Putting patients at the centre of health care

Article published on International Journal of Care, May 30, 2021

On 20 January 2021, when President Joseph Biden was sworn in as the 46th President of the United States of America, the National Patient Advocate Foundation (NPAF) urged him to adopt person-centred health care policies as he pursues health care reforms. Moreover, the NPAF urged the Biden administration to guard against financial toxicity; eliminate barriers to safety net programs; broaden access to insurance; prioritize affordability; and remember that patients and caregivers are experts.¹ More recently, President Biden has signed orders to strengthening American’s access to quality, affordable health care, has released funding to support the health of older Americans, and is responding to COVID-19 by means of a national vaccination program.² 

There is a growing worldwide agreement on the necessity of a patient centred care approach to deliver value-based care. Since the early 2000s, leading international and national governmental organizations, including the World Health Organization (WHO), have been fostering patient centred care. The National Academy of Medicine, formerly the Institute of Medicine, recognizes patient centred care as one of the six domains of quality care and defines it as: “care that is respectful of and responsive to individual patient preferences, needs, and values; and ensures that patient values guide all clinical decisions”.³ 

Already in 1987, Picker developed their internationally renowned eight principles of person centred care: fast access to reliable healthcare advice; effective treatment delivered by trusted professionals; continuity of care and smooth transitions; involvement and support for family and carers; clear information, communication and support for self-care; involvement in decisions and respect for preferences; emotional support, empathy and respect; and attention to physical and environmental needs.⁴ 

Patient centredness engages individual patients and their carers in healthcare provision and guides decision making by including their needs and values, experiences of illness and care, and other psychosocial contexts.⁵ 

In this issue of the International Journal of Care Coordination one can learn from international examples of efforts to put patients at the centre of health care. In their systematic review, Davidson et al. aimed to develop an understanding of integrated care model in the United Kingdom and determine whether evaluations of patient experience reflect a person-centred coordinated care approach. In the included 16 studies, both positive and negative experiences of integrated care were identified, whereas associations between integration processes and person-centred coordinated care seem very limited. As a result, Davidson et al. highlight the importance of measuring patient experience of integrated care.⁶ 

Acknowledging the challenges of evaluating care coordination, Chakurian et al. applied the Care Coordination Atlas as a theoretical framework to evaluate the components of selected transitional care models (i.e. RED and BOOST model), to review the current evidence about the facilitators and barriers to model implementation, and associated 30-day all-cause hospital readmission rates. It was concluded that the Care Coordination Atlas provided a way to compare and contract critical components of the selected models to identify opportunities for shared measurement and comparison of findings across settings, providers, and levels of care.⁷ 

A patient centered care approach is of utmost importance in international care. Bouwmans et al. collected data from 846 healthcare workers regarding their experiences with international handovers in a European border region. Among the biggest risks identified are procedural differences, sharing patient information, unfamiliarity with foreign healthcare systems, and not knowing the roles and responsibilities of peers working across the border. The results of this study are a valuable starting point to further optimize international patient handovers and providing high quality patient centered care across borders.⁸ 

In the final paper of this issue of the International Journal of Care Coordination, Reerink et al. argue that people who have complex health problems affecting multiple areas of their lives need a different approach than people who have singular health problems. Moreover, in painting a separate roadmap for dealing with complex health problems they advise people to enter into a enriched, iterative decision-making process that focuses on various problems, addresses multiple areas and considers the patients’ context. For this, a multi-disciplinary network of care and support surrounding the patients rather than focusing on the end result (i.e. outcomes) is recommended.9

At the International Journal of Care Coordination we welcome more insightful, refreshing and robust research into (the measurement) of person centered coordinated care strategies to support world wide policies to redesign health care.
Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.

Find the article under this link:
https://journals.sagepub.com/doi/full/10.1177/20534345211019964