Wednesday, July 27, 2011

Reflections on Patient Centred Care

In the last few months it seems that many health services in Australian have caught up with the concept of patient centred care and we hear the term bandied about all over the place.  Over the last three weeks I have seen six different onion charts that represent patient centred care.  (I will endeavour to post links to these over time.)  

Consumer organisations have been talking about these principles for decades. The medical profession have been considering the benefits of this approach for over a decade. I certainly remember a clinician commenting to me in 2001 that they thought patient centre care would evolve to become part of the way clinicians think, just as evidence-based medicine has become the accepted norm.  

Health services in are adopting the concept as a key driver for service delivery in terms of improving outcomes for consumers as well as improving efficiency and effectiveness of health services.  The attention of the needs and preferences of consumers is certainly welcomed and consumer organisations are well placed to work with consumers, health services and our communities to achieve the objective of patient centred care.  Here in Australia we are a little behind the UK and the US in terms of establishing indicators for what constitutes patient and family centred care. Very few services report against patient experience indicators ... but that will change.

The Australian Commission on Safety and Quality in Health Care (ACSQHC) has released their paper on Patient Centred Care  and consumer centred care features in the Health Care Services Standards that are currently before AHMAC for consideration.  

What is patient centered care?
  • Providing care that is easy for patients to get when they need it. Making sure that healthcare staff respect and respond to patient choices, needs and values. Forming partnerships between patients, their family, carers and healthcare providers.  ACSQHC
  • providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions The Kings Fund
  • one aspect of health care quality, as important as care being safe, clinically effective, timely and equitable  The Kings Fund
  • the essence of patient-centred healthcare is that the healthcare system is designed and delivered to address the healthcare needs and preferences of patients so that healthcare is appropriate and cost-effective  International Alliance of Patients' Organizations (IAPO)
  • the essential theme is the importance of delivering healthcare in a manner that works best for patients.  In a patient-centered approach to health care, providers partner with patients and their family members to identify and satisfy the full range of patient needs and preferences. Planetree
  • The Seven Attributes of Patient-Centered Care Superb access to care, patient engagement in care,  clinical information systems that support high-quality care, practice-based learning, and quality improvement, care coordination, integrated and comprehensive team care, routine patient feedback to doctors, publicly available information  The Commonwealth Fund
  • Five Principles of patient centred care: Respect, choice and empowerment, patient involvement in health policy, access and support, information. (IAPO)
Based on these sites we constructed a word cloud using wordle.

definitions of patient centred care based on web pages from IAPO, Kings Fund, Planetree, Commonwealth Fund NSW Clinical Excellence Commission and ACSQHC

In the US the Affordable Care Act has Patient-Centered Outcomes Research Institute (PCORI) which was created by US Congress through the 2010 Patient Protection and Affordable Care Act as an independent, non-profit research organization to help patients and those who care for them make informed health decisions.  PCORI will commission research that is responsive to the values and interests of patients and will provide patients and their caregivers with reliable, evidence-based information for the health care choices they face.

One of the first things PCORI is doing is developing a definition of patient centred care so that there is shared understanding.  They are currently Seeking Public for Input on Definition of Patient-Centered Outcomes Research.  This consultation period ends on 2 September. Individuals and organisations are invited to provide feedback on five questions through PCORI's website,  they will refine their working definition based on the input they receive.

The working definition says "Patient-Centered Outcomes Research helps people make informed health care decisions and allows their voice to be heard in assessing the value of health care options." It answers four patient-focused questions:
  • "Given my personal characteristics, conditions and preferences, what should I expect will happen to me?"
  • "What are my options and what are the benefits and harms of those options?"
  • "What can I do to improve the outcomes that are most important to me?"
  • "How can the health care system improve my chances of achieving the outcomes I prefer?"
The need for a shared understanding is very strong and we can safely anticipate more converations between clinicians, policy makers and consumers around what we mean when we say patient centred care. 

Darlene Cox
Executive Director

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