Definitions Patient Centered Care (PCC)

Comments

Transcription

Definitions Patient Centered Care (PCC)
What does patient-centered care
mean and how might/do leaders
work with patients to help shape
our healthcare system?
Marilyn Macdonald RN PhD, Associate Professor and Associate Director
Graduate Studies
Dalhousie School of Nursing
Overview
Definitions
Origins
Assumptions
PCC vs System Centered Approach
Theory and PCC
PCC in Action
PCC Drivers
Advantages
Challenges
PCC Competencies
Shifting the power
Definitions
Patient Centered Care (PCC)
A dimension of health care quality in its own right, not
just because of its connection with other desired aims,
like safety and effectiveness. Its proper incorporation into
new health care designs will involve some radical,
unfamiliar, and disruptive shifts in control and power, out
of the hands of those who give care and into the hands of
those who receive it
(Berwick, 2009)
Cont’d
A standard of practice that demonstrates respect for the
patient, as a person
(Shaller, 2007)
A way of viewing health and illness that affects a person’s general
well-being and an attempt to empower the patient by expanding his
or her role in their healthcare.
(Rogers et al. 2005)
Person-Centered, Patient-Centered, Family
Centered
Person-centered, a term coined more than 50 years ago
by nurse theorists Abdellah and Wiedenbach
(interaction theorists)
PCC meant shifting the focus of nursing care from
tasks to the patient and family as the focus of care
Getting to know patients and providing individualized
care
Understanding the person within the context of their
circumstances
(Gottlieb, 2013)
Personhood is central to PCC in clinical decision-making (McCormack,
2003)
Assumptions of Patient-Centered Care
Treating the patient as a unique individual
Assuming that patients are qualified to identify their
own needs and expectations
Expecting patients to make their own decisions about
what they need and want
Understanding the patient as a person rather than a
cluster of diseases
Involving patients in their care and individualizing that
care
Patient-Centered Medicine
1.
2.
3.
4.
5.
6.
A model developed to alter physician practice and to
improve communication. The model has 6 interactive
processes
Exploring disease as well as the illness experience
Understanding the person at the personal level
Finding common ground
Incorporating prevention and health promotion
Enhancing patient-doctor relationship
Being realistic
(Stewart et al., 2003)
PCC versus System Centered Approach
Provider-centered
Emphasis on the
evaluation and treatment
of diseases
Provider perspective
predominates
Compliance
Families not part of
treatment plan
Focused on outcomes of
importance to providers &
regulators
Patient-centered
Evaluation and treatment
of patients
Patient perspective valued
Shared decision-making
Collaboration with families
Focused on outcomes for
all involved
Origins of PCC
Rise of consumerism in the 1960’s
Nader, consumer activist and the automobile industry
on safety devices including seat belts
Demonstrating that one individual can make a
difference
Citizens can empower themselves
Questioning need for radical mastectomy, 1975
the rise of the breast cancer movement (Rose Kushner)
PCC, cause and consequence of litigation culture
Consumerism in Action
WHO World Alliance for Patient Safety
CPSI Patients for Patient Safety
Patient’s Association of Canada
Countless consumer groups (e. g. Canadian Cancer
Society)
Consumers Advancing Patient safety
National Breast Cancer Coalition
System Theory of PCC
Structure
Health professional attributes
professional competence
interpersonal skills
commitment
personal characteristics
Organizational Aspects
time
health worker’s role
effective staff relationships
skill mix
power sharing
shared decision-making
Patient Attributes
Perception of care
Participation in care
Perspective on illness
Cooperation
Culture
Theory cont’d
Process
Working with patient’s beliefs and values
Providing for physical, psychological, social and
cultural needs
Sharing decision-making
Having an empathetic presence
Engagement (provider-patient relationship)
A system theory of patient-centered care (McCormack & McCane, 2006)
Theory cont’d
Outcome
Satisfaction with care
Involvement with care
Improved health
Feeling of well-being
Creating a therapeutic culture
Patient-Centered Care in Action
Virtually same-day access to primary health care in
England, and performance indicators (publicly
available) that in large measure reflect PCC concepts
Web-based patient access to their EHRs (electronic
health records) in Denmark, with the capacity to add or
amend information and an audit trail of providers who
have looked at the record
(Lewis, 2009)
The South-Central Foundation in Alaska
Health System with a PCC focus
It’s not about working endless hours and perpetuating
life-long dependence on repeated services. The goal is to
wean the patients from system dependency and increase
their capacity to self-manage and otherwise participate in
their health. This focus on PCC achieved a decline not
only in the use of specialists and acute care; it also
reduced by 20% the number of primary care visits.
(Lewis, 2009)
Patient-Centered Care in Action
“Now, Mrs. Smith, we’ve got three tablets here, and I’m
double checking that they are the ones the doctor has
prescribed in your chart to treat the H pylori infection that
caused your ulcer, There’s amoxicillin and
clarithromycin-they’re the two antibiotics, and this is the
omeprazole, which helps reduce the acidity, OK?”
(Entwistle, p. 82, 2009)
Is this PCC?
PCC Drivers
Leadership
Strategic vision
Involvement of patients and families
Supportive work environment
Systematic measurement and feedback
Quality of the physical environment
Supportive technology
Consumerism movement
Advantages
Placing the patient at the center of care redirects
activities so that the right job is performed effectively
by the right person
Improves continuity of care
Provides patients with opportunities to be informed
and involved in care decision-making.
Shifts emphasis from the body to total care
Facilitates reflection, learning, and sharing skills and
abilities among health professionals
Challenges to delivering to PCC
Varying definitions of PCC
Inadequate educational emphasis on PCC
Current levels of coordination, collaboration, and
continuity of care
The need for more time and human resources to care
for patients
Absence of good teaching model on patient-centered
care
Dominance of biomedical model
Challenges
A lack of clear descriptions of measurable behaviors
and patient outcomes
The requirement for structural changes at
organizational and practice levels
Not as useful in certain fields (pediatrics, anesthesia,
emergency)
Not all patients are skilled or confident enough to
define, clarify, and participate in care planning
PCC Competencies for Health Care Providers
Commitment to patient/family involvement
Interpersonal skills
Personal characteristics
Ability to adapt consultation style to the needs of
individual patients so that all patients have the
opportunity to be involved in decisions about their care
at the level they wish
Researchers and PCC
Funders have realized the importance of direct
involvement of patients in research (SPOR)
Canadian Patient Safety Institute in 2005 called for
researchers to illicit patient perspectives on safety
NSHRF funded study on the role of the hospitalized
patient in medication administration safety
CIHR funded study with adults with CF to generate theory
related to adherence from the perspective of the persons
living with CF
Pan-Canadian Safety in Home Care Study
Shifts in Control and Power
What about patients having their copy of the medication
administration record?
What about keeping them in the loop as much as possible
with medication changes?
Do we believe that patients cannot really understand their
illnesses and treatments and therefore we limit what we
share?
If it takes a nurse to give me my medications today and I
am home tomorrow on my own, how did I get to be the
expert?
References
Deegan, P.E., & Drake, R.E. (2006). Shared decision making and medication management in the recovery process. Psychiatric
Services 57(11) 1636-1639.
Entwistle, V. (2007). Differing perspectives on patient involvement in patient safety. Quality and safety in healthcare 16 82-83.
Gottlieb, L. (2103). Strengths-based nursing care. New York: Springer Publishing
Lewis, S. (2009) Patient-Centered Care: An introduction to what it is and how to achieve it. Saskatchewan Ministry of Health.
Lyons, M. (2007) Should patients have a role in patient safety? A safety engineering view. Quality and safety in healthcare 16 140142.
McCormack, B., McCane, T. V. (2006). Development of a framework for person-centered nursing. Journal of Advanced Nursing,
56 (5), 472-479
McCormack, B. (2003). Researching nursing practice: Does person –centeredness matter? Nursing Philosophy, 4 (3), 179-188.
Pelzang, R. (2010). Time to learn: Understanding patient-centered care. British Journal of Nursing 19(14) 912-917.
Reynolds, A. (2009). Patient-centered care. Radiologic Technology, 81 (2), 133-147.
Rogers, A., Kennedy, A., Nelson, E., Robinson, A. (2005). Uncovering the limits of patient-centeredness: Implementing a selfmanagement trail for chronic illness. Qualitative Health Research, 125 (2), 224-239.
Sacristan, J. A. (2013). Patient-centered medicine and patient-oriented research: improving health outcomes for individual
patients. BMC Medical Informatics and Decision Making 13:6 doi:10.1186/1472-6947-13-6
Shaller, D. (2007). Patient-centered-care: What does it take? Picker Institute, Oxford and The Commonwealth Fund.
Stewart, M., Brown, J. B., Weston, W. W., McWhinney, I.R., McWilliam, C. L., Freeman, T. R. (2003). Patient-centered medicine:
Transforming the clinical method. (2nd ed). Abingdon, UK: Radcliffe Medical Press Ltd.

Similar documents