Putting patients’ goals first: strategies and challenges through the eyes of primary care stakeholders

Abstract

Introduction: Primary care is in constant transformation to optimize integrated care delivery according the increase of people with multiple and long-term care needs. One of the suggested strategies is person centered integrated care (PC-IC). PC-IC has an explicit focus on patients’ personal goals. This should reorient care delivery from the focus on disease oriented quality indicators to outcomes that matter to people. To get this focus on patients goals implemented throughout the system, actions in practice, research, education and policy are required.
 Aim: This study aims to explore the experiences of primary care providers, scholars and policy makers towards putting patients’ goals first in primary care, the strategies they use, and challenges they encounter.
 Methods: Primary care stakeholders (n=41) - recruited via maximal variation purposive sampling- participated in six focus groups. Data were collected through a semi-structured interview guide, audio recorded, and analyzed following a phenomenological-hermeneutical philosophy of Lindseth and Norberg.
 Results: All participants emphasized their fundamental commitment in putting patients' goals first. Participants who were active in patient care discussed how they enabled patients to talk about their values and personal stories in order to elicit their personal goals. They also attempted to establish a balanced relationship by integrating their medical expertise with the goals of their patients. Participants stated that they listened to the goals of patients' significant others in order to gain common understanding on goals and recognize everyone's contribution to the care process. Finally, they used patients’ personal goals as a focus for guiding interprofessional collaboration. Both the clinicians and scholars stressed that (future) care providers need more training to develop the competencies necessary to discuss patients' personal goals and integrate them into care delivery. According to policy, all types of participants agreed that there’s challenges related to organizational constraints, such as time restrictions and a lack of registration systems.
 Discussion: The results of this study provide an integrated perspective on the strengths, weaknesses, opportunities and threats for adopting an explicit focus on patient goals throughout the system. In order to support primary care stakeholders to fully engage in the adoption of patients' personal goals in care delivery, the development of models of practice, training and policy plans from a person-centered integrated system approach are required.