Improving patient-centredness of care practices for people with multimorbidity

Abstract

Issue For people with multimorbidity, a patient-centred approach of their care is very important. Because of the many health problems, the treatment goals to strive for are not always obvious, but should be extensively discussed with the patient. The patient’s personal goals should be taken as a starting point when prioritizing treatment goals, and his preferences and resources should be taken into account when deciding about the type(s) of treatment or care. Description of the problem Providing patient-centred care may not be easily realized in daily practice, as it requires specific skills of healthcare providers, and characteristics of the delivery system may be hindering. In the ICARE4EU project we explored whether and how patient-centredness was improved in European integrated care practices for people with multimorbidity. Results Almost all contact persons of the 101 integrated care practices reported that the practice improved patient-centredness (92%), but there was a wide variety in practices and tools used for this purpose. For instance, motivational interviewing by care providers was applied in 52 practices and case managers were appointed in 41 practices. In 70 practices individual care plans were introduced, but implementation of such plans was often lower than intended. Reported barriers to provide more patient-centred care were e.g. inadequate knowledge of patients (61%), lack of time (56%), inadequate knowledge or skills of care providers (45%) and lack of a clear vision of managers (40%). To illustrate successful approaches as well as their barriers, we will present two practices in more detail: the Finnish POTKU project (Putting the Patient at the Driver’s Seat) and another highly patient-centred European practice. Lessons A positive attitude of healthcare providers is key, but not sufficient to provide care that is really patient-centred. Structural changes are needed in all domains, e.g. training, care delivery, information systems and financing.