Group medical visits can deliver on patient-centred care objectives: results from a qualitative study

Josée G Lavoie,Martha Lp Macleod,Annette J Browne,Sabrina T Wong,Meck Chongo,Cathy Ulrich

doi:10.1186/1472-6963-13-155

Josée G Lavoie, Martha Lp Macleod + Show 4 more

Open Access

https://doi.org/10.1186/1472-6963-13-155

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Abstract

BackgroundPatient-centred care emerged in the late 1960s as a framework to guide providers and decision-makers towards the provision of more effective health care and better outcomes. An important body of literature has since emerged, reporting mixed results in terms of outcomes. To date, assessments of the effectiveness of patient-centred approaches have focused one-on-one consultations. The purpose of this article is to explore dimensions identified as key in the patient-centred literature in the context of primary health care services delivered in a group setting. Group Medical Visits (GMVs) offer a novel format for the delivery of patient-centred primary health care services, especially for patients living with complex morbidities.MethodsDrawing on a large study of GMVs, we report on key format and process-oriented elements identified in GMVs, and on their link to improved outcomes. For the purpose of this study, we interviewed 34 providers and 29 patients who have been engaged in GMVs, delivered in rural, northern and First Nation communities in British Columbia, Canada.ResultsOur analysis shows that the delivery of PHC in a group format results in a shift in the role of the provider, from that of an adjudicator involved in imparting norms of self-care, to that of a facilitator who assists the group in defining norms of self-care that are based on medical knowledge but also on the broader context of patients’ lived experience and on their pragmatic experience. In a group process, peer-patients take on the role of promoting these norms to other patients. This results in a significant shift in the role of the provider, increased trust, increased knowledge for the providers and the patients and better patient self-management. Our results also show increase satisfaction for patients and providers.ConclusionsGMVs offer an alternative format for the provision of PHC that brings together the benefit of a group process and of a clinical encounter. This format can successfully deliver on the promises of patient-centred care.

Highlights

Patient-centred care emerged in the late 1960s as a framework to guide providers and decisionmakers towards the provision of more effective health care and better outcomes
We have identified that Group Medical Visits (GMVs) can provide comprehensive primary healthcare (PHC) services in a manner that addresses some of the shortcomings of the one-on-one CE
The analysis presented in this article draws on a larger mixed-methods study of GMVs conducted in several rural communities in the Canadian province of British Columbia (BC)

Summary

Introduction

Patient-centred care emerged in the late 1960s as a framework to guide providers and decisionmakers towards the provision of more effective health care and better outcomes. Boyer and Lutfey have eloquently argued that while this conceptualization might have aligned with reality in the past, the patient-provider relationship has changed considerably over the past 50 years, as a result of recognizing the significance of social contexts in shaping patients’ individual experiences; the expansion in the construct of the “patient” from one experiencing an acute episode to include those managing chronic conditions and those at risk of developing a condition as a result of surveillance technologies; and patients’ ability to independently access information to actively engage in and/or challenge decision-making related to their treatment [6]. Providers and patients are expected to interact in ways that are non-biased, demonstrating understanding and acceptance of the other’s potentially diverse background [9]

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