hand in hand with anxiety.
6. Family and friends
Illness affects the family and friends, how can they be supported (or how can they support the
patient when he/she comes back home), addressing their needs.
7. Coordination and care
Within 1 healthcare organisation (so different physicians like nurse and GP within one organisation)
8. Continuity and transition
Multiple healthcare organisations are involved (dietist, fysio etc. from different organisations)
Barriers (Kuipers, 2021):
Patient 🡪 differences in patient needs and health literacy (every patient is different, for some
patients it is difficult to be in charge, look at the context of the patient like what is their education
level?).
Organization 🡪 differences in education, motivation, and skills of healthcare
professionals/organizations (organization as a whole should be motivated to provide PCCD, there is a
difference in skills between professionals and everyone does it differently or are better trained than
others).
National 🡪 restrictive information sharing and a lack of supportive financial structures (think of
privacy laws, being PC takes more time than the 10 minutes that a GP has right now, it is not
stimulating to work PC financially).
,1.2 Lecture Person-centred care for people living with obesity
People often think obesity is the logical result of an unhealthy lifestyle, however this seems a simple
approach (there are many determinants like environment, safe neighbourhood, financial status,
hormones and illness, stress, social factors etc.).
Access to care: blood pressure cup that is suitable for an obesity patient (a simple piece of
equipment was not available for the patient).
Physical comfort: chronic pain, respiratory problems
Emotional support: bias and discrimination (think about work)
There is no one size fits all, every patient is different so should receive a personal approach.
Weight stigma = discrimination or bias towards individuals of their weight of size
Also prevalent in healthcare settings (f.e. professionals holding negative attitudes or making
assumptions, patients taken less seriously, the other way around can be that a professional does not
feel trained to talk about the weight topic and rather avoids the topic).
A barrier to the provision of PCC for patients living with obesity (patients experience stress and
mistrust).
1.3 Workgroup PCCD
Article 1: Rathert C, Wyrwich MD, Boren SA. (2013). Patient-Centered Care and Outcomes: A
Systematic Review of the Literature. Med Care Res Rev., 70(4), 351-79
Article 2: Jayadevappa R, Chhatre S. (2011). Patient Centered Care - A Conceptual Model and Review
of the State of the Art. The Open Health Services and Policy Journal, 4, 15-25.
1. Explain the two conceptual models (both Rathert and Jayadevappa) and their addition to the
literature.
Conceptual Model Rathert et al. (2013): the model shows how the PCC processes are built up and
related to outcomes (patient satisfaction clinical outcomes and organizational outcomes). In so
,doing, this study identified some hypothesised moderators and mediators, and these have been
included in the conceptual framework. Framework for what PCC is.
Addition to literature: The present study
focuses on PCC and outcomes across settings
and patient types. They also look more at
patient conditions and a wide array of
dependent variables and distinguishing those
(onderscheiden) in terms intermediate and
long-term outcomes. Also, this study identifies
variables that may play key moderating
(influences the process so the dimensions, can
be either positive or negative. So, the
outcomes are always limited by the conditions
of the moderators. The moderators always
have an effect on the outcome) or mediating
(underlying mechanisms) roles in the PCC–
outcomes relationship.
Conceptual Model Jayadevappa & Chhatre
(2011): It is a model for an organization who
wants to introduce PCC. You see all the domains
that are involved (e.g., patient demographics –
age, insurance, education - and clinical
characteristics – hospital, nurse and physician -
that influence treatment choice, process of care
and outcomes). Shared-decision making is seen
as very important, with respect to the patient in
how far they want to be involved in making
decisions. This is relevant information for an
organization to have.
Addition to literature: macro policy measures
have to be taken and on micro level incentives at
organization- and system level have to be
introduced to make PCCD attractive.
Furthermore, the patient’s role in her or his own healthcare process, and the importance of shared
decision making. Thus, physicians must facilitate the process of informed decision making and tailor
the treatment(s) to match patient preferences (or needs).
2. Explain the eight dimensions of PCC and give an example of care within each dimension.
Think of examples that were not mentioned in the video lecture.
I. Patient preferences
A patient wants to give birth in a specific hospital, chemotherapy given in a garden.
II. Information and education
, A patient with a migration background is provided with understandable information in her own
language using an interpreter (tolk).
III. Access to care
There are wheelchairs and elevators available in a clinic.
IV. Physical comfort
There is a special family room made available (privacy) in the hospital where a family can come
together and support each other when their loved one is not doing so well.
V. Emotional support
The GP advices a young woman who has been just diagnosed with breastcancer, to visit a
psychologist to speak about the difficult upcoming time.
VI. Family and friends
The physician organizes a meeting with the closest family of an old patient who had a heart attack
but is coming home soon to inform them what to expect and how they can help him recover. Family
hotel near EMC.
VII. Coordination and care – within an organisation
The physician and nurse have in-depth conversations about the rehabilitation process of a patient
and work closely together to make this process go fluently.
VIII. Continuity and transition – between organisations
A patient with obesity has help from a dietitian, physiotherapist, and her own GP to lose weight in a
planned period of time.
3. In which situations are the PCC models of Jayadevappa and Chhatre and Rathert and
colleagues best applicable?
Rathert: applicable to one specific patient and their own values for the dimensions.
Jayadevappa: for a healthcare organization that wants to introduce PCCD, you clearly see what
domains are involved and how they
can differ from patient to patient.
4. Can the two models be
integrated? If so, what
would that look like?
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