Patient-centred Clinical Method Research Articles

'El Carmel' community-orientation experience

Introduction: “El Carmel” health center is located in a social deprived area in Barcelona city with around 20000 inhabitants. Since the Spanish reform of the primary health care in 1984, Primary Healthcare Centers (PHC) have to provide healthcare services for individuals, families and the assigned. However the reality is that the majority of PHC focus their practice into individuals, and care is frequently left in oblivion. Here we present the strategy to progressively orient our practice to the community. Description of practice change implemented: Our project aim is to improve the health of the as a whole, empowering citizens to face their own problems, beating against health inequities and creating a healthier neighborhood. Goals are: to achieve a health diagnosis and to implement health programs based on priorities agreed We identified three eligible situations: 1. In the medical/nurse consultation, using the patient-centered clinical method, contextualizing the health demands and looking for a salutogenic approach when possible. 2. At the PHC level we conducted a health diagnosis, and established priorities of action. 3. In the PHC outreach activity, we collaborate with the Neighborhood-Community-Project (NCP) in which are represented the main local citizen associations, the local government and other public and private services included social services. Key findings: In 1994 the PHC team began a orientation in a very slow pace, facing internal and external constraints. a) In 2000 we finished a health diagnosis (quantitative and qualitative). The document was updated in 2004 with a list of priorities b) In 2000 the NCP invited us to participate to developing a strong social network and promoting the engagement. From 2004 until 2014 the NCP has developed a wide range of activities in which the PHC has participated, especially when related to health promotion. This process follows the community plans methodology. c) From 2005 to 2012 a child-obesity program has been implemented to improve healthy food habits and an active life style. This program follows the Community-Oriented-Primary-care methodology. Health outcomes: significant improvement in life-style (from 40% to 61%) and quality of diet (from 52% to 64%) d) Since 2004 a walking group project for people over 65 has been developed, especially for those at risk of social isolation. At this moment we have 6 walking groups with around 150 participants. The project follows the Participatiory-Action-Research methodology. Health outcomes: significant decrease in blood pressure (from 136,7 to 131,3 for systolic blood pressure and from 75,6 to 73,2 for dyastolic) and even more in patients over 70 yo. e) In 2014 the NCP decides to engage issues on health inequities. In March 2015 we presented a short illustrated book explaining the role of social factors in the neighborhood health. We look forward using them in future events (schools, local associations). f) In September 2014 a choral group was formed with patients affected by chronic conditions with the aim to improve quality of life. A 6 months clinical trial has showed an improvement in the quality of life and the participants expressed great interest to continue with the activity. Nowadays there are around 25 participants and the group has started to sing in events. g) In 2015 the PHC joined the ‘COMsalut' project. The aim of this project is to facilitate and recognize the work of the PHC in Catalonia. h) At this time we are working in a data base of assets and preparing a basic set of socioeconomic data to include in the individual electronic health record. Highlights: The main constraints for the orientation has been the lack of knowledge in engagement; the overload of work in consultation; the few recognition of the work and the pressure of the employer to achieve goals in clinical area. We have been developing a close relationship with different partners of the NCP and we’ve been progressively improving our competences in and groups work. We have realized along these years that the presence of the PHC in events or activities is a tool to gain citizens interest. We have developed the ability to accompany various groups and slowly let them gain autonomy. Joining the ‘COMsalut’ project has been a good resource to face eventual problems in future. Conclusion: The orientation of the PHC team is an important contribution to face social and health iniquities of a defined community. With the support of our employer and the recognition of these activities as a part of the assigned work task, the orientation of the primary care services could be sustainable. We think our experience is not unique and in any case is transferable to other practices with a similar context.

Patient and health professions student team perceptions of patient-centeredness in an inter-professional education home-visit program: An exploratory study

The purpose of this study was to compare patient and health professions student team perceptions of patientcenteredness in an inter-professional clinical education home-visit program. Following an inter-professional clinical education home-visit program, patient and health professions student team perceptions of patient-centeredness were compared using a modified version of the Patient Perception of Patient Centeredness Questionnaire. The results showed both patient and student team participants perceived that student teams focused on how much they cared about the patient as a person and the opportunity to discuss any questions. Patients, however, reported significantly higher levels of patient-centered clinical method used during the visits than did health professions and osteopathic medical/dental student participants. The study reveals more practice and focus on patient feedback and the patient’s central role in their healthcare decisions is recommended for this inter-professional clinical education program as well as for any program that includes team-based care. Patient-centeredness also requires instruction to the patient about their role in their own healthcare. Health and medical professions educators need to continue to motivate students through inter-professional education programs and activities to adopt a more patient-centered practice. For future research as a follow-up study, adding independent observations of the home visit interactions may allow for a better understanding of which specific behaviors contribute the most to the experienced patient-centeredness.

Vícios e vicissitudes na adesão à terapêutica: um relato de caso

Introduction: Non-adherence to therapy is a prevalent problem, especially among patients with multiple comorbidities. The aim of this case report is to raise awareness of the importance of the patient-centered clinical method in dealing with this issue. Case report: We present the case of a 49-year-old single female living alone with type 2 diabetes, hepatitis C infection, and a previous history of drug abuse. She had poor metabolic control even after suffering an ischemic stroke at 48 years of age, which left her with weakness of her left arm. The patient was invited by her family physician for a family assessment interview, including a review of her habits and medications and an exploration of her beliefs, fears, and expectations about her health problems and their importance to her. There was no evidence of family dysfunction but she was found to have a compulsion to eat sweets and she reported current hashish and tobacco consumption. Her poor adherence to therapy was confirmed. She was only taking three out of eight medications prescribed, due to a lack of awareness of their indications and fear of adverse effects. The patient’s ideas and fears about her treatment were explored and clarified, and therapy was optimized according to her expectations. Nursing support was obtained and contact was made with her neurologist and endocrinologist. In subsequent visits, adherence to therapy reported by the patient was improved along with partial adherence to the recommended diet, resulting in improved metabolic control. Discussion: This is a case report of a patient with multimorbidity and non-adherence to therapy. The patient benefitted from a multidisciplinary approach, a good doctor-patient relationship, and effective communication. The patient centered clinical method was helpful in achieving these goals and the family physician was well placed to apply it.

Compaixão e medicina centrada na pessoa: convergências entre o Dalai Lama Tenzin Gyatso e Ian McWhinney

O método clínico centrado na pessoa (MCCP) é uma proposta de reorientação da prática clínica que identifica um distanciamento, na medicina contemporânea, da experiência subjetiva e qualitativa dos pacientes. Para superar este distanciamento, o MCCP utiliza teorias e técnicas de diversas escolas da psicologia moderna ocidental. Neste trabalho, analisamos possíveis contribuições para o MCCP de uma escola de pensamento oriental, o budismo tibetano, na perspectiva delineada por seu atual líder espiritual, Tenzin Gyatso, o XIV Dalai Lama. Também são utilizados elementos de trabalhos de Ian McWhinney para intermediar e enriquecer esta reflexão, que apresenta como proposição final o desenvolvimento da compaixão como qualidade fundamental para lidar com a dimensão psicossocial do sofrimento humano. O MCCP e a abordagem ética budista plasmada no pensamento do Dalai Lama compartilham um objetivo comum: uma compreensão e um manejo não reducionistas do sofrimento humano. Em ambos os casos, identifica-se a necessidade de reconhecer e valorizar aspectos mentais e emocionais das relações humanas como estratégia para lograr esta abordagem ampliada.

Validação de Instrumento de Registro do Atendimento Clínico Centrado na Pessoa

Diante do desafio de formar médicos para o século XXI, em que se pretende uma abordagem integral da pessoa, incluindo seus sentimentos e o contexto que a cerca, este trabalho teve como objetivo validar, para a realidade de uma cidade brasileira, um modelo de registro de atendimento clínico centrado na pessoa, com base numa proposta reconhecida internacionalmente. O documento resultante representa um instrumento que poderá facilitar o aprendizado e a adesão do estudante de Medicina ao método clínico centrado na pessoa, por se tratar de uma sistematização do roteiro para o registro da consulta médica, guiando a entrevista no formato centrado na pessoa. Os autores acreditam que a utilização deste roteiro de registro contribuirá de forma relevante para que os estudantes de Medicina, iniciantes no ofício e mais dependentes de guias de registro, desenvolvam de forma plena, em cenários simulados e reais, as habilidades necessárias ao atendimento clínico centrado na pessoa.

Solution-Based Therapy Assuming More Prominent Role

Solution-Based Therapy Assuming More Prominent Role

From Qualitative Data to GP Training on CRC Screening

Colorectal cancer (CRC) is the third most common cancer worldwide. In France, although mass screening has been performed using the guaiac fecal occult blood test since 2008, the participation rate remains too low. Previous studies have explored the perspectives of doctors and patients as well as the performance of general practitioners (GPs) by recording and analyzing consultations in which patients came and asked for fecal occult blood test. Results indicated that improvement was needed in patient-centered communication. This research aims to develop educational material and training programs for GPs in order to enhance their communication with patients on CRC screening, based on data from two qualitative studies. Triangulation of all qualitative data was performed and discussed with communication experts in order to develop educational material and training programs based on the patient-centered clinical method. Two different scenarios were developed to improve communication with patients: one for a compliant patient and another for a noncompliant patient. Two videos were made featuring a doctor and a simulated patient. A two-sequence training program was built, including role-playing and presentation of the video followed by a discussion. The qualitative data helped us to produce a useful, relevant training program for GPs on CRC screening.

The patient-centered clinical method: a family medicine perspective

Summary This paper describes the patient-centered clinical method for family practice. It was presented as a speech at the Family Medicine Research Days, Izmir, November 2012. As well as describing, in depth, the four components of the patient-centered clinical method, I also cover the reasons why patient-centeredness is important to patients. I offer examples that explain how patientcentered care has a role in diagnosis and cure. Our own research studies provide guides to encourage others to conduct research on patient-centered care. I cite worldwide research which has found that patient-centered care has a positive influence on patient perceptions of their care and on their own health. Finally, I describe the effective ways that patient-centeredness can be taught and learned.

Primary health-care patients’ reasons for complaint-related worry and relief

Primary care patients are commonly worried about their complaints when consulting their doctor. Knowing the reasons behind patients' worries would enhance consultation practices. The aim of this study was to find out the reasons patients themselves give for their worries before a consultation and for possible relief or persistent worry after the consultation. Our previous study using quantitative methods suggested that worried patients were uncertain about what was wrong with them and they perceived their complaints as serious. These results left some aspects unanswered; for instance, why did the patients consider their complaints severe. We conducted semi-structured interviews of patients, aged 18-39 years, with somatic complaints other than a common cold (n = 40), both before and after a consultation, and the patients described their reasons for worry in their own words. These qualitative data were analysed using thematic content analysis. The patients gave as reasons for their worries uncertainty, consequences of their complaints (eg, inability to work), insufficient control (eg, inadequate treatment) and prognosis. The patients were relieved when their uncertainty was diminished by getting an explanation for their complaint or when they achieved more control by getting treatment for their complaint. After a consultation, their reasons for worry, except for concern about the ability to function, tended to be replaced by other reasons. Psychological consequences and mistrust in health care also played a role in persistent worry. Our findings offer support to the patient-centred clinical method in primary care. To address the patients' worries properly, the GP should bring them up for discussion. Special attention should be given to worries about the ability to function, as they tend to persist even after a consultation.

Complexity and health – yesterday's traditions, tomorrow's future

‘If it is complex it means we don’t really understand it,and the way forward is to break the problem down into its partsto make sense of it’. This thought reflects the way we havebeen taught, and the way we largely practise in clinical care everyday.But are we really functioning on this basis? Or is it the only waywe know how to live? We all experience situations every daywhere the evidence does not really fit our understanding of aproblem – the familiar reductionist approach limits our ability tofully explore new problems and to gain new insight. An increas-ingly persistent question has emerged in relation to what consti-tutes the knowledge we need for effective and efficient clinicalcare, an issue taken up by this new

Integrating teaching into the busy resident schedule: A learner-centered approach to raise efficiency (L-CARE) in clinical teaching

Background: Clinical teachers are sometimes challenged by residents who seem too busy to concentrate on their learning. In such situations, teachers must be aware to diagnose underlying problems in learners and to effectively help them maximize learning while minimizing time and energy requirements.Objective: To develop a learner-centered model to improve efficiency of clinical teaching.Methods: We reviewed the literature on educational diagnosis, self-directed learning, and effective/efficient teaching to put together a new model.Results: The Learner-Centered Approach to Raise Efficiency (L-CARE) in Clinical Teaching is inspired from the well-known patient-centered clinical method. Using the L-CARE in clinical teaching involves: (1) addressing the learners’ feelings regarding their environment as well as patient care and study issues, which provides a good learning climate facilitating educational diagnosis and management of issues that could impair learning; (2) establishing a learning contract (expectations); (3) sharing resources and strategies (ideas) that should be effective without wasting time or energy; (4) self-assessment and constructive feedback (impact). These steps are grounded in self-directed learning theory to improve motivation and ensure that learners concentrate on their own needs to promote learning efficiency.Conclusion: The L-CARE model integrates educational diagnosis principles, self-directed learning theory, and efficient teaching strategies to improve efficiency of clinical teaching.

Adapting an Effective Counseling Model from Patient-centered Care to Improve Motivation in Clinical Training Programs

The value of establishing a patient-centered relationship within the context of the clinical encounter is well documented. The learner-centered method of medical education parallels the patient-centered clinical method; therefore, it should be explored as a method for teaching in the context of the learning encounter. In Japan and other Asian countries, rotations through services not related to the learner’s chosen medical specialty are mandatory parts of the medical internship. Participation and effort in these rotations are often met with resistance from learners and are a common problem for medical educators. We adapted the counseling method for patients based on patient-centered methods such as motivational interviewing and solution-focused therapy to address this common problem.We show one case of a medical resident who lost his motivation to learn during his training. A resident has many kinds of mental and physical stress. One such problem arises from the gap between what they want to do and what they have to do. Strategies from motivational interviewing and solution-focused therapy were adapted to successfully resolve a common teaching problem in Japan. A physician teacher (preceptor) helped this resident solve the issue for himself instead of arguing in favor of change. The positive aspects of the counseling method were based on patient-centered medicine and proved useful and effective in counseling for medical residents. We may take the lessons learned from using patient-centered counseling methods to further develop a clear and systematic process of counseling methods for residents to conduct learner-centered medical education.

The Biopsychosocial Approach: Past, Present, and Future

Back to table of contents Previous article Next article Book ReviewsFull AccessThe Biopsychosocial Approach: Past, Present, and FutureDaniel Bradford, M.D., M.P.H.Daniel BradfordSearch for more papers by this author, M.D., M.P.H.Published Online:1 Nov 2005https://doi.org/10.1176/appi.ps.56.11.1466-aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The basic tenet of the biopsychosocial model—that health outcomes affect and are affected by biological, psychological, and social factors—is understandable and even intuitive for many in the health care field. In fact, the biopsychosocial model makes for good "common sense" and thus could easily be disregarded as simplistic. However, the intricacies of the biopsychosocial approach are belied by the model's accessibility. The biopsychosocial clinician's task is no easy one—he or she must assess the interrelationships of multiple systems as they constantly affect and are affected by presenting—as well as nonpresenting—medical problems and must use skill and finesse in working with the patient to choose appropriate interventions, knowing that all systems will then be further affected. The Biopsychosocial Approach: Past, Present, and Future is a comprehensive work that explicates the complexities and richness of the biopsychosocial model and its implications in clinical practice, education, and administration.The book is organized into six parts. The introduction presents the basic components of the biopsychosocial model, which was developed by George Engel, M.D., as an application of systems theory to medical practice. Part 1 discusses clinical applications, emphasizing the importance of a communicative, empowering relationship between the physician and the patient. Part 2 examines research in psychoneuroimmunology, relationship-centered health care, and the patient-centered clinical method. Part 3 considers educational and administrative issues. Of note, the University of Rochester's "Double Helix" curriculum for medical students is presented here. Another fascinating chapter explains how the biopsychosocial model can be applied to organizational management in a health care setting, increasing employee satisfaction and, consequently, patient care. Part 4 discusses the development of the biopsychosocial model and includes an ethnographic study of Engel's correspondence. Finally, the editors conclude by considering the future of the biopsychosocial approach.This text will benefit professionals in a variety of health service disciplines. Most chapters are relatively free of medical jargon, although having a background in health services would certainly make for easier reading. In particular, readers without a medical background may find the chapter on psychoneuroimmunology less than accessible.Some patients may find the book helpful. As one of the contributing authors suggests, "The patient must understand her illness at a level of technical sophistication concordant with her needs." The same could be said for understanding the treatment model. In addition, understanding the approach will help patients become empowered in their own care, which is integral to the biopsychosocial model.For community psychiatrists, this text is virtually "required reading." The problems that our patients face are compounded by breakdowns across so many systems—biological, family, housing, and employment—and the distrust that many patients have for mental health practitioners is so overwhelming that effective treatment practically mandates a biopsychosocial approach.In short, The Biopsychosocial Approach is informative, clearly written, and inclusive. However, one of its most important attributes may be that it is thought provoking. By explaining the origins and implications of the biopsychosocial approach, the authors force us to critically examine the origins and implications of our own beliefs about medicine. This self-examination can help us identify areas for growth in our own practices.Dr. Bradford is a Robert Wood Johnson clinical scholar at the University of North Carolina School of Medicine in Chapel Hill and a clinical instructor in the department of psychiatry at the university.edited by Richard Frankel, Timothy Quill, and Susan McDaniel; Rochester, New York, Boydell and Brewer, 2003, 298 pages, $65 FiguresReferencesCited byDetailsCited ByCross-sectional study to investigate the health-related quality of life in children with severe lower limb trauma in Victoria21 January 2013 | Journal of Paediatrics and Child Health, Vol. 49, No. 2 Volume 56Issue 11 November 2005Pages 1466-a-1467 Metrics History Published online 1 November 2005 Published in print 1 November 2005

Challenges and solutions in patient-centered care Brown JB Challenges and solutions in patient-centered care, MStewart WWWeston Radcliffe Medical PressNo of pages: 264£24.9518577598691857759869

This publication examines how a patient-centred clinical method of consultation can be applied to primary care.

Medically unexplained symptoms: the biopsychosocial model found wanting

The recognition that all illnesses have both mental and physical components and that there is a dynamic relationship between components of systems (general systems theory) led to criticisms of the biomedical model and to the development of the biopsychosocial model of Western medicine.1,2 From this model emerged the concept of triple diagnosis, whereby clinicians make diagnoses at three levels, the biological or physical, the personal or psychological and the social and contextual.2,3 By understanding relevant factors at all three levels and their interactions, clinicians are better able to treat the whole person—the patient-centred clinical method.4

Patient‐centered Medicine, Transforming the Clinical Method (2nd edition)

Patient‐centered Medicine, Transforming the Clinical Method (2nd edition)

The development and evaluation of an integrated community-based, patient-centred learning activity at the University of Hong Kong.

To develop and evaluate the Patient Care Project (PCP), an integrated patient-centred, community-based learning activity, implemented at the University of Hong Kong since 1992. The PCP, a required course in the first 2 preclinical years, is structured into four learning cycles over 9 months. Each cycle consists of a patient interview followed by a debriefing group tutorial. In-depth interviews with the same patient allow students to explore the impact of disease and patients' illness experience, as well as the contribution of the wider determinants of health to their condition. The debriefing tutorial frames empirical observations into theoretical models and its format reinforces habits of problem-based learning. The programme was evaluated using survey questionnaires completed by students, patients and tutors. 324 first- and second-year medical students. Students, participating patients and tutors all rated the PCP positively in end-of-course evaluations. Specifically, 68% of students commented that the PCP had met all or most of its stated objectives, while there was nearly unanimous agreement among patients that students demonstrated understanding and empathy in the visits and interviews. Tutor appraisal of student performance also indicated the attainment of all stated aims and objectives overall. The PCP is a valuable contribution to community-based learning and the promotion of the patient-centred clinical method.

Using the patient-centered method to achieve excellence in care for women with breast cancer

The diagnosis of breast cancer remains one of the most threatening and emotionally debilitating diagnoses given to patients. Breast cancer elicits fears of loss of ability, control, hope, and at worst — loss of life. Patients and their families, devastated by the diagnosis of cancer, often feel unsupported or dismissed by their health care providers. Using the example of breast cancer, this paper describes how the application of the patient-centred clinical method can assist physicians in caring for patients diagnosed with breast cancer. Composite cases and quotes drawn from qualitative research studies with breast cancer patients are used to illustrate the application of the patient-centred clinical method.

A description of the patient-centred clinical method

A description of the patient-centred clinical method

The evidence supporting the patient-centred clinical method

The evidence supporting the patient-centred clinical method