What is patient-centred care? / Que sont les soins axés sur le patient?

Abstract

Case Study: Mr. S is a 56-year-old long-time patient of yours. He has type 2 diabetes and hypertension. He comes for refills of his metformin and perindopril, which he ordered online after receiving an automated refill reminder on his smartphone. He takes a seat in your newly renovated lounge area (with plants and leather sofas) and helps himself to an ethically sourced espresso coffee. Mmmmmm! He catches your eye and says, “I heard you won an award from Canuck Pharmacist Magazine for patient-centred care. Congratulations!” “Thanks,” you say as you hand him his prescriptions. “It’s folks like you that make it all worthwhile. Do you have your JumboPoints card? It’s double points day today.” You turn to your student. “Now that is what patient-centred care is all about. It’s the blueprint for our future. . . .” You know it by heart: The vision of the Blueprint for Pharmacy: “Optimal drug therapy outcomes for Canadians through patient-centred care.”1 It’s our mantra. But is the pharmacist in this case practising patient-centred care? Certainly, the surrounds are plush and the exchange is pleasant, but is this patient-centred care? Resoundingly, no. So, if a leafy-leather-espresso-lounge (with loyalty points) is not patient-centred care, then exactly what is? If we look to the Blueprint, it defines patient-centred care as “the merging of several models of health care practice including patient education, self-care and evidence-based care into 4 broad areas of intervention: communication with patients, partnership with patients, health promotion and delivery of care.”1 Not very helpful. We need a more explicit definition of patient-centred care; otherwise, we run the risk of misinterpreting the Blueprint, as in the example above. Since patient care is many different things, we propose a set of principles of patient-centred care (modelled after Epstein and Street2): It is a professional obligation to take responsibility for, and provide care targeted to, the individual patient’s needs. It involves: Respect: A deep sense of respect for the individual patient Listening to and understanding what patients want, their values, their treatment goals, the context and environment in which they are living Informing: Providing patients with unbiased and context-specific information Empowering patients to actively participate in decision making regarding their health Assisting patients in setting achievable goals with enabling strategies to improve their health outcomes Providing continuity of care to regularly review patients’ progress in meeting their health goals So, patient-centred care is defined by the patient but fulfilled by the practitioner. As stated by Leslee Thompson, president and CEO of Kingston General Hospital, “At the heart of patient-centred care is a commitment to working with patients as partners, which is a shift from a ‘doing to and doing for’ approach to patient care to a ‘doing with’ approach.”3 For pharmacists, that should mean practising to their full scope to meet the patient’s needs. It means taking responsibility. It means listening to, understanding and advocating for all of your patients. It is also important to define what is not patient-centred care: Needs/desires/aversions of the practitioner Getting credit Getting paid Status Turf Market share Superficial consumer marketing As such, pharmacists must put aside their insecurities about patient and physician acceptance of their care and patient advocacy and take responsibility for their duty of care. Now back to our case study: Upon seeing Mr. S, you check his blood pressure (which is 152/96 mmHg) and inquire about his last hemoglobin A1c (which was 9.5%). You discuss your concerns about his cardiovascular risk with him, as well as his desired outcomes and challenges. He states that his physician is “happy with his blood pressure,” but he is fearful of having a stroke. You offer to discuss these matters with his family physician and ask him to come back in 2 weeks to check his blood pressure again. Pharmacy needs to deliver patient-centred care as much as patients need it. Remember, most of us chose pharmacy as a profession because we wanted to care for patients. What we have going for us is that we are highly accessible, approachable, and respected; are good communicators; and have a strong desire to please. Patient-centred care truly is our future and we must get it right. In this article, we have offered some principles of patient-centred care. Many of you already practise with this philosophy in mind. We invite you write to us with your comments and examples so we can add to this list. Let’s support each other in this journey. ■