People-centred health care

In recent years, there has been increasing interest in the patient’s perspective of health care and how health systems can better respond to the needs of all health care stakeholders and constituencies in a holistic manner. Previous recommendations of Member States through the WHO Regional Committees for the Western Pacific and South-East Asia reflect the need to pursue work in the following: equity and fairness into policies; the development of programmes firmly grounded in ethical principles; the quality of health care and patient safety; human dignity, patients’ rights and needs, and the role of families, culture and society; the broader psychosocial and cultural determinants of health; and ethics related to medical practice, research and education. These issues have widespread relevance and significance. Improving health care quality and safety and enhancing the people’s experience of care require attention not only to health system design but also to the focus ...

The patient-as-partner approach in health care: a conceptual framework for a necessary transition.

A new model to enforce the partnership between patients and healthcare professionals has been developed at the University of Montreal’s Faculty of Medicine. Their patient-as-partner approach is rooted in patient-centered perspectives that have inspired previous initiatives like shared decision making, therapeutic education, expert patient and self-management. The main contribution of “Montreal model” is to consider the patient as a caregiver of himself and, as such, a genuine member of the treatment team, endowed with competencies and limitations just like any other member of the team.
This article describes the theoretical basis and summarize the main achievements of this innovative approach, established since 2010. Authors examine the issues of patient partnerships on medical practice and medical education cultures. Two key challenges are identified: 1) Integrate patients in existing professional education structures, instead of separate spaces as patient’s universities and 2) Develop a formal recruitment process for those patients, including ...

Person-centered care - ready for prime time

Long-term diseases are today the leading cause of mortality worldwide and are estimated to be the leading cause of disability by 2020. Person-centered care (PCC) has been shown to advance concordance between care provider and patient on treatment plans, improve health outcomes and increase patient satisfaction. Yet, despite these and other documented benefits, there are a variety of significant challenges to putting PCC into clinical practice. Although care providers today broadly acknowledge PCC to be an important part of care, in our experience we must establish routines that initiate, integrate, and safeguard PCC in daily clinical practice to ensure that PCC is systematically and consistently practiced, i.e. not just when we feel we have time for it. In this paper, we propose a few simple routines to facilitate and safeguard the transition to PCC. We believe that if conscientiously and systematically applied, they will help to make PCC the ...

Digital Health and Care Congress 2016. Enabling patient-centred care through information and technology

The congress will feature presentations and case studies from: NHS trusts; clinical commissioning groups; local authorities; voluntary sector organisations; universities and private sector providers, who will present innovative projects that are using technology and data to deliver high-quality sustainable health and care services.

Imperial child health general practice hubs

For most children, the GP is their main point of contact with the health servivce. While children make up nearlyy one-fifth of the population in England, they are estimated to account for two-fifths of a typical GP´s workload. Despite this, the Royal College of Paediatrics and Child Health estimate that in many parts of the country, between 40 and 50 per cent of GPs have a had little or no formal paediatric training. Evidence suggest that many of these case could be managed outside an acute setting. 

Towards Patient-Centered Conflicts of Interest Policy

Financial conflicts of interest exist between industry and physicians, and these relationships have the power to incluence physicians´medical practice. Transparency about conflicts matters for ensuring adequate informed consent, controlling healthcare expenditure, and encouraging physicians´reflection on professionalism. The US Centers for Medicare & Medicaid Services (CMS) launched the Open Payments Program (OPP) to publicly disclose and bring transparency to the relationships between industry and physicians in the United States. These changes considerably improve transparency and the utility of available data, and caan furthermore enhance professionalism and accountability by encouraging physicians to reflect more actively on their own practices. 

The Western Sydney Integrated Care Program (WSICP): Qualitative Evaluation

The ageing population together with an increasing prevalence of chronic conditions require a systems wide integrated approach to health care. This includes overcoming barriers between primary and secondary care, physical and mental health, and health and social care in order to provide patient centred care. In Australia, the New South Wales Ministry of Health is piloting an innovative Integrated Care Program in Western Sydney, foccussed on care facilitator roles to coordinate patient care between General Practices and hospitals. 

Health Services Research Spending and Healthcare System Impact

The challenges associated with translating health services and policy research evidence into practice are many and long-standing. Indeed, those challenges have themselves spawned new areas of research, including knowledge translation and implementation science. These sub-disciplines have increase our understanding of the critical success factors associated with the uptake of research evidence into (system) practice. In that regard, building on Canada´s recent Strategy for Patient Oriented Research would seem to offer consideravle promise. The "modest" proposals offered by Thakkar and Sulivan seem less likely to bear fruit. 

Family Medicine Clinic: a case study of a hospital–family medicine practice redesign to improve chronic disease care in the community in Singapore

Singapore´s health care system is strained by the health care needs of a rapidly aging population. The unprecedented collaboration between a public hospital and a private family practice to set up the Family Medicine Clinic (FMC) to co-manage patients with chronic desease is an example of efforts to shift care to community. 

Integrated Care Planning for Cancer Patients: A Scoping Review

There has been growing emphasis on the use of integrated care plans to deliver cancer care. However little is known about how integrated care plans for cancer patients are developed including featured core activities, facilitators for uptake and indicators for assessing impact. A scoping review was conducted to explore the components of integrated care plans and contextual factors that influence design and uptake. 

The perceived impact of family physicians on the district health system in South Africa: a cross-sectional survey

The 2008 World Health Report "Primary Health Care-Now More Than Ever" defines strong Primary Health Care (PHC) systems as those systems which offer first contact care that is patient-centred with an orientation to the patient´s family and community context, embedded in a service that is comprehensive, integrated, continuos, and community-orientated, and in which patient-care is well co-ordinated. This report warned against oversimplified approaches to PHC in developing countries, which only focus on priority deseases or rely on unsupported health workers who are poorly equipped for the complexity of PHC. The World Health Assembly supports the report´s recommendation that PHC should be offered by a multidisciplinary team that includes a family physician. 

Achieving Integrated Care for Older People: Shuffling the Deckchairs or Making the System Watertight For the Future?

Integrated care has been recognised as a key initiative to resolve the issues surrounding care for older people living with multi-morbidity. Multiple strategies and policies have been implemented to increase coordination of care globally however, evidence of effectiveness remains mixed. The reasons for this are complex and multifactorial, yet many strategies deal with parts of the problem rather than taking a whole systems view with the older person clearly at the centre. 

Integrating Community Health Workers Into Medical Homes

Though evidence supports the value of community health workers (CHWs) in chronic disease self-management support, and authorities have called for expanding their roles within patient-centered medical homes (PCMSs), few PCMHs in Minnesota have incorporated these health workers into their care teams. They undertook a qualitative study to (1) identify facilitators and barriers to utilizing a CHW model among PCMHs in Minnesota, and (2) define roles played by this workforce within the PCMH team

Talking leadership: clinicians leading transformational change

Taj Hassan, Consultant in Emergency Medicine at Leeds Teaching Hospitals NHS Trust, and President, Royal College of Emergency Medicine, answers some questions about how clinicians are contributing to transformational change in the NHS

Patient-centred care for multimorbidity: an end in itself?

Multimorbidity, which is defined as living with two or more chronic health problems, is a major and growing problem, especially in societies with ageing populations and substantial socioeconomic disparities. It is associated with reduced quality of life, impaired functional status, poor physical and mental health, and increased mortality

Case management for integrated care of frail older people in community settings

Demographic changes and advances in medical care and technology have led to an ageing population. Despite gains in life expectancy, compression of morbidity in later life has not been achieved, meaning that although growing numbers of older people are living longer, they are doing so with one or more long?term conditions. A key driving force for international policy agendas worldwide is to improve the quality, efficiency and safety of health and care services through the delivery of effective integrated care systems. Integrated care can be broadly defined as "an organising principle for care delivery that aims to improve patient care and experience through improved coordination", and such approaches are being increasingly implemented as a key policy in many countries. This review will focus on case management as one service model for delivering integrated care, among others. 

Health professional-patient communication practices in East Asia: An integrative review of an emerging field of research and practice in Hong Kong, South Korea, Japan, Taiwan, and Mainland China.

There is a need to consider local culture in understanding and interpreting medical encounters in East Asia. So the aim of this study was to provide an integrative review of literature on health communication in East Asia and detail culturally-specific influences wicht highlights the need for a specific culturally-appropriate model of health communication in East Asia which may significantly improve relationships between clinicians and patients.

Patient experience of primary care and advance care planning: a multicentre cross-sectional study in Japan.

Advance care planning (ACP) is a process whereby a patient, in consultation with health care providers, family members, and important others, makes decisions about his or her future health care. ACP process includes discussions regarding goals of care, resuscitation and life support, palliative care options, surrogate decision-making and advance directives (AD). Previous studies have shown positive impact of ACP on end-of-life care, including less aggressive medical care and better quality of life; decreased rates of hospital admission, especially of nursing home residents; and increased rates of hospice admission. So the aim of this study was to investigate the relationship between patient experience of primary care and ACP.

The role of patient value and patient-centred care in health systems

Patient-centred care, with its emphasis on patient value, is a widespread health system goal. To examine the progress of the evolution towards more patient-centred health care and draw lesson for the future, the Economist Intelligence Unit conducted a survey and interviews on patient representatives, a cohort in which IAPO was present. However, the findings show that despite some progress, especially in Europe and the US, in practice such care often remains more aspiration than reality.

Measuring patient-centred system performance: a scoping review of patient-centred care quality indicators

Patient-centred care (PCC) is one of the six dimensions of healthcare and was formally described by the Institute of Medicine in 2001 as healthcare that respects and responds to the preferences, needs and values of the individual patients throughout all healthcare decisions. PCC is an approach that has become central to policies and programming to improve healthcare efficiencies and address patient safety issues.
In that sense, The shift to the patient-centred care (PCC) model as a healthcare delivery paradigm calls for systematic measurement and evaluation. In an attempt to develop patient-centred quality indicators (PC-QIs), this study aimed to identify quality indicators that can be used to measure PCC

Evaluating a Community-Placed and Clinically Integrated Community Health Worker Program

Community health worker (CHW) programs can act as bridges between patients and health care teams, but the complexity and variability of program components and outcomes make them difficult to evaluate. This evaluation used a realist approach to identify underlying mechanisms and contextual factors associated with successful implementation of a community-placed CHW program affiliated with a primary care practice in the Midwest United States. The analysis identified mechanisms by which stakeholders built trust, self-efficacy, and empowerment to improve patient-centered outcomes and experiences.

Continuity of care and referral rate: challenges for the future of health care

Continuity of care could reduce health care consumption by patients and reduce the number of referrals to specialist care, but it is unknown if there is a difference in referral rates to specific medical specialties. The aim was to determine the relationship between continuity of care and both the referral rate (referrals per patient per year) and the medical specialties for which this relationship was strongest.

Development of the ACTIVE framework to describe stakeholder involvement in systematic reviews

Involvement of patients, health professionals, and the wider public (‘stakeholders’) is seen to be beneficial to the quality, relevance and impact of research and may enhance the usefulness and uptake of systematic reviews. However, there is a lack of evidence and resources to guide researchers in how to actively involve stakeholders in systematic reviews. In this paper, we report the development of the ACTIVE framework to describe how stakeholders are involved in systematic reviews

Exploring nurse navigators’ contribution to integrated care: a qualitative study

This paper examines nurse navigation as a model of integrated care operating across primary and secondary healthcare settings. A two-phase qualitative study involving a focus group with seven nurse navigators (NNs) to explore their understandings and perceptions of the role, followed by in-depth interviews with three NNs to examine current practice, was undertaken in Queensland, Australia.

Patient feedback to improve quality of patient-centred care in public hospitals: a systematic review of the evidence

Public health services have been moving towards putting patients at the centre of their care. This paper aimed to review systematically the published literature relating to interventions informed by patient feedback for improvement to quality of care in hospital settings. Multi-component interventions which targeted both individual and organisational levels were more effective than single interventions. Care is truly patient-centred when it is guided by the perspective of the one that matters - the patient.

Patient-centred care: The patients’ perspective – A mixed-methods pilot study

Patient centredness is a broad concept, a moral philosophy. Patient-centred care can be viewed as the actions of patient-centredness. One of the most pertinent actions that a healthcare practitioner can utilise to deliver patient-centred care is empathic communication. Whilst many medical programmes include empathetic communication skills as part of their curricula, the recipients of this care are not asked about the relevance of this teaching.

Building a Digital Bridge to Support Patient-Centered Care Transitions From Hospital to Home for Older Adults With Complex Care Needs: Protocol for a Co-Design, Implementation, and Evaluation Study

Older adults with multimorbidity and complex care needs (CCN) are among those most likely to experience frequent care transitions between settings, particularly from hospital to home. Transition periods mark vulnerable moments in care for individuals with CCN. Poor communication and incomplete information transfer between clinicians and organizations involved in the transition from hospital to home can impede access to needed support and resources. Establishing digitally supported communication that enables person-centered care and supported self-management may offer significant advantages as we support older adults with CCN transitioning from hospital to home.

This protocol outlines the plan for the development, implementation, and evaluation of a Digital Bridge co-designed to support person-centered health care transitions for older adults with CCN. The Digital Bridge builds on the foundation of two validated technologies: Care Connector, designed to improve interprofessional communication in hospital, and the electronic Patient-Reported Outcomes (ePRO) tool, designed to support goal-oriented care planning ...

ARIA 2019: An Integrated Care Pathway for Allergic Rhinitis in Portugal

The Allergic Rhinitis and Its Impact on Asthma (ARIA) initiative started more than 20 years ago and has developed and disseminated evidence-based guidelines and projects in the field of allergic rhinitis. This initiative is currently focused on providing patient-centred guidelines that contribute to an integrated care pathway between the various levels of care and take advantage of digital solutions, and the introduction of integrated care pathways in clinical practice has been recommended. In this article we describe the adaptation for Portugal of the ARIA Integrated Care Pathways document. After a brief review of the epidemiology and impact of allergic rhinitis in Portugal and the activities carried out in Portugal within the ARIA initiative, we describe the broad knowledge base used for the development of recommendations for the pharmacological treatment of allergic rhinitis, and these recommendations are based on the GRADE methodology, real world evidence acquired by mobile technology (mHealth) and ...

What do older people want from integrated care? Experiences from a South Australian co-design case study

The challenges of improving the integration of care for older people with complex care needs are well recognised. Evidence suggests that solutions should be co-designed with older people to ensure they are contextually relevant and person-centred.

Implementing patient-centred integrated care for multiple chronic conditions Evidence-informed framework

Fifteen years ago, the term multimorbidity rarely appeared in chronic disease health care policies. Today, research has revealed very high rates of multimorbidity, leading to it being labeled the number one challenge in developed countries. Paradoxically, chronic disease prevention and management (CDPM) programs of integrated care have popped up in all health care systems but they mainly follow a single-disease approach in their interventions. In this article, we define CDPM programs broadly as any interventions intended to improve care for patients with chronic diseases and risk factors; these are added to usual care and are typically delivered by a team.

Putting patients first: development of a patient advocate and general practitioner-informed model of patient-centred care

Patients, providers and health care organisations benefit from an increased understanding and implementation of patient-centred care (PCC) by general practitioners (GPs). This study aimed to evaluate and advance a theoretical model of PCC developed in consultation with practising GPs and patient advocates.

Implementation of patient-centred care: which system-level determinants matter from a decision maker’s perspective? Results from a qualitative interview study across various health and social care organisations

The healthcare system is characterised by a high degree of complexity and involves various actors at different institutional levels and in different care contexts. To implement patient-centred care (PCC) successfully, a multidimensional consideration of influencing factors is required. Our qualitative study aims to identify system-level determinants of PCC implementation from the perspective of different health and social care organisations (HSCOs).

The results showed the necessity of enforcing paradigm changes at the system level from disease-centredness to patient-centredness while aligning policy and reimbursement decisions directly with patient needs and values. A systematic, long-term planned strategy that extends across all organisations is lacking, rather each organisation seeks its own possibilities to implement PCC activities under external restrictions.

Patient-Centred Care for Patients With Diabetes and HIV at a Public Tertiary Hospital in South Africa: An Ethnographic Study

Healthcare systems across the globe are adopting patient-centred care (PCC) approach to empower patients in taking charge of their illnesses and improve the quality of care. Although models of patient?centredness vary, respecting the needs and preferences of individuals receiving care is important. South Africa has implemented an integrated chronic disease management (ICDM) which has PCC component. The ICDM aims to empower chronic care patients to play an active role in disease management process, whilst simultaneously intervening at a community/ population and health service level. However, chronic care is still fragmented due to systemic challenges that have hindered the practice of PCC. In this article, we explore provider perspectives on PCC for patients with comorbid type 2 diabetes and HIV at a public tertiary hospital in urban South Africa.

The conceptualisation of patient-centred care: A case study of diabetes management in public facilities in southern Malawi

Patient-centred care (PCC) is one of the pillars of Malawi’s quality of care policyinitiatives. The role of PCC in facilitating quality service delivery is well documented, and its importance may heighten in chronic disease management. Yet, PCC conceptualisation is known to be context specific. The prominent themes emerging from the participants’ conceptualisation of PCC included the following: meeting individual needs, goals and expectations, accessing medication, supporting relationship building, patient involvement, information sharing, holistic care, timeliness and being realistic.

Commentary: how person-centred is pharmaceutical care?

Person-centred care: looking back, looking forward

An interdisciplinary group of clinical and non-clinical academics in Sweden created a research centre for the study of person-centred care (PCC) in long-term illness. The GPCC steering committee formulated a position paper with three ‘simple routines’ to initiate, implement, and safeguard PCC in daily clinical practice. 

Barriers and facilitators to patient-centred care in pharmacy consultations: A qualitative study with Malaysian hospital pharmacists and patients

Patient-centred care (PCC) has been suggested to provide benefits such as improved patient-healthcare provider communication and better disease self-management to patients. The practice of PCC should involve all healthcare professionals, including pharmacists who are well-positioned in providing pharmaceutical care to patients. However, a better understanding of the factors that can affect the practice of PCC in pharmacists’ consultations is needed.

Needs and resources of people with type 2 diabetes in peri-urban Cochabamba, Bolivia: a people-centred perspective

The rising prevalence of type 2 diabetes results in a worldwide public healthcare crisis, especially in low- and middle-income countries (LMICs) with unprepared and overburdened health systems mainly focused on infectious diseases and maternal and child health. This study identifies mostly contextual factors like low literacy levels, linguistic problems in care, the need to articulate people’s worldview including traditional use of natural remedies with the Bolivian health system and the lack of expertise on type 2 diabetes by primary health care providers. Understanding the needs and structuring them in different areas wherein action is required serves as a foundation for the planning and evaluation of an integrated people centred care program for people with type 2 diabetes. This participative method serves as a tool to implement the often theoretical concept of integrated people centred health care in health policy and program development.

Associations between person-centred care and job strain, stress of conscience, and intent to leave among hospital personnel

Hospitals have experienced difficulty in retaining qualified healthcare personnel. Previous studies have shown that working in a person-centred environment could offset this challenge, but research is scarce. The organisational and environmental support subscale of perceived PCC showed significant correlations with all explanatory variables, while the extent of personalising care subscale only correlated with job strain and intent to leave. Higher perceived PCC is associated with work-related factors in hospital departments.

Association between doctor-patient familiarity and patient-centred care during general practitioner's consultations: a direct observational study in Chinese primary care practice

Patient-centred care is a core attribute of primary care. Not much is known about the relationship between patient-centred care and doctor-patient familiarity. This study aimed to explore the association between general practitioner (GP) perceived doctor-patient familiarity and the provision of patient-centred care during GP consultations.

Proposals for person-centred care in the COVID-19 era. Delphi study

In this COVID-19 era, we need to rethink the criteria used to measure the results of person-centred care strategies. The objective of this study is to identify priorities, and criteria that health services can use to pursue actually the goal of achieving person-centred care.

Terms of engagement for working with patients in a person-centred partnership: A secondary analysis of qualitative data

Evidence is emerging of the potential of person-centred approaches to create partnerships between professionals and patients while also containing healthcare costs. This is important for enhancing outcomes in individuals with complex needs, who consistently report poor experiences with care. The shift towards person-centred care (PCC) is, however, a radical departure from the norm, with increased expectations of both professional and patient. 

Patient-centred care delivered by general practitioners: a qualitative investigation of the experiences and perceptions of patients and providers

Patient-centred care (PCC) is care that is respectful and responsive to the wishes of patients. The body of literature on PCC delivered by general practitioners (GPs) has increased steadily over time. There is an opportunity to advance the work on GP-delivered PCC through qualitative research involving both patients and providers.

Person-centred care in individuals with stroke: a qualitative study using in-depth interviews

Person-centred care (PCC) has considerable effects on the clinical practice of health professionals. The purpose of this study was to describe the perspectives and perceived barriers and enablers of individuals with stroke regarding the PCC model in stroke rehabilitation.

Person-centred care among intensive care unit nurses: A cross-sectional study

Practising person-centred care is crucial for nurses in the intensive care unit, as patients have high physical and psychological care needs. We aimed to identify the predictors of person-centred care among nurses working in intensive care settings.

The road to patient-centred care in Peru: The difficulties and opportunities to achieve participatory health care

Patient-centred care (PCC) is a pillar of quality health services, where decision-making power is shared between the clinician and the patient. Although, this approach could be adopted with easiness in high income settings or in countries with unified health systems, in settings such as Peru, where universal access and other structural problems remain a challenge, the practice of PCC is not a priority. In Peru, research on PCC has been conducted for almost two decades, but this has not generated a need for development in academia, decision makers, health personal or patients. 

Patient-centred care in Hungary: Contributions to foster a policy agenda

In Hungary, the National Health Insurance Fund provides health care coverage for nearly all residents, but healthcare spending is below the EU’s average (6.4% versus 9.9% of the GDP in 2019, respectively). In 1997, patients’ rights were established by laws of the healthcare system. The patients’ voice, however, has remained weakly embedded in decision-making processes both on the system and individual patient levels. Policy progress achieved in the past years may foster patient-centeredness in health policy decision-making. However, people-reported data are not yet embedded in the Hungarian health information system and national population or household surveys, thus undermining the monitoring of the performance of the health system regarding patient-centred aspects. From the academic research side, several advances have occurred regarding the availability of validated instruments for the measurement of patient-centred aspects. These recent studies have placed Hungary in a uniquely advanced position compared with other countries in ...

Perceptions of people living with dementia regarding patient-centred aspects of their care and caregiver support

This study examined the perceptions of a sample of Australian people living with dementia regarding the person-centred care and support they received from health professionals and family.

Fit for the Future: a new plan for GPs and their patients

General practice is the cornerstone of the NHS, helping around 50 million people in England every year, carrying out 370 million consultations last year. So, when GPs and their patients tell us that general practice is in crisis, we should all be concerned.

In 2022, the RCGP launched Fit for the Future: a new plan for GPs & their patients to put pressure on politicians and decision makers with responsibility for the NHS in England to commit to a bold new plan to provide GPs and patients with the support that they need.

This campaign follows our 2019 Fit for the Future (PDF file, 1.1 MB) vision which set out how, with the right tools and support, we can revitalise and reform general practice by 2030, so that it can continue to deliver world class patient care. Pressures on general practice have since intensified even further and have been exacerbated ...

Integrated Care: Reflections on Change in Health Services

This book critically examines integrated care, looking at integration from an unconventional angle to reveal the tacit assumptions we make when we manage and change health services. Kaehne questions our premises on health services management, the motivations for change and the shortcomings of health policy in complex environments.

Integrated person- and people-centred primary care for diabetes in low- and middle-income countries: The nurses' perspective on patient needs

The aim of this study was to identify what nurses working in primary care settings perceive as necessary to support the life needs of people with type 2 diabetes. Articulate these needs with the needs expressed by people with diabetes in a previous study. This study demonstrates nurses' important contribution to analysing and designing people-centred care in their community.