Person-centred Care For Patients Research Articles

“Getting to Know Them”: Person-Centered Care for Patients With Dementia in Acute Care

Older adults with dementia are reported to have twice as many hospital stays as their age-matched counterparts without dementia. Acute care hospitals are generally not equipped to provide best care for persons with dementia. The purpose of the current qualitative study was to gain an understanding of the needs and perspectives of nursing staff and patient care technicians regarding delivering person-centered care (PCC) to patients with dementia. Nine focus groups (N = 49) were conducted. Participants discussed the importance of "getting to know them" as the basis for their care. Several themes emerged that served to support or detract from providing PCC: (a) communication, (b) education, and (c) care environment. Findings from this study support the desire of nurses and patient care technicians to provide PCC, highlight challenges, and indicate needed system-level changes to education, communication, and the care environment to support best practices. [Journal of Gerontological Nursing, 47(5), 37-44.].

Optimizing Cardiovascular Health Worldwide: The Global Cardiovascular Nursing Leadership Forum.

Optimizing Cardiovascular Health Worldwide: The Global Cardiovascular Nursing Leadership Forum.

Modelling the cost-effectiveness of person-centred care for patients with acute coronary syndrome

BackgroundPerson-centred care has been shown to be cost-effective compared to usual care for several diseases, including acute coronary syndrome, in a short-term time perspective (< 2 years). The cost-effectiveness of person-centred care in a longer time perspective is largely unknown.ObjectivesTo estimate the mid-term cost-effectiveness of person-centred care compared to usual care for patients (< 65) with acute coronary syndrome, using a 2-year and a 5-year time perspective.MethodsThe mid-term cost-effectiveness of person-centred care compared to usual care was estimated by projecting the outcomes observed in a randomized-controlled trial together with data from health registers and data from the scientific literature, 3 years beyond the 2-year follow-up, using the developed simulation model. Probabilistic sensitivity analyses were performed using Monte Carlo simulation.ResultsPerson-centred care entails lower costs and improved effectiveness as compared to usual care, for a 2-year time and a 5-year perspective. Monte Carlo simulations suggest that the likelihoods of the person-centred care being cost-effective compared to usual care were between 80 and 99% and between 75 and 90% for a 2-year and a 5-year time perspective (using a 500,000 SEK/QALY willingness-to-pay threshold).ConclusionsPerson-centred care was less costly and more effective compared to usual care in a 2-year and a 5-year time perspective for patients with acute coronary syndrome under the age of 65.

Finding common ground: meta-synthesis of communication frameworks found in patient communication, supervision and simulation literature

BackgroundEffective communication between patients-clinicians, supervisors-learners and facilitators-participants within a simulation is a key priority in health profession education. There is a plethora of frameworks and recommendations to guide communication in each of these contexts, and they represent separate discourses with separate communities of practice and literature. Finding common ground within these frameworks has the potential to minimise cognitive load and maximise efficiency, which presents an opportunity to consolidate messages, strategies and skills throughout a communication curriculum and the possibility of expanding the research agenda regarding communication, feedback and debriefing in productive ways.MethodsA meta-synthesis of the feedback, debriefing and clinical communication literature was conducted to achieve these objectives.ResultsOur analysis revealed that the concepts underlying the framework can be usefully categorised as stages, goals, strategies, micro-skills and meta-skills. Guidelines for conversations typically shared a common structure, and strategies aligned with a stage. Core transferrable communication skills (i.e., micro-skills) were identified across various types of conversation, and the major differences between frameworks were related to the way that power was distributed in the conversation and the evolution of conversations along the along the path of redistributing power. As part of the synthesis, an overarching framework “prepare-EMPOWER enact” was developed to capture these shared principles across discourses.ConclusionsAdopting frameworks for work-based communication that promote dialogue and empower individuals to contribute may represent an important step towards learner-centred education and person-centred care for patients.

Barriers to Care Amongst Patients with Inherited Bleeding Disorders: Results from Two Nation-Wide Canadian Surveys

Introduction: The literature surrounding inequity in healthcare is robust, with factors such as socioeconomic status (SES), race, immigration status, and geographic access being extensively documented as influencers of both healthcare access and healthcare outcomes. However, the ways in which social determinants of health (SDOH) affect patients with inherited bleeding disorders remains unclear. To the best of our knowledge, no study has specifically examined for health inequities or barriers to care amongst this patient population. The objective of this study was to survey Canadian patients and healthcare providers (HCPs) regarding their perceptions around access to care and diagnostic delay. Methods: A 40 question bilingual patient survey and a 24 question HCP survey were developed and tested with experienced hematologists, a mixed-methodology research expert, and patient advocates from the Canadian Hemophilia Society (CHS). Surveys were launched online on January 1st, 2019. The HCP survey remained live for 2 months, and the patient survey for 6 months. Patient recruitment occurred through e-mails, newsletters and social media announcements through the CHS, a nation-wide patient advocacy group comprised of patients, caregivers, and supporters (N=2261). HCP recruitment occurred via e-mail to all members of The Association of Hemophilia Clinic Directors of Canada (N=73), the Canadian Association of Nurses in Hemophilia Care (N=40) and the Canadian Physiotherapists in Hemophilia Care (N=44). Results: There were 46 patient respondents (exact response rate unknown) and 70 HCP respondents (response rate of 45%). Patient ages ranged from 18-75, with 56% (N=26) of respondents being women. Diagnoses amongst patients included von Willebrand disease (VWD) (29%, N=12), hemophilia A (32%, N=13), hemophilia B (10%, N=4), hemophilia A carrier (10%, N=4), disorders of platelet function (10%, N=4), factor 7 deficiency (5%, N=2), and bleeding disorders not yet diagnosed (5%, N=2). All patient respondents described being symptomatic, with easy bruising (90%, N=38), bleeding from gums (67%, N=28), bleeding into joints (57%, N=24), and hospitalization due to bleeding being most common (60%, N=25). The majority of patients (90%, N=38) described symptoms of bleeding prior to age 18; however, 25% (N=10) estimated it took over 10 years to reach a correct diagnosis. Female gender, distance from a hemophilia treatment centre (HTC), and being sent home from the emergency room without a treatment plan or referral were identified as barriers to care. Of the HCP respondents, 76% (N=53) were women, 46% (N=32) physicians, 28% (N=20) nurses, and 26% (N=18) physiotherapists. HCPs felt that there were diagnostic delays for patients with mild symptomatology (71%, N=50), women presenting with abnormal uterine bleeding as their only or primary symptom (59%, N=41), and patients living in rural Canada (50%, N=35). Fewer HCP respondents felt that factors such as SES (46%, N=32) or race (21%, N=15) influenced access to care, particularly as compared to rural location (77%, N=54). Conclusion: To our knowledge, this is the first study to assess patient and HCP perceptions of barriers to care for patients with inherited bleeding disorders. Vulnerable patient populations identified by patients and healthcare providers alike included women, particularly those with isolated abnormal uterine bleeding, and patients living in rural Canada, who may have less access to a HTC. This study highlights that, in order to provide equitable and person-centered care for patients with inherited bleeding disorders, SDOH should be taken into consideration. These factors warrant additional study, and will be investigated further using in-depth qualitative patient interviews with Canadian men and women. Disclosures Sholzberg: Novartis: Honoraria; Amgen: Honoraria, Research Funding.

Patient Perspectives to Inform a Health Literacy Educational Program: A Systematic Review and Thematic Synthesis of Qualitative Studies.

Patient-centred care is tailored to the needs of patients and is necessary for better health outcomes, especially for individuals with limited health literacy (LHL). However, its implementation remains challenging. The key to effectively address patient-centred care is to include perspectives of patients with LHL within the curricula of (future) healthcare providers (HCP). This systematic review aimed to explore and synthesize evidence on the needs, experiences and preferences of patients with LHL and to inform an existing educational framework. We searched three databases: PsychInfo, Medline and Cinahl, and extracted 798 articles. One-hundred and three articles met the inclusion criteria. After data extraction and thematic synthesis, key themes were identified. Patients with LHL and chronic diseases encounter multiple problems in the care process, which are often related to a lack of person-centeredness. Patient perspectives were categorized into four key themes: (1) Support system; (2) Patient self-management; (3) Capacities of HCPs; (4) Barriers in healthcare systems. “Cultural sensitivity” and “eHealth” were identified as recurring themes. A set of learning outcomes for (future) HCPs was developed based on our findings. The perspectives of patients with LHL provided valuable input for a comprehensive and person-centred educational framework that can enhance the relevance and quality of education for (future) HCPs, and contribute to better person-centred care for patients with LHL.

How well do public sector primary care providers function as medical generalists in Cape Town: a descriptive survey

BackgroundEffective primary health care requires a workforce of competent medical generalists. In South Africa nurses are the main primary care providers, supported by doctors. Medical generalists should practice person-centred care for patients of all ages, with a wide variety of undifferentiated conditions and should support continuity and co-ordination of care. The aim of this study was to assess the ability of primary care providers to function as medical generalists in the Tygerberg sub-district of the Cape Town Metropole.MethodsA randomly selected adult consultation was audio-recorded from each primary care provider in the sub-district. A validated local assessment tool based on the Calgary-Cambridge guide was used to score 16 skills from each consultation. Consultations were also coded for reasons for encounter, diagnoses and complexity. The coders inter- and intra-rater reliability was evaluated. Analysis described the consultation skills and compared doctors with nurses.Results45 practitioners participated (response rate 85%) with 20 nurses and 25 doctors. Nurses were older and more experienced than the doctors. Doctors saw more complicated patients. Good inter- and intra-rater reliability was shown for the coder with an intra-class correlation coefficient of 0.84 (95% CI 0.045–0.996) and 0.99 (95% CI 0.984–0.998) respectively. The overall median consultation score was 25.0% (IQR 18.8–34.4). The median consultation score for nurses was 21.6% (95% CL 16.7–28.1) and for doctors was 26.7% (95% CL 23.3–34.4) (p = 0.17). There was no difference in score with the complexity of the consultation. Ten of the 16 skills were not performed in more than half of the consultations. Six of the 16 skills were partly or fully performed in more than half of the consultations and these included the more biomedical skills.ConclusionPractitioners did not demonstrate a person-centred approach to the consultation and lacked many of the skills required of a medical generalist. Doctors and nurses were not significantly different. Improving medical generalism may require attention to how access to care is organised as well as to training programmes.

Impact of an educational programme in Portuguese people with diabetes

This study, conducted in the north of Portugal, is the result of a group of nurses’ intent to develop a closer and meaningful person-centered care for patients with diabetes, empowering them with skills to better manage their therapeutic regimen. Through a participatory action research process, the group of nurses involved in this study, reflected on the current healthcare enabling them an in-depth analysis of the best scientific evidence, aiming to design context tailored solutions, which would contribute to patients’ empowerment. Through a longitudinal study developed over several stages, the nurses outlined the educational programme Living in harmony with diabetes, which was applied to 85 patients with diabetes mellitus type 2. The programme had a positive impact on the psychosocial variables, in self-care behaviour and in the metabolic control, helping patients to better cope with their disease and have greater control over their health condition. Throughout the process of participatory action research, the nurses were able to increase their self-efficacy and empowerment on person-centered care implementation.

An eHealth Diary and Symptom-Tracking Tool Combined With Person-Centered Care for Improving Self-Efficacy After a Diagnosis of Acute Coronary Syndrome: A Substudy of a Randomized Controlled Trial

BackgroundPatients with cardiovascular diseases managed by a person-centered care (PCC) approach have been observed to have better treatment outcomes and satisfaction than with traditional care. eHealth may facilitate the often slow transition to more person-centered health care by increasing patients’ beliefs in their own capacities (self-efficacy) to manage their care trajectory. eHealth is being increasingly used, but most studies continue to focus on health care professionals’ logic of care. Knowledge is lacking regarding the effects of an eHealth tool on self-efficacy when combined with PCC for patients with chronic heart diseases.ObjectiveThe objective of our study was to investigate the effect of an eHealth diary and symptom-tracking tool in combination with PCC for patients with acute coronary syndrome (ACS).MethodsThis was a substudy of a randomized controlled trial investigating the effects of PCC in patients hospitalized with ACS. In total, 199 patients with ACS aged <75 years were randomly assigned to a PCC intervention (n=94) or standard treatment (control group, n=105) and were followed up for 6 months. Patients in the intervention arm could choose to use a Web-based or mobile-based eHealth tool, or both, for at least 2 months after hospital discharge. The primary end point was a composite score of changes in general self-efficacy, return to work or prior activity level, and rehospitalization or death 6 months after discharge.ResultsOf the 94 patients in the intervention arm, 37 (39%) used the eHealth tool at least once after the index hospitalization. Most of these (24/37, 65%) used the mobile app and not the Web-based app as the primary source of daily self-rating input. Patients used the eHealth tool a mean of 38 times during the first 8 weeks (range 1–118, SD 33) and 64 times over a 6-month period (range 1–597, SD 104). Patients who used the eHealth tool in combination with the PCC intervention had a 4-fold improvement in the primary end point compared with the control group (odds ratio 4.0, 95% CI 1.5–10.5; P=.005). This improvement was driven by a significant increase in general self-efficacy compared with the control group (P=.011). Patients in the PCC group who did not use the eHealth tool (n=57) showed a nonsignificant composite score improvement compared with those in the control group (n=105) (odds ratio 2.0, 95% CI 0.8–5.2; P=.14).ConclusionsWe found a significant effect on improved general self-efficacy and the composite score for patients using an eHealth diary and symptom-tracking tool in combination with PCC compared with traditional care.Trial RegistrationSwedish registry, Researchweb.org, ID NR 65 791.

Building integrated care systems: a case study of Bidasoa Integrated Health Organisation.

This paper analyses the implementation of integrated care policies in the Basque Country through the deployment of an Integrated Health Organisation in Bidasoa area during the period 2011-2014. Structural, functional and clinical integration policies have been employed with the aim to deliver integrated and person-centred care for patients, especially for those living with chronic conditions. This organisational case study used multiple data sources and methods in a pragmatic and reflexive manner to build a picture of the organisational development over a 4-year period. In order to measure the progress of integration three concepts have been measured: (i) readiness for chronicity measured with Assessment of Readiness for Chronicity in Healthcare Organisations tool; (ii) collaboration between clinicians from different care levels measured with the D'Amour Questionnaire, and (iii) overall impact of integration through several indicators based on the Triple Aim Framework. The measurement of organisational readiness for chronicity showed improvements in five of the six areas under evaluation. Similarly the collaboration between professionals of different care levels showed a steady improvement in each of the 10 items. Furthermore, the Triple Aim-based indicators showed a better experience of care in terms of patients' perceptions of care coordination; a reduction in hospital utilisation, particularly for patients with complex chronic conditions; and cost-containment in terms of per capita expenditure. There is a significant amount of data that shows that Bidasoa Integrated Health Organisation has progressed in terms of delivering integrated care for chronic conditions with a positive impact on several Triple Aim outcomes.

Patients' experiences of living with persistent back pain

ObjectivesThis Masterclass discusses findings from a growing body of qualitative research studies that have investigated the subjective experience of having persistent non-malignant low back pain. These studies have found that people with experience changes in self image, personal relationships and life roles. They have also reported on how subjectivity affects the therapeutic relationship, what patients have found helpful in dealing with healthcare professionals, and what it is like to go through a healthcare system for a pain that may not be curable or even diagnosable. The findings are of great importance for clinicians who wish to provide person centred care for patients with persistent low back pain, so this Masterclass ends with key lessons for practitioners.

Person-centred care for patients with chronic heart failure - a cost-utility analysis.

Costs of care for patients with chronic heart failure have been estimated at between 1% and 2% of the total health care expenditure in Europe and North America. Two-thirds are for inpatient care. Person-centred care (PCC) asserts that patients are persons and should not be reduced to their diseases alone. The aim of this study was to estimate the cost-utility of PCC when compared with conventional care in patients hospitalized for worsening chronic heart failure. Data for the cost-utility analysis were collected alongside a prospective clinical intervention study with a controlled before and after design from 2008 to 2010. Patient-specific resources used and preference-based health status data were collected at an individual level.Only 63% received PCC as intended illustrating the difficulties of introducing new methods in established organizations. The group intended to have PCC yielded higher costs in comparison with the conventional care group. The incremental cost was estimated as €98. The costs for those who actually received PCC, per protocol (PP) (63%) were significantly (p=0.026) lower than for those in the conventional care group, with an incremental cost-saving of €863. For the first three months, patients in the conventional care group showed decreasing health-related quality of life, with a corresponding improvement in the PCC(PP) group. It must be emphasized, however, that these positive effects, both cheaper and somewhat better, were obtained only among those receiving the PCC intervention in its intended form, PCC(PP).