PATIENT-CENTERED CARE By HISTORY q 1950

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PATIENT-CENTERED CARE By

HISTORY q 1950 – Michael Balint explored ‘illness-centered’ medicine, conventional method inadequate to reach deep understanding of patient illness. q 1964 – Balint dev. Concepts of ‘attentive’ listening and responding to patient offers. q 1970 – Ian R. Mc Whiney – patient-centered care medical model q 1986 – Levenstein et al evaluated and formulated patient centered as clinical method

PATIENT-CENTERED CARE: Defined as ‘a philosophy of care that encourages: (a) shared control of the consultation, decisions about intervention or management of the health problems with the patient, and/or (b) a focus in the consultation on the patient as a whole who has individual preferences situated within social context’ (in contrast to a focus in the consultation on a body part or disease)

c)“treating patients as partners, involving them in planning their health care and encouraging them to take responsibility for their own health” d)help your patients become medical decision makers who take an active role in their own care’ Cochrane review, issue 2, 2003 & Lowes R. 1998. Patient-centered care for better patient adherence. Fam. Prac. Management

THE SCIENCE OF PATIENT CENTERED CARE “The process of healing depends on knowing the patient as a person, in addition to accurately diagnosing their disease. ” Ronald M, J. Fam. Pract 2000, no 49

1) Bio-psycho-social perspective 2) Patient as a person 3) Sharing power and responsibility 4) Therapeutic alliance 5) Doctor as person Peter C et al: Analysis of large cohort BMJ 2002; 325: 691 -692

Primary Care Physician Is The Captain Of Ship

PATIENT CENTERED MODEL • Provides description of specific behaviors needed to be learned and when/how to use them with patients. • Simplifies complexity of doctor’s job without distorting it. • Provides a framework for research. • ‘method’ operationalize this model

PATIENT-CENTERED METHOD : Six interactive components: 1) 2) 3) 4) 5) 6) Exploring both the disease and the illness experience. Understanding the whole person. Finding common ground regarding management. Incorporating prevention and health promotion. Enhancing the patient-doctor relationship. Being realistic.

Patient centered care is …. 1. Not a strictly defined process, sequential stages, standardized procedures or interviewing styles 2. Though presented separately, reality – interwoven. 3. Varies from patient to patient. 4. Learning is different from acquiring the process. 5. When performing focally aware of the whole process, not the components

WHY PRACTICE PATIENTCENTERED CARE?

ØImproved satisfaction for patient and service provider. Patient-centered approach have positive relationship with patient recovery, emotional health, physical function and physiologic outcome and treatment satisfaction. ØImproved adherence. Research shows patients more likely to take their pills, lay off sour cream, show up for appointment thus a better patient adherence. ØEvidence that patient-centered communication skills promote adherence.

ØFunctional outcome improvement. Research shows fewer limitations imposed by the disease on patient functional ability. ØDecreased litigation Studies demonstrated that physicians behave like devaluing patients views, delivering information poorly, failing to be attentive to patients perspective often face malpractice claims.

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