Patient-centered care – Part 2

As mentioned in Part 1, Patient-centered care (PCC) involves four areas of intervention: communication, partnering, health promotion and physical care. Communication and partnering were discussed in Part 1.

Health Promotion

A study on patient preferences in primary care consultations showed that patients overwhelmingly agreed on the need for communication, partnership and health promotion.1 The level of agreement was extremely high, noticeably

  • 88% to 99% for good communication
  • 77% to 87% for partnership
  • 85% to 89% for health promotion

Patients want to stay well and methods to promote health and to avoid exacerbations are primary motives for learning about a disease such as asthma. This requires the health care professional (HCP) to

  • determine the patient’s preferences with respect to the amount and format of information required (ensure that the patient is not over-loaded with information that is not pertinent to their current needs)
  • seek out and respond to the patient’s beliefs, concerns and expectations with regard to the disease (ascertaining fears about side effects and under-estimation of benefits of regular treatment)
  • help patients understand the treatment and how to do what is required (such as how to use devices correctly and implement asthma action plans); and how to incorporate the teaching into their lifestyle (practical application of knowledge involving skill building).

The asthma educator has a major role to play in health promotion when it comes to educating the patient with respect to

  • environmental control
  • avoidance of triggers
  • explaining adjustments in therapy
  • encouraging self-efficacy in the use of personal asthma action plans
  • providing regular structured review
  • mentoring patients to achieve guided self-management of their asthma.

 

Physical Care

Organizations that promote cultural competence have been associated with better care, particularly for children with asthma.2 Cabana3 suggested that since guidelines are colour-blind, “improved adherence to evidence-based guidelines, such as the NHLBI Guidelines for the Management of Asthma may be a potentially powerful tool for reducing or eliminating such racial/ethnic disparities in asthma treatment”. Appropriate treatment and education are essential ingredients in the formula for self-management. However, education, to be successful must be individualized and based on both cultural and literacy sensitivity combined with a high level of communication skills.

Weiner-Ogilvie et al4 found that guideline implementation was affected by organization of care, communication and decision making within practices. They found that practices that were ‘highly compliant’ with the guidelines were ‘more sympathetic to the patient’s perspective’. These practices were marked by

  • a consistent approach to diagnosing and treating asthma according to the guidelines
  • clearly defined roles and responsibilities of the professionals within the practice
  • good communication
  • trust and confidence between physicians and other health care professionals
  • “flatter hierarchical arrangements”

 

Competencies required for PCC

The six competencies required for PCC include5

  • communication
  • certainty and strength in one’s own professional role
  • knowledge of the professional role of others in the team
  • leadership
  • teamwork
  • conflict resolution through negotiation

Barriers to these competencies are created when communication is inadequate between colleagues and inter-professional roles are poorly defined so that team work is impeded with either too much overlap of roles or a ‘someone else will do it’. Consistency in education is hindered when it is left to ‘someone else’ and also when the team uses terminology that is confusing to the patient.
    
Strong leadership, clearly defined roles and continuing education help build trust and confidence in members of the team. And the patient (and family) too should be considered a member of the team.

References

  1. Little P, Everitt H, Williamson I et al. Preferences of patients for patient centered approach to consultation in primary care: observational study. BMJ 2001; 322:468-72
  2. Lieu TA, Finkelstein JA, Lozano P et al. Cultural competence policies and other predictors of asthma care quality for Medicaid insured children. Pediatrics 2004; 114(1): e102-e110
  3. Cabana MD, Lara M, Shannon J. Racial and ethnic disparities in the quality of asthma care. Chest 2007; 132(5): 810S - 817S
  4. Weiner-Ogilvie S, Huby G, Pinnock H et al. Practice organizational characteristics can impact on compliance with the BTS/SIGN asthma guideline: qualitative comparative case study in primary care. BMC Family Practice 2008; 9:32 doi:10.1186/1471-2296-9-32
  5. Macdonald MB, Bally JM, Ferguson LM et al. Knowledge of the professional role of others: a key interprofessional competency. Nurse Educ Pract. 2010;10(4):238-42.