Person-centered Health Research Articles

Flip focus and emphasise patient resources in person-centred care over the telephone-A retrospective descriptive study.

The study aim was to describe the content of person-centred health plans, formulated via telephone conversations between registered nurses and patients with chronic obstructive pulmonary disease and/or chronic heart failure. Patients who had been hospitalised due to worsening chronic obstructive pulmonary disease and/or chronic heart failure were enrolled. After hospital discharge, the patients received a person-centred telephone support where a health plan was co-created with registered nurses who had received training in the theory and practice of person-centred care. A retrospective descriptive review of 95 health plans using content analysis was conducted. The health plan content revealed personal resources such as optimism and motivation in patients with chronic obstructive pulmonary disease and/or chronic heart failure. Although patients reported severe dyspnoea symptoms, the most common goals were to engage in physical activity and to be able to manage social life and leisure activities. Additionally, the health plans illustrated that patients were capable of using their own interventions to reach their goals rather than accessing municipal and health care support. The focus on listening, that person-centred telephone care affords, promotes the patient's own goals, interventions, and resources, which can be used to tailor support and engage the patient as an active partner in their care. The flipped focus from patient to person highlights the person's own resources, which in turn may contribute to a reduced need for hospital care.

Patient-centricity: Research's new shibboleth?

Patient-centricity: Research's new shibboleth?

New horizons in holistic, person-centred health promotion for hearing healthcare

Over the course of a lifetime, the risk of experiencing multiple chronic conditions (multimorbidity) increases, necessitating complex healthcare regimens. Healthcare that manages these requirements in an integrated way has been shown to be more effective than services that address specific diseases individually. One such chronic condition that often accompanies ageing is hearing loss and related symptoms, such as tinnitus. Hearing loss is not only highly prevalent in older adults but is also a leading cause of disability. Accumulating evidence demonstrates an interplay between auditory function and other aspects of health. For example, poorer cardiometabolic health profiles have been shown to increase the risk of hearing loss, which has been attributed to microvascular disruptions and neural degeneration. Additionally, hearing loss itself is associated with significantly increased odds of falling and is a potentially modifiable risk factor for cognitive decline and dementia. Such evidence warrants consideration of new possibilities-a new horizon-for hearing care to develop a holistic, person-centred approach that promotes the overall health and wellbeing of the individual, as well as for audiology to be part of an interdisciplinary healthcare service. To achieve this holistic goal, audiologists and other hearing healthcare professionals should be aware of the range of conditions associated with hearing loss and be ready to make health promoting recommendations and referrals to the appropriate health practitioners. Likewise, healthcare professionals not trained in audiology should be mindful of their patients' hearing status, screening for hearing loss or referring them to a hearing specialist as required.

TRANSGENDER PERSON-CENTERED CARE IN PANDEMIC TIMES

Introduction and Objectives: This article aims to outline the need for a person-centered approach to sexual health for transgender people in COVID-19 pandemic times.Methods: These involved reviews of international healthcare standards and the principles and strategies of person-centered health care, which articulate science and humanism. Ethical imperatives, including respect for all persons’ dignity and “first do not harm” as well as scientific considerations, including recognition of the eco-bio-psycho-social-spiritual multidimensionality of person and health were attended to.Results: The approach outlined here attends to Universal Sexual Rights, and the multidimensionality of persons’ sexual diversity, in the context of the current pandemic. This is illustrated through the Gender Identity Law enacted by the Argentine Ministry of Health in 2014 and its 2020 amendment, formulated in the face of the pandemic. The healthcare approach outlined here involves recommendations to promote access to health care for transgender, transvestite, and sexual non-binary people in the context of the pandemic.Conclusions: All persons can present and experience a unique and multidimensional sexual profile that should be assessed thoroughly within the multidimensional framework of total health and total person. Health care should be scientifically thorough, provided prudently, informed by the “first do not harm” ethical principle, fully respectful of human and sexual rights and responsibilities, and aimed at advancing total health and complete well-being for all throughout their life course.

RESPONDING TO THE COVID-19 PANDEMIC WITH INTEGRAL AND MUTUAL HEALTHCARE ORIENTED TO THE WELL-BEING OF ALL PERSONS

Introduction. The complex problem of COVID-19 and the possibilities of responding through innovative general health strategies have been raised. The development of innovative health strategies was stimulated by the 1978 Alma Ata Declaration on Primary Health Care and by related perspectives around the 2018 Astana Conference. To this may be added the contributions of the International College and the Latin American Network of Person Centered Medicine toward the exploration and formulation of innovative concepts and strategies of health focused on persons.Objectives: (1) Ontological clarification of the concept of health and of the strategies and tactics for health actions; (2) Delineation of and assessment of multifactorial support for promising general health strategies focused on persons; and (3) Elucidation of the relevance of such strategies to respond to the demands of the COVID-19 pandemic.Methods: (a) Analysis and reflection on health concepts and strategies by a multidisciplinary authors group; (b) Selective review of the international and Latin American literature on health systems and the pandemic, displayed, and analyzed tabular and narratively.Results1. Ontological concepts corresponding to the meaning and functions of health and of specific general strategies and tactics to restore and promote health were formulated.2. A general health strategy was outlined based on an analysis of the process of building promising health constructs emerging from conferences and international declarations in recent years. Then, early and contemporary historical considerations, as well as contextual perspectives (Social Determinants of Health, the Sustainable Development Goals, and the Essential Functions of Public Health) were identified as supporting the specific elements of the persons-centered mutual and integral healthcare strategy.3. The relevance of the essential concept of health and the elements of the examined general health strategy was ascertained positively to respond to the demands of the current pandemic.Discussion: The value, implications, and limitations of the results obtained were discussed in the light of COVID-19 and future pandemics. Emerging recommendations on desirable next steps were also presented.Conclusions: The contributions of this study include the ontological clarification of the concept of person-centered health and the strategies and tactics for health actions, as well as the historical and contemporary multifactorial substantiation of the general health strategy involving Integral and Mutual Health Care Oriented to the Well-being of all Persons, particularly in the face of the demands of the COVID-19 pandemic.

Person-Centered Health Intervention Programs, Provided at Home to Older Adults with Multimorbidity and Their Caregivers: Protocol for a Systematic Review.

The WHO has been promoting the paradigm shift in health care towards person-centered care, considering this strategy as fundamental for the personalization of care, but globally, the implementation of person-centered health intervention programs is still in an early stage. Older adults have high morbidity rates, which are often precursors to functional dependence on informal caregivers. Person-centered health intervention programs may answer the vulnerability of older adults and their caregivers, but they are not yet intensively implemented. This systematic literature review aims to identify which person-centered health programs exist in-home settings for this population and show the health gains. Methods: A systematic review of the literature will be conducted in the following databases: PubMed, CINAHL, MedicLatina, Scopus, and MEDLINE. The search strategy will contain the following MesH terms or similar: "older adults", "caregivers", "home care", and "patient-centered care." Criteria inclusion: Person-centered health intervention programs performed to older adults and their caregivers' in-home context; scientific articles from 2017 to 2022. For the extraction and synthesis, two independent reviewers will quality analyze the inclusion and exclusion criteria and the data quality analysis. Disagreements will be resolved by a third reviewer.

Harnessing People's Lived Experience to Strengthen Health Systems and Support Equitable Musculoskeletal Health Care.

BACKGROUND: Despite the rising burden of musculoskeletal (MSK) problems (MSK conditions, MSK pain, and MSK injury and trauma) in most countries, actions to improve (strengthen) systems for supporting MSK health are often low on the priority list, relative to other noncommunicable diseases. Delivering effective, person-centered and equitable MSK health care requires strengthening systems for health, for example, through policy, financing, service delivery, and workforce initiatives. A critical, but often overlooked component is genuine integration of lived experience perspectives to cocreate care and systems that are responsive to people's needs and contexts. CLINICAL QUESTION: How can cocreation approaches support effective, person-centered and equitable MSK health care? What principles can stakeholders adopt to build responsive health systems? KEY RESULTS: Lived experience perspectives are not systematically integrated in initiatives to strengthen health systems. However, such integration is critical to creating equitable and person-centered health systems that provide care and support healthy populations. Cocreation principles and frameworks can guide processes to strengthen health systems, which must include historically marginalized groups and consider social and environmental contexts as they relate to health. CLINICAL APPLICATION: Clinicians, educators, and policy-makers play a critical role in creating equitable health systems and environments, and driving system reform with people who have lived experience. Genuine cocreation approaches capture diverse economic development (in particular, low-resource settings where health inequities are more prevalent), span the life course and diagnostic categories, are appropriate and/or adapted for the context and setting, and reflect evolving standards and opportunities for MSK health. J Orthop Sports Phys Ther 2023;53(4):1-10. Epub: 12 December 2022. doi:10.2519/jospt.2022.11427.

How the Esther Network model for coproduction of person-centred health and social care was adopted and adapted in Singapore: a realist evaluation

ObjectivesThe Esther Network (EN) model, a person-centred care innovation in Sweden, was adopted in Singapore to promote person-centredness and improve integration between health and social care practitioners. This realist evaluation...

The Social Contexts of Birthing People with Public- and Private-Payer Prenatal Care: Illuminating an Understudied Aspect of the Patient Experience.

In pursuit of more equitable and person-centered health care, patients and professional medical societies increasingly call for better clinician understanding of patients' perspectives and social contexts. A foundational but understudied aspect of patients' social contexts are the ideas they encounter about health-related behaviors. We investigated this aspect of the social contexts of birthing people, comparing those with public versus private insurance to discover setting-specific insights. Based on ethnographic fieldwork, we created an original survey featuring 29 statements about 12 prenatal, perinatal, and postpartum health behaviors (e.g., drinking alcohol, epidural use, breastfeeding). Participants were 248 individuals receiving prenatal care in Northern California in 2009-2011, split evenly between public- and private-payer coverage. Participants reported whether they were familiar or unfamiliar with each statement. Ninety-eight percent of all participants had heard contradictory ideas about ≥1 health behavior (mean=3.9 behaviors for public- and 5.4 for private-coverage respondents). For 20 of the 29 behavior-related ideas, exposure varied significantly by coverage type. Among other differences, public-coverage respondents were much more familiar with ideas related to risk and constrained autonomy (e.g., that serious perinatal complications are common; that new mothers should try to breastfeed even if they do not want to). Birthing people are exposed to a wide range of ideas about health behaviors, many of which vary by the structural systems in which they are embedded. Understanding and engaging this complexity can help clinicians to provide more respectful, person-centered, and equitable maternity care.

Propuestas para salir de la crisis

Primary health care crisis is shown in user satisfaction surveys and in the discouragement of professionals. Government, scientific societies, and unions have drawn up numerous documents with proposals to get out of the crisis, but very few have been applied or ended up with a significant change. The crisis is inherent to the primary care discipline because person centered care and population health condition interventions are not aligned with the growing medicalization of a health system focused on health problems care. The proposals are along the following lines: the integration of services in order to deal with the growing increase in chronic pathologies and comorbidity; the transition from control and command leadership to shared leadership; innovations aimed at easing the shortage of family doctors, including increasing other team members and the incorporation of new professions; organizational innovations aimed to improve accessibility, but at the same time increase continuity; the rational use of telemedicine; the modification of the undergraduate curriculum to finally include the discipline of family medicine; and the generalization of successful local community care projects. The future economic crisis, the shortage of professionals and the growing population aging could lead to the gradual application of some of these proposals, since it is not expected that a radical reform will take place.

Reasons to use constructivist principles to prepare the workforce for personalized and person-centred health care

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Intelligent Healthcare Provided by Nano-Enhanced Biosensing Systems: Progress in COVID-19 Management via the Artificial Neural Network Approach

Biosensors using opto electronics mechanisms are evolving as efficient (sensitive and selective) and low-cost analytical diagnostic devices for early-stage disease diagnosis, which is crucial for person-centered health and wellness management. Due to advancements in nanotechnology in the areas of sensing unit fabrication, device integration, interfacing, packaging, and sensing performance at the point-of-care (POC), personalized diagnostics are now possible, allowing doctors to tailor tests to each patient’s unique disease profile and management requirements. Innovative biosensing technology is being pushed as the diagnostic tool of the future because of its potential to provide accurate results without requiring intrusive procedures. Because of this, this visionary piece of writing explores analytical methods for managing personalised health care that can enhance the health of the general population. The end goal is to take control of a healthier tomorrow as soon as possible. Right now, the most crucial part of controlling the COVID-19 pandemic, a potentially fatal respiratory viral disease, is the rapid, specific, and sensitive detection of human beta severe acute respiratory system coronavirus (SARS-CoV-2) protein.

PERSON-CENTERED CARE STARTS IN THE CLASSROOM: AN ACADEMIC JOURNEY OF REFINING CURRICULUM AND CULTURE

Background: Person-centered health care is becoming the norm which has prompted a need for educating academic and health care professionals upstream to embed this culture and philosophy in graduates prior to beginning their role in a professional health care setting. The Planetree International Certification for Excellence in Person-Centered Care is recognized as the highest mark of achievement an organization can earn, demonstrating a commitment to include patients, families, staff, and the community in the planning process to improve overall health and well-being. Previously the Planetree certification had been reserved for health care enterprises. This article highlights the journey of the first academic institution to achieve the Planetree Silver Certification level of recognition.Methods: Gap analyses of curriculum, culture, operations, student resources, and data for evidence-based evaluation were systematically undertaken.Results: After 18 months of collaboration, multiple site visits by Planetree leaders, and the compilation of a 550+ page self-study detailing the methodology used to address each Planetree standard of person centeredness, the National University, former School of Health and Human Services achieved the level of Planetree Certified Silver recognition.Conclusions: Achieving sustained success remains a continuum of efforts and embraces the journey to the destination while celebrating successes along the way. Early faculty engagement and “grass roots” efforts were sought to lead the National University former School of Health and Human Services toward the first-of-a-kind academic Planetree Silver Certification. Efforts are underway in seeking the Planetree Gold Certification level.

Putting life on hold: A longitudinal phenomenological-hermeneutic study of living with [or close to someone with] an enterocutaneous fistula before and after reconstructive surgery.

Illuminate meanings of living with [or close to someone with] an enterocutaneous fistula before and after reconstructive surgery. Enterocutaneous fistula is a serious condition affecting the well-being and social life of both patients and families, sometimes for several years. A longitudinal qualitative design. Patients and families (n=14) were followed with dyadic interviews at three occasions, conducted 2017-2020. The interviews were analysed with a phenomenological-hermeneutic approach. COREQ guidelines were followed. Living with an enterocutaneous fistula was explained as life being put on hold, while living in a bubble for an uncertain time. This bubble meant facing an unpredictable and restricted life where the dyads were forced to take control over the situation despite being vulnerable inside, striving to resume normality. The patients dealt with never-ending symptoms such as leakage from the fistula, pain and fatigue, while the family supported with practical matters and just being close. Dependency on intravenous fluids resulted in social isolation, which caused mode swings and depressiveness. In this situation, healthcare professionals often became a substitute for other interactions, but the lack of understanding about the dyads' situation, affected their trust in the healthcare. Despite all, they still had belief in the future, the patients having higher expectations than the family. Living with an enterocutaneous fistula meant a daily life struggling with many limitations. This implies that the transition was associated with difficulties and the dyads strived to accept their situation. The findings indicate that these patients must be cared for with a multidisciplinary approach. A person-centred health plan could impact on the dyads' feeling of control and thereby making them less dependent on healthcare. Every patient should have their own contact nurse and be offered psychological support. Not applicable due to the current method.

"Post-Roe" Abortion Policy Context Heightens the Imperative for Multilevel, Comprehensive, Integrated Health Education.

The exceptionalism of abortion in public health education, due to social stigma, politicization, and lack of training, contributes to misinformation, policies unjustified by rigorous science, lack of access to person-centered health care, and systemic pregnancy-related inequities. Now that abortion access has vanished for large portions of the United States, following the Supreme Court decision in Dobbs v. Jackson Women’s Health Organization (JWHO), health educators must work to eliminate abortion-related silos, destigmatize abortion education, and bring comprehensive sexual and reproductive health information and evidence to the many audiences that will require it. We discuss consequences of abortion exceptionalism in health education for the public, health care providers, pregnant people, and health professionals in training—and opportunities to better and more accessibly provide sexual and reproductive health education to these audiences.

Tailored interviewing to uncover the perspectives of children with multiple disabilities on daily activities: A qualitative analyses of interview methods and interviewer skills.

Uncovering the perspective of children with multiple disabilities is important in health care to enable person-centred health care. For occupational therapists, uncovering the child perspective on meaningful activities is necessary to set appropriate goals for treatment. It is not always evident that children with multiple disabilities can express themselves in an interview. The interviewer should adapt his communication to the child. In literature, alternative communication is widely studied, but a clear algorithm for deciding what to use to successfully gain insight into the child perspective is missing. This study aims to identify helpful interview techniques and interviewer skills and how they can be used to effectively uncover the perspective of children. Videos of nine interviews with children with a mitochondrial disorder, conducted by an occupational therapist, were analysed by five researchers. The interviews were analysed to see how well the interviewee had obtained the child's perspectives followed by observation of communicative abilities of the child and the types of questions the interviewer asked. A qualitative directed content analysis of the semi-structured interviews followed. An interview pattern was observed in the children's communication leading to six successful interviews. Children communicated verbally on four different levels and also used non-verbal communication. The interviewer used five types of questions, which varied between and within the children. The content analysis resulted in two themes: parental influences and interviewer skills. Results show the importance of matching the type of questions to the verbal communication level of the child and revealed several interviewer skills and techniques. An overview to guide tailor-made interviewing is presented. The interviewer has a major role in successful interviewing and thus in enabling the inclusion of the child perspective in research and care.

CULTURE IN PERSON- AND PEOPLE-CENTERED HEALTH CARE

Background: Person- and people-centered medicine (PCM) underscores the importance of accounting for culture and cultural values.
 Objective: The objective of this article is to clarify the concept of culture and describe misleading or faulty ways of understanding this concept in averting blind-spots for culture in person- and people-centered health care.
 Method: Drawing on the conceptualization of PCM, the philosophy of values, values-based Practice, and principles of anthropology, misleading or faulty ways of understanding the concept of culture are identified by meeting criteria of conflation, confusing contingency as if necessity, being too narrow, or contracting blind-spots.
 Results: Six ways of understanding the concept of culture are identified that may undermine person-centered practice. These may be corrected by understanding culture as necessarily constituted by a set of shared practices underpinned by values. So understood, this clarifies the distinction between culture and group identity, and that: subcultures and counter-cultures are proper cultures; symbols, language, and geographic locality are contingent qualities of culture; culture is subject to change and not fixed by history or an individual’s group identity; and that culture is readily ascribed to others/foreigners owing to blind-spots for one’s own culture.
 Conclusion: By averting too narrow an understanding of culture and overcoming one’s blind-spot for one’s own cultural values, the clinician may recognize and account for culture and cultural values in person-centered health care. When the differences in cultural values bring about conflict or potential alienation in the interpersonal relationship, the differences need to be subjected practically to a process of dissensual decision-making, accounting for the uncommon ground within a safe space created by common ground and consensus.

Designing narrative for professional development: A programme for improving international health care practitioners’ cultural competence

To maintain and improve skills for practice, health care professionals across all disciplines need to engage in ongoing professional development. However, helping clinicians learn and apply new knowledge in practice can be challenging. This article reports on a purpose-designed professional development programme targeting experienced practitioners of a particular music therapy, focusing on their cultural competency. The author conceptualised a workshop format with a relevant clinical scenario at its centre. She describes how she developed the programme, which she subsequently delivered to an international community of 57 practitioners attending professional development conferences. To capture participants’ reactions and evidence of their new thinking applied to an everyday clinical practice, she used Brookfield’s Critical Incident Questionnaire (CIQ). Her analysis of the data, which provided feedback on the training scenario and structured group discussion materials, found that this continuing professional development training workshop was effective in challenging clinicians to think differently, and to plan the application of their newly acquired knowledge to their everyday practice. This paradigmatic case study contributes new knowledge towards the current reform of health systems, where achieving person-centred health care depends on the ongoing professional development of established health practitioners. Replacing traditional health care, where the patient receiving treatment is accorded a passive role, person-centred health care engages patients’ active participation in their therapy. Practitioners who have graduated a while ago therefore need to change some of their ingrained practices and approaches in treating their clients and patients, which will then lead to improved health outcomes.

Living with frailty and haemodialysis: a qualitative study

BackgroundFrailty is highly prevalent in people receiving haemodialysis (HD) and is associated with poor outcomes. Understanding the lived experiences of this group is essential to inform holistic care delivery.MethodsSemi-structured interviews with N = 25 prevalent adults receiving HD from 3 HD units in the UK. Eligibility criteria included a Clinical Frailty Scale (CFS) score of 4–7 and a history of at least one fall in the last 6 months. Sampling began guided by maximum variation sampling to ensure diversity in frailty status; subsequently theoretical sampling enabled exploration of preliminary themes. Analysis was informed by constructivist grounded theory; later we drew upon the socioecological model.ResultsParticipants had a mean age of 69 ± 10 years, 13 were female, and 13 were White British. 14 participants were vulnerable or mildly frail (CFS 4–5), and 11 moderately or severely frail (CFS 6–7). Participants characterised frailty as weight loss, weakness, exhaustion, pain and sleep disturbance arising from multiple long-term conditions. Participants’ accounts revealed: the consequences of frailty (variable function and psychological ill-health at the individual level; increasing reliance upon family at the interpersonal level; burdensome health and social care interactions at the organisational level; reduced participation at the community level; challenges with financial support at the societal level); coping strategies (avoidance, vigilance, and resignation); and unmet needs (overprotection from family and healthcare professionals, transactional health and social care exchanges).ConclusionsThe implementation of a holistic needs assessment, person-centred health and social care systems, greater family support and enhancing opportunities for community participation may all improve outcomes and experience. An approach which encompasses all these strategies, together with wider public health interventions, may have a greater sustained impact.Trial registrationISRCTN12840463.

The role of the home health care physician in mobile integrated care: a qualitative phenomenograpic study

BackgroundAn increasing older population, along with the organizational principle of remaining at home, has moved health care from institutions into the older person’s home, where several health care providers facilitate care. The Mobile Integrated Care Model strives to provide cost-efficient, coherent, person-centered health care in the home. In the integrated care team, where the home health care physician is the medical authority, several health care professions work across organizational borders. Therefore, the aim of this study was to describe Home Health Care Physicians perceptions of working and providing health care in the Mobile Integrated Care Model, as well as perceptions of participating in and forming health care.MethodsA phenomenographic qualitative study design, with semi-structured interviews using an interview guide.ResultsWorking within Mobile Integrated Care Model was a different way of working as a physician. The physicians’ role was to support the patient by making safe medical decisions. Physicians described themselves as a piece in the team puzzle, where the professional knowledge of others was crucial to give quality health care. Being in the patients’ homes was expressed as adding a unique dimension in the provision of health care, and the physicians learned more about the patients by meeting them in their homes than at an institution. This aided the physicians in respecting patient autonomy in medical decision making, even though the physicians sometimes disregarded patient autonomy in favor of their own medical experience. There was a divided view on next of kin participation among the home health care physicians, ranging from always including to total absence of involving next of kin in decision making.ConclusionsThe home health care physicians described the Mobile Integrated Care Model as the best way to work, but there was still a need for additional resources and structure when working in different organizations. The need for full-time employment, additional time or hours, more equipment, access to each other’s medical records, and additional collaboration with other health care providers were expressed, which could contribute to increased work satisfaction and facilitate further development of person-centered care in the Mobile Integrated Care Model.