Patient-centredness and improving healthcare outcomes
In the UK recently there have been a series of high profile stories of abuse, neglect and lack of care in the very places we expect to be cared for – in our hospitals, doctors surgeries, nursing homes, etc.
New training courses and conferences have sprung out of nowhere… processes and procedures to encourage compassionate care are much debated … back in April the General Medical Council departed its usual remit and published a new guide “What to expect from your doctor: a guide for patients”. The focus has been increasingly on patient centred care and improved healthcare outcomes.
In the drive for better outcomes much work continues on improving technical processes based on the most up to date evidence, the ‘science’ of medicine, and rightly so but the essential nature of the human interaction between the patient and the caregiver, the ‘art’ of medicine, can be so easily overlooked or pushed out by the lab results, targets and time pressures of modern day healthcare culture.
Previous editions of the PRIME International Email have highlighted the need for and evidence of continuing professional education, role modelling and the interpersonal aspects of care that are crucial to improve healthcare outcomes. We expect the supporting evidence base to increase still further over coming years and one of our missions is to highlight that research to the members of the PRIME Network.
A recent study published in the Annals of Internal Medicine highlights again the impact of such care on clinical outcomes. Weiner et al in their study found that among 548 contextual red flags, such as deteriorating self-management of a chronic condition, 208 contextual factors were confirmed, either when physicians probed or patients volunteered information. Physician attention to contextual factors (both probing for them and addressing them in care plans) varied according to the presenting contextual red flags. Of the 157 contextual factors with known outcome data, 96 were found to have been addressed by patient centred decision making with improvement in healthcare outcomes identified in 68 (71%) of cases, compared with 28 (46%) of the 61 that were not addressed by patient centred decision making.
Other contemporary research shows clear links between patient centred care and patient satisfaction, perceptions of care, shared decision making, health behaviours and adherence to treatment.
The editorialin the same edition of the Annals of Internal Medicine Aboumatar and Cooper highlighted the need for both patient centredness and cultural competence. “Patient-centred care is care that is respectful and responsive to individual patient preferences, needs and values and ensures that patient values guide all clinical decisions. Cultural competence in healthcare is the ability of healthcare professionals to provide care to patients with diverse values, beliefs and behaviours and includes tailoring delivery to meets patients social, cultural and linguistic needs.” They go on to explain that “at the core of patient-centredness and cultural competence is the ability of healthcare professionals to see patients as individuals, build effective rapport, use the biopsychosocial model, explore patient beliefs, values and attitudes toward illness and find common ground regarding treatment plans.”
A recent article in The Lancet stated that “The proliferation of reports on the failings of the doctor—patient interaction, and the numerous proposed solutions—more time, better health systems, more training, more compassion, more staff—point to the complex nature of this relationship. However, the continued dissatisfaction with the current state of affairs does at least remind us that although the background scenery has changed, the enigmatic ideal portrayed in Fildes' picture is as real today as it was in 1891.”
Huw Morgan
References
Ann Intern Med. 2013;158(8):573-579
Ann Intern Med. 2013;158(8):628-629.
The Lancet, Volume 381, Issue 9876, Page 1432, 27 April 2013
