Patient Centered Care Delivery
Theme 1;
The need for well-being management
It is important to see that there are different levels, the highest goal is overall well-being. Person-
centered care is knowing what that specific person needs. For example: chronic disease. Not only
physical impact, but also social life, for example doing sports and making friends. Social well-being is
harder to reach for this person.
Person-centered care
‘providing care that is respectful of and responsive to individual patient preferences, needs, and
values and ensuring that patient values guide all clinical decisions.’
Organizing person-centered care is not easy. In order to deliver this, you need to address a lot of
things. In order to know what you should do, there are 8 dimensions identified.
1. Patient preferences
2. Information and education
3. Access to care
4. Physical comfort
5. Emotional support
6. Family and friends
7. Coordination of care
8. Continuity and transition
,For example: an organisation decides to invest in only 1 or 2 points, you are not delivering patient
centered care truly. But, it’s a good start.
These points/ dimensions are the base of the course.
1. Patient preferences
You should know what their preferences/ goals etc. are to deliver patient centered health care.
Stimulate and help them to achieve goals. Different treatment plan for someone who wants to play
with their grandchildren, than someone who wants to run a marathon. Preferences and values of a
patient should guide clinical decision making. But, this takes up a lot of time, attention etc. It’s not
that simple to identify the preferences of patients.
2. Information and education
You want to make sure that the patient is in charge of their care. In order to be in charge, you have to
know all aspects of your care. Healthcare professionals should provide that information, keeping in
mind the educational level, background, language etc. But the patient should also provide personal
information to make the best decision together.
3. Access to care
Healthcare should be financially accessible, not waiting to long, easily accessible (wheelchair) etc.
There are big differences (Holland and America). It seems to be a basic thing, but for a lot of people,
this is not normal.
4. Physical comfort
Mainly pay attention to the physical effects of illness. You tend to only look al this dimension, but it’s
a important one. Whatever the physical effects are, you should address it. Physical comfort provided
by the organisation, nice chairs, clean waiting room, privacy etc.
5. Emotional support
Having an illness does not only come with physical discomfort, but also emotional effects like anxiety.
‘What should I do?’. A healthcare professional should pay attention to this. This sounds easy and
logical, but they do not have a lot of time and knowledge etc.
6. Family and friends
They also have a lot of questions, how do I best support? Especially when patients get home, how are
they supported by family and friends? Important to take these into account.
7. Coordination of care
Within one healthcare organisation. Multiple healthcare professionals treat a patient together, they
have to communicate with each other to deliver patient centered health care.
8. Continuity and transition
When multiple healthcare organisations are involved. A physiotherapist, dietist, hospital etc. They
also have to communicate (for example about medication), to deliver patient centered health care.
So, the patient doesn’t have to tell what’s going on to each professional separately.
,If you organise your care according to the 8 dimensions, it will lead to better outcomes in those three
subjects.
Barriers to patient centered care;
- Patient: differences in patient needs and health literacy -> every patient is different and it’s
difficult to figure out their exact needs. Also, they have different levels of knowledge and
ideas of healthcare. This makes it difficult for a healthcare professional to decide (in the short
time that they have).
- Organization: differences in education, motivation and skills of healthcare professionals/
organizations -> an organisation has to be motivated as a whole to deliver. And also different
skills in professionals, one is better in asking what preferences are than others. This has to be
taking into account.
- National: restrictive information sharing and a lack of supportive financial structures -> for
example with changes in medication, it would be ideal if there is a system in which you can
change the information and it changes at the other organisation too. This financial structure
is not stimulating patient centered care. For example, having the 10 minutes at a GP.
Lecture; person-centered care for people living with obesity
Why person-centered care specifically for this group?
Looking at the Netherlands, half of the population is overweight. But this is also worldwide.
Underlying causes of obesity in adults
Obesity is simply the result of a unhealthy lifestyle, that is what we believe know. But it’s a simplistic
approach, since underlying diseases, social factors etc.
This figure is mainly to show the complexity behind obesity and differences between individuals. An
one size fits all approach, doesn’t work.
, Most of the time, people with obese are told to lose weight. But, this can be ineffective and a bad
experience for the patients. We have to look: what is the best treatment plan for this patient?
When care is organised according to the 8 dimensions, this will lead to better care experiences and
also better outcomes, also for patients with obesity.
But what does this really entail?
Examples: these are not true for every single patient. Obesity has various cases.
1. Patient preferences
Care is often centered around weight. This can be in contrast with what the patient was hoping to
discuss. Some patients might be looking to discuss weight loss, for some it is part of it and for others
they might not want to discuss it at all. Patient go to the doctor for issues with well-being, not the
number on the scale.
2. Information and education
Some patients might be hoping to achieve weight loss but are struggling. This patient won’t be
helped by giving basic lifestyle information. Most of the times, the information doesn’t fit their needs.
But for some patients, this can help.
3. Access to care
Not all healthcare is accessible. For example, blood pressure equipment was not available for a
patient with obesity. But also lack of information of the professionals with new medication for
example.
4. Physical comfort
For example, fatigue. These things can influence well-being of patients, it can cause discomfort. These
things have to be considered. Taking measures in the physical environment can be done for example.
5. Emotional support
The relationship between mental health and obesity is very. Living with obesity can give stress, but
also discrimination. Not every patient is the same and they have different needs in terms of
emotional support. Some patients feel that this is their most important dimension.
6. Family and friends
Some patients may experience lack of support from others. For example lack of support of their
partner, or the social context. It can be beneficial to involve others and inform others in care.
7. Coordination of care
Most of the time, more healthcare professionals are involved. Coordination and information is
important for this.
8. Continuity of care
Most of the time, more healthcare professionals are involved. Coordination and information is
important for this.
There is no one-size-fits-all.
Rathert figure: we have now discussed the process part.
Patient with obesity with patient centered care report:
- Greater satisfaction with care
- Greater social and physical well-being
Person centered care seems to be the way forward, but it’s not easy
Weight stigma;
- Weight stigma = discrimination or bias towards individuals because of their weight or size
- Also prevalent in healthcare settings
- A barrier to the provision of PCC for patients living with obesity
