Patient-centered Care Approach Research Articles

Person-Centered Care Design with Reference to Healthcare Outcomes in Saudi Arabia: An Overview

The Person-Centered Care approach improves the facility design and revolves around user preferences with the added value of superior services, respect with dignity and teamwork, infrastructure, and innovation. This study based on healthcare professionals practicing person-centered care dimensions investigates conceptualization and the process of creating high quality to examine improve healthcare systems efficiency and effectiveness. To enhance the healthcare environment, ensuring a comprehensive assessment of patient journey throughout the care process and ensure safety, timeliness, effectiveness, efficiency, and patient-centered care approach have been considered. The consideration for home-like acknowledged built environment, aesthetically delighted, space for family and friends, noise-free, rooms exposed to nature, provision to access healing gardens and promote healthcare outcomes as well as better culture and better care consequence increase patient experience and thus have positive impact on patient satisfaction. In this paper the Person-Centered Care Design facility with reference to the healthcare outcomes in Saudi Arabia has been studied.

Patient-Centred Care for Patients With Diabetes and HIV at a Public Tertiary Hospital in South Africa: An Ethnographic Study.

Background: Healthcare systems across the globe are adopting patient-centred care (PCC) approach to empower patients in taking charge of their illnesses and improve the quality of care. Although models of patient‐centredness vary, respecting the needs and preferences of individuals receiving care is important. South Africa has implemented an integrated chronic disease management (ICDM) which has PCC component. The ICDM aims to empower chronic care patients to play an active role in disease management process, whilst simultaneously intervening at a community/ population and health service level. However, chronic care is still fragmented due to systemic challenges that have hindered the practice of PCC. In this article, we explore provider perspectives on PCC for patients with comorbid type 2 diabetes and HIV at a public tertiary hospital in urban South Africa. Methods: This study utilizes ethnographic methods, encompassing clinical observations, and qualitative interviews with healthcare providers (n=30). Interview recordings were transcribed verbatim and data were analyzed inductively using a grounded theory approach. Results: Providers reported various ways in which they conceptualized and practiced PCC. However, structural challenges such as staff shortages, lack of guidelines for comorbid care, and fragmented care, and patient barriers such as poverty, language, and missed appointments, impeded the possibility of practicing PCC. Conclusion: Health systems could be strengthened by: (i) ensuring appropriate multidisciplinary guidelines for managing comorbidities exist, are known, and available, (ii) strengthening primary healthcare (PHC) clinics by ensuring access to necessary resources that will facilitate successful integration and management of comorbid diabetes and HIV, (iii) training medical practitioners on PCC and structural competence, so as to better understand patients in their sociocultural contexts, and (iv) understanding patient challenges to effective care to improve attendance and adherence.

Development of a process to improve medication adherence in patients with rheumatoid arthritis in the specialty pharmacy setting

ObjectiveTo develop a disease-specific patient questionnaire to be used during monthly follow-up telephone calls (“refill calls”) for patients with rheumatoid arthritis receiving a noninfused biologic medication. SettingIndependent specialty community pharmacy in North Carolina. Practice descriptionRealo Specialty Care was formed to provide a patient-centered care approach to patients with complex, chronic conditions such as HIV/AIDS, hepatitis, rheumatoid arthritis, and plaque psoriasis. The services include medication therapy management, patient education, prior authorization assistance, adverse drug reaction monitoring, and an adherence program. Practice innovationUsing national guidelines, an 8-item questionnaire that addressed overall health, adherence, and adverse medication events for noninfused biologic medications for rheumatoid arthritis was developed. When an eligible patient was identified, a notification was added within the pharmacy’s dispensing software. The pharmacist or technician was prompted to use the newly developed questionnaire during the monthly refill call. EvaluationPatients’ responses were archived in their profiles within the pharmacy’s dispensing software. The change in adherence was assessed by the mean medication possession ratio (MPR) before the intervention (July 2018 to September 2018) and monthly after the intervention (November 2018 to February 2019). ResultsA total of 29 patients were eligible on the basis of an MPR less than 90%; data from 18 patients were used. The mean MPR increased from 71% preintervention (September 2018) to 75% in the first month after the start of the intervention (November 2018). The mean MPR reached a high of 81% in the fourth month after the start of the intervention (February 2019), representing a 10% increase in the MPR. ConclusionThe specialty pharmacy team successfully developed and used the rheumatoid arthritis questionnaire during the monthly refill calls. The implementation of the disease-specific questionnaire led to increased medication adherence and enhanced communication with patients with regard to their health and outcome of therapy.

Trends in Patient-Centered Care in South West Nigeria: A Holistic Assessment of the Nurses Perception of Primary Healthcare Practice

BACKGROUND: A key dimension of a quality healthcare to patients is patient-centered care approach which is increasingly gaining recognition worldwide. However, this concept is not fully implemented in practice.
 
 AIM: The aim of this study is to provide outcomes from assessment of nurses’ perceptions about patient-centered care and the current trends in Primary Health Care system in South West Nigeria.
 
 METHODS: This study employed a qualitative participatory action research study approach and conducted a semi-structured individual interview with thirty-five nurses and four focus group discussions in Osun State South West Nigeria Primary Health Care centres.
 
 RESULTS: Primary Health Care (PHC) nurses perceived and described patient-centered care (PCC) as a global approach to improve and enhance nursing care to foster patient participation. The narratives were categorised into two: positive and negative perception. Ten main themes emerged: (I) Attitude of the nurses (ii) Lack of enforcement and implementation, (iii) Experience of the nurses, (iv) Quality-Caring, (v) Effective communication with patient, (vi) Motivated and Proactive healthcare, (vii) Sharpen the form of care, (viii) Outcome and after-effect driven healthcare, (ix) Approved support, and (x) Guarantor of service and motivation.
 
 CONCLUSION: Our participatory action research study on the assessment of nurses’ perception on the utilization of PCC at the PHC for effective and quality healthcare service revealed the importance of nurses’ role, acceptability of PCC and current nursing care practice at the Primary Health Care (PHC) rural community setting. Nurses as healthcare providers expressed PCC as a common and global approach that would enhance patient experiences and improves the quality of nursing healthcare delivery through integration of PCC and healthcare service at the PHC healthcare system.

Patient Assessment and Chronic Pain Self-Management in Ethnomedicine: Seasonal and Ecosystemic Embodiment in Ayurvedic Patient-Centered Care.

Background: Ayurveda’s preventive focus complements its strength with the interventionist approach of the biomedical in chronic pain self-management. Patient-centered care (PCC) using ethnomedicine promises greater patient self-management; however, few studies have examined environmental relationships and PCC in self-management of chronic pain through Ayurveda. Objective: To examine how Ayurveda’s philosophical focus on whole system frameworks describes the integration of the individual and the ecological in tailoring an integrative patient-centered diagnostic and prognostic approach to chronic pain management. Methods: This qualitative case study conducted in-depth semi-structured interviews of Ayurvedic physicians from India (N = 10) and a qualitative inductive content analytic approach. Findings: The diagnostic and interpretational framework of the doshas supports the integration of the individual and the ecological through (a) the circadian and seasonal cycles relating mind-body awareness with diet, lifestyle (e.g., yoga), and breath (e.g., pranayama), and (b) biogeographical and ecosystemic regions relating the biogeographical and the ecological (e.g., desh) with the regulatory principle of pain and its physiological and anatomical perception (vata) in an approach that goes beyond treating pain etiology to a whole person PCC approach. Conclusions: The study highlights how circadian and seasonal cycles and evolutionary spatial-temporal factors of biogeographical and ecological regions are employed in patient assessment and self-management to support patient involvement. Recommendations for PCC in integrative chronic pain management include supporting patient ownership of their care through the dosha framework that relates the individual and the ecological in the patient’s own life-context and supports co-creation of a collaborative plan of care using an ethnomedical framework.

Quality in Healthcare: The New Frontier of “Patient-Centered Care Approach” in Day Clinics

Quality in Healthcare: The New Frontier of “Patient-Centered Care Approach” in Day Clinics

12th Roche Diabetes Care Network Meeting: April 11-13, 2019, Copenhagen, Denmark.

A panel of international experts in the field of diabetes and diabetes technology met in Copenhagen, Denmark, for the 12th Roche Diabetes Care Network Meeting. The goal of these meetings is to share current knowledge, facilitate new collaborations, and encourage further research projects that can improve the lives of people with diabetes. Specific areas of interest included use of telemedicine and mobile health technologies, behavior change, patient-centered care, and multifactorial approaches to addressing all metabolic abnormalities associated with diabetes. The 2019 meeting covered a comprehensive scientific program and four keynote lectures.

Pharmacogenetic Testing: The Ethics of Implementing in Clinical Practice for Chronic Pain Patients

Chronic pain is a common and costly healthcare problem where standard of care often involves the use of opioids and patient response varies widely. Designing a treatment plan based upon an individual’s genetic signature provides an individualized patient-centered care approach that can improve functional status, quality of life, and reduce adverse drug events (ADEs). This paper will discuss the ethical implications of pharmacogenetic (PGx) testing using the principlism framework of the four moral principles: beneficence, non-maleficence, autonomy, and justice. Beneficence involves balancing the benefits and risks associated with PGx testing. Non-maleficence is the directive to do no harm to the patient in the delivery or use of PGx test results. Autonomy encompasses self-determination; the patient’s right to select PGx testing. Justice is concerned with distributing benefits and burdens of PGx testing access and costs. Maximizing patient autonomy and beneficence during treatment promotes patient-centered care. Principlism supports PGx testing for patients experiencing chronic pain. Integrating PGx testing impact treatment plans and may improve the outlook for patients with chronic pain.

Communication and Respect for Patient Value as Significant Factors in Patient-Centered Infertility Care: A Survey of Patients' Experiences in Two Infertility Centers.

Context:The patient-centered infertility care (PCIC) approach emphasizes the patient's role in choosing the most appropriate clinical approach in infertility care. The concept can improve the patient satisfaction with care performed as well as the efficacy of the treatment. In addition, this concept can also lead to improve collaboration between patient and care provider, ultimately supporting a more cost-effective health-care scheme.Aims:This study was developed in order to determine patients' experience in their PCIC.Settings and Design:This is a descriptive study. We conducted the study in two fertility care clinics, Clinic A and Clinic B.Subjects and Methods:The Patient-Centeredness Questionnaire-Infertility (PCQ-I) was used, consisting of 7 essential themes. The questionnaire was completed by consenting patients in two infertility clinics.Statistical Analysis Used:The questionnaire was analyzed using the Statistical Package for the Social Sciences 21 version statistical software.Results:Eighty-eight Clinic A patients who completed the questionnaire responded that the best element of their treatment received was communication (correlation with global score [CGS]: 0.747), whereas the least acceptable aspect was the low accessibility (CGS: 0.211). A total of 20 Clinic B patients responded that the best element of their treatment received was respect for the patient's value (CGS: 0.866), whereas the least acceptable aspect was also the low level of accessibility (CGS: 0.193).Conclusions:The PCQ-I can be used to evaluate patients' experience during treatment and may help the health-care provider to improve their performance.

What do we know about patient-provider interactions in sub-Saharan Africa? a scoping review.

Introductionpatient-centred care has become a rallying call for improving quality and access to care in countries where health system responsiveness and satisfaction with health services remain low. Understanding patient-provider interactions is important to guide implementation of an effective patient-centred care approach in sub-Saharan Africa. This review aims to overcome this knowledge gap by synthesizing the evidence on patient-provider interactions in sub-Saharan Africa.Methodswe conducted a scoping review using Arksey and O´Malley´s framework. We searched in eight databases and the grey literature. We conducted a thematic analysis using an inductive approach to assess the studies.Resultsof the 80 references identified through database searching, nine met the inclusion criteria. Poor communication and several types of mistreatment (service denial, oppressive language, harsh words and rough examination) characterize patient-provider interactions in sub-Saharan Africa. Nevertheless, some health providers offer support to patients who cannot afford their medical expenses, cost of transportation, food or other necessities. Maintaining confidentiality depends on the context of care. Some patients blamed health providers for consulting with the door open or carrying out concomitant activities in the consultation room. However, in the context of HIV care provision, nurses emphasized the importance of keeping their patients´ HIV status confidential.Conclusionthis review advocates for more implementation studies on patient-provider interactions in sub-Saharan Africa so as to inform policies and practices for patient-centred health systems. Decision-makers should prioritize training, mentorship and regular supportive supervision of health providers to provide patient-centred care. Patients should be empowered in care processes.

Assessing the Benefit of Palliative Care in Germany - Perspective of Patients, Relatives and Professionals

The evaluation of complex interventions such as palliative care is challenging. Methods guidance such as the guidance documents of the Integrated Health Technology Assessment for the Evaluation of Complex Technologies (INTEGRATE-HTA) project help address specific challenges. The INTEGRATE-guidance was developed cooperatively by various international stakeholders and it was applied in a case study on palliative care. The presented study was part of the INTEGRATE-HTA project. ObjectivesThe objective was to identify important assessment aspects of palliative care in Germany from the perspective of patients, relatives and professional providers. Applying the structured consensus method of the Improved Nominal Group Technique, we conducted interviews with two focus groups - one with relatives and one with professionals. Additionally, we conducted 4 interviews with patients. We used an open coding procedure to analyze the data and a dialogical approach to validate the results. 8 assessment aspects were found to be important. These are the definition and legitimacy of the term benefit, understanding of palliative care, patient-centered and holistic care approach, access to palliative care, continuity and flexibility of care, education of palliative care providers, and multidisciplinary approach. A central point was the need to address the intervention in its complexity and to include interactions between the different components. To be able to integrate various models and different perspectives of palliative care, it is important to have the involvement of different stakeholders. This also enhances the incorporation of important aspects during the development of assessment instruments.

PATIENT-CENTERED CARE WITH SHARED DECISION-MAKING: PHYSICIAN-PATIENT RELATIONSHIP: COMPARATIVE ANALYSIS

The physician-patient interaction and relationship is the core element of the health-care system, which is developing towards greater patient's involvement in required medical decisions, regarding patient's medical condition. Sharing physicians-patient decisions issue is deepening on the medical discourse. It includes a sociological essence, which is considered in the current article, which tends to compare physician-patient relationship in Israel and worldwide. The current article presents a literary Review of academic articles, mainly from the past decade, inquiring searching databases, such as NCBI, Elsevier, JAMA and Research Gate, using keywords of Patient-Centered Care, professionalism, and human and sociological approaches of patients' medical care. Among dozens of found articles, 40 were assessed and selected for the review. Although, a recognition of the importance of using SDM and CCM can be found within healthcare teams, hardly no use of the models is actually in practice in healthcare systems in Israel. The CCM and the SDM models should be implied in Israel for the best of patients, physician and the healthcare system.

Patient-centred care in haemophilia: Patient perspectives on visualization and participation in decision-making.

The British Columbia Adult Haemophilia Team recently adopted a patient-centred care approach. The team presented visual information on an individual's pharmacokinetic profile and bleed history and encouraged patients to participate in treatment decisions. This qualitative study explored how this approach changed patients' understanding of haemophilia and how it facilitated them to make treatment decisions. We interviewed 18 males with mild, moderate or severe haemophilia, using a convenience sample from the adult haemophilia clinic at St. Paul's hospital in Vancouver, Canada. Interviews were recorded and transcribed verbatim and analyzed using descriptive content analysis. Most participants reported that reviewing visual information with the Clinic Team helped them in their communication with their care providers during their annual review clinic appointment. Despite this improved communication, for some the most important feature of their treatment was that they had switched from on-demand treatment to prophylactic treatment in recent years and were able to prevent bleeds. Almost half of the participants reported that the visual information presented increased their understanding of haemophilia and the pharmacokinetics of coagulation factor. Three patients improved their treatment adherence or had changed their prophylaxis schedules based on this. Most participants felt that they were involved in decision-making about their treatment schedule, which they appreciated. On the other hand, two participants thought the Clinic Team should make these decisions. Participants perceived the patient-centred prophylaxis approach helpful because it enhanced communication with the Clinic Team, increased their understanding of haemophilia and pharmacokinetics of coagulation factor and facilitated treatment decisions.

U.S. Survey of Shared Decision Making Use for Treating Pregnant Women Presenting with Opioid Use Disorder

Background: The incidence of pregnant women with an opioid use disorder (PWOUD) at delivery has quadrupled since 1999. State-specific statutes regarding PWOUD often pose punitive measures to the mother–infant dyad, involving the child welfare and criminal justice systems. Shared decision making (SDM) assists individuals through complex health and recovery processes. Objectives: To determine use of SDM in treating PWOUD and associated factors and to quantify physicians’ review and discussion of child welfare statutes. Methods: The American College of Obstetricians and Gynecologists (ACOG) e-mailed the survey to a random sample of members, with 568 responding. Bivariate analyses to identify factors associated with each outcome were performed using Wilcoxon Rank Sum tests or Fisher’s Exact tests. Variables yielding p values < .20 were included in initial logistic regression models; the final model included only significant (<.05) variables. Results: Sixty-one percent used SDM most of the time. Logistic regression indicated that those using SDM were more likely to have had training in substance use disorder and felt prepared for caring for PWOUD; 39% reviewed statutes, and 54% discussed them with PWOUDs. Conclusion: Survey results provide evidence for patient-centered care approaches that support PWOUD involvement in treatment decision making. The SDM model provides an empowerment framework for women to be involved in the process during their pregnancies and opioid use disorder treatments. Future studies might assess the effectiveness of SDM dialogs with PWOUD and evaluate CME training and medical curricula regarding the SDM model.

Prostate cancer tool may help patients to decide on treatment

Prostate cancer tool may help patients to decide on treatment

Ask the Expert: What Is the Exercise “Prescription” That You Provide to Your Patients?

Ask the Expert: What Is the Exercise “Prescription” That You Provide to Your Patients?

A discrete choice experiment on preferences of patients with low back pain about non-surgical treatments: identification, refinement and selection of attributes and levels.

Objectives: Hospital-based health technology assessment (HB-HTA) needs to consider all relevant data to help decision making, including patients’ preferences. In this study, we comprehensively describe the process of identification, refinement and selection of attributes and levels for a discrete choice experiment (DCE).Methods: A mixed-methods design was used to identify attributes and levels explaining low back pain (LBP) patients’ choice for a non-surgical treatment. This design combined a systematic literature review with a patients’ focus group, one-on-one interactions with experts and patients, and discussions with stakeholder committee members. Following the patient’s focus group, preference exercises were conducted. A consensus about the attributes and levels was researched during discussions with committee members.Results: The literature review yielded 40 attributes to consider in patients’ treatment choice. During the focus group, one additional attribute emerged. The preference exercises allowed selecting eight attributes for the DCE. These eight attributes and their levels were discussed and validated by the committee members who helped reframe two levels in one of the attributes and delete one attribute. The final seven attributes were: treatment modality, pain reduction, onset of treatment efficacy, duration of efficacy, difficulty in daily living activities, sleep problem, and knowledge about their body and pain.Conclusion: This study is one of the few to comprehensively describe the selection process of attributes and levels for a DCE. This may help ensure transparency and judge the quality of the decision-making process. In the context of a HB-HTA unit, this strengthens the legitimacy to perform a DCE to better inform decision makers in a patient-centered care approach.

Speech difficulties and patient health communication mediating effects on worry and health-related quality of life in children, adolescents, and young adults with Neurofibromatosis Type 1.

The objective was to investigate the serial mediating effects of speech difficulties, patient health communication, and disease-specific worry in the relationship between neurofibromatosis (NF) symptoms (pain and skin symptoms) and total generic health-related quality of life (HRQOL) in children, adolescents, and young adults with NF Type 1 (NF1) from the patient perspective. The Speech, Communication, Worry, Pain, Skin Itch Bother, and Skin Sensations Scales from the Pediatric Quality of Life Inventory (PedsQL) NF1 Module and the PedsQL 4.0 Generic Core Scales were completed in a multi-site national study by 305 patients ages 5-25 years. A serial multiple mediator model analysis was conducted to test the hypothesized sequential mediating effects of speech difficulties, health communication, and worry as intervening variables in the association between NF1 symptoms and HRQOL. Symptoms predictive effects on total generic HRQOL were serially mediated by speech difficulties, patient health communication, and worry. In predictive analytics models utilizing hierarchical multiple regression analyses with age and gender demographic covariates, the pain, skin itch bother, and skin sensations multiple mediator models accounted for 61%, 59%, and 56% of the variance in generic HRQOL (p < .001), reflecting large effect sizes. Speech difficulties, patient health communication, and disease-specific worry explain in part the mechanism of symptoms predictive effects on total generic HRQOL in pediatric patients with NF1. Identifying NF1-specific predictors and serial mediators of total generic HRQOL in pediatric patients with NF1 from the patient perspective enables a patient-centered comprehensive care approach for children, adolescents, and young adults with NF1.

“I Am Because We Are”: Awakening Revolutionary Patient-Centered Care

While in nursing school, I studied abroad in Cape Town, South Africa to experience different perspectives and to build a socially and culturally conscious medical practice. Nursing is my second career. A decade prior to my travels in Cape Town, I was a grassroots labor organizer. My worldview was shaped by a commitment to the principle of justice long before I donned my scrubs. Justice is the the ethical principle of treating people equitably. Equality is treating everyone the same way. Some individuals or entire communities will require more support or different interventions to reach the same outcome, because of inequality. Values are not innate—they are personal, learned, taught, and shaped by experience. Values inform the choices that we make both consciously and subconsciously. Ubuntu, or “I am because we are,” is the belief that the self-interests of any individual are inextricably linked to the self-interests of all individuals. It is the belief that our individual existence is validated by our connection to each other. Collaborative, patient-centered care approaches and the philosophy of Ubuntu are deeply rooted in Humanism. Nicole C. Blais is Emergency Nurse, Middlesex Hospital, Marlborough, CT.

A small dose of impertinence in end-of-life care at home

The patient-centred palliative care approach means establishing partnerships between him or her, the caregivers, the family, social sector professionals and care volunteers. Communication, which takes the form of dialogue, listening, establishing a relationship of trust and observing behaviour and body language is essential faced with the uncertainty and existential questioning of the patient and their family. In the patient's home, as this experienced nurse describes, this questioning leads caregivers to reflect on their professionalism and humanity.