Abstract
BackgroundThe present study describes how primary care can be improved for patients with multimorbidity, based on the evaluation of a patient-centered care (PCC) improvement program designed to foster the eight PCC dimensions (patient preferences, information and education, access to care, physical comfort, coordination of care, continuity and transition, emotional support, and family and friends). This study characterizes the interventions implemented in practice as part of the PCC improvement program and describes the experiences of healthcare professionals and patients with the resulting PCC delivery.MethodsThis study employed a mixed-methods design. Semi-structured interviews were conducted with nine general practitioners and nurse practitioners from seven primary care practices in Noord-Brabant, the Netherlands, that participated in the program (which included interventions and workshops). The qualitative interview data were examined using thematic analysis. A longitudinal survey was conducted with 138 patients with multimorbidity from these practices to assess perceived improvements in PCC and its underlying dimensions. Paired sample t tests were performed to compare survey responses obtained at a 1-year interval corresponding to program implementation.ResultsThe PCC improvement program is described, and themes necessary for PCC improvement according to healthcare professionals were generated [e.g. Aligning information to patients’ needs and backgrounds, adapting a coaching role]. PCC experiences of patients with multimorbidity improved significantly during the year in which the PCC interventions were implemented (t = 2.66, p = 0.005).ConclusionThis study revealed how primary PCC can be improved for patients with multimorbidity. It emphasizes the importance of investing in PCC improvement programs to tailor care delivery to heterogenous patients with multimorbidity with diverse care needs. This study generates new perspectives on care delivery and highlights opportunities for its improvement according to the eight dimensions of PCC for patients with multimorbidity in a primary care setting.
Highlights
The present study describes how primary care can be improved for patients with multimorbidity, based on the evaluation of a patient-centered care (PCC) improvement program designed to foster the eight PCC dimensions
Study objectives In the present study, we aimed to describe how primary care could be improved for patients with multimorbidity by evaluating a program designed to improve PCC delivery to these patients in general practitioners’ (GPs’) practices in the Netherlands
Study participants In total, 22 healthcare professionals from the seven General practitioner (GP) practices participated in the PCC delivery improvement program
Summary
The present study describes how primary care can be improved for patients with multimorbidity, based on the evaluation of a patient-centered care (PCC) improvement program designed to foster the eight PCC dimensions (patient preferences, information and education, access to care, physical comfort, coordination of care, continuity and transition, emotional support, and family and friends). Primary care organizations throughout the world strive to make their care more patient centered, defined as “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions” [1] To achieve this goal, an organization must fulfill the eight dimensions of patient-centered care (PCC; referred to as person-centered care) defined by the Picker Institute [2]: 1) patient preferences, 2) information and education, 3) access to care, 4) physical comfort, 5) coordination of care, 6) continuity and transition, 7) emotional support, and 8) family and friends (Table 1, Method section) [2,3,4]. As care delivery must be tailored to their needs to improve outcomes, primary PCC is important for this patient population
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