Articles
What is Patient-centred care? (5)
- November 15, 2021
- Posted by: mghalandari
- Category: Definition Digital health
Patient-Centered vs Person-Centered Care
Both patient-centered and person-focused care are important, but they are different. In contrast to patient-centered care (at least as described in the current study with assessments that are visit-based), person-centered care is based on accumulated knowledge of people, which provides the basis for better recognition of health problems and needs over time and facilitates appropriate care for these needs in the context of other needs.
That is, it specifically focuses on the whole person. Proposed enhancements and innovations to primary care do not appear to address person-centered care. Tools to assess person-centered care are available and deserve more widespread use in primary care.
Patient-centered is a term in widespread use. For example, the recent movement toward reforming primary care is known as the patient-centered medical home. The preponderance of the literature assesses patient-centered care by focusing on visits involving care of (generally chronic) diseases, whereas person- centered care is provided to patients over time independent of care for particular diseases.
Both patient-centered care and person- centered care require adequate recognition of health problems experienced by people. Care is better when it recognizes what patients’ problems are rather than what the diagnosis is. The challenge is to do better at recognizing and documenting their problems. Assessing quality of problem recognition requires documenting the problems and how they change in response to what clinicians do.
Diagnoses are professional interpretations of observations and, increasingly, of laboratory values. A few primary care researchers in various countries have been trying at least since the late 1980s to understand the relationship between presenting problems and eventual diagnoses. There is still poor understanding of this relationship, and the more it is neglected, the less attention can be focused on problem reduction over time as a legitimate goal of treatment.
Chronic Care Management: The chronic care model is theoretically consistent with the primary care focus on care over time. It deviates from primary care in its application. Chronic has been interpreted as if it referred to chronic disease. This makes it inherently incompatible with primary care, which is person- centered. All of the implementations of chronic care management are disease-oriented, and they have all of the problems of disease-oriented care.
The Patient-Centered Medical Home: The patient-centered medical home, at least as reflected in the requirements for qualification, is heavily focused on care in the context of disease management or communication within specific encounters. There are notable exceptions. Some studies evaluated interventions consisting of elements such as secure e-mail interactions between patients and health care professionals, disease registries, care planning, self-management strategies, increased outreach to patients, team discussions, performance evaluation, practice teams, population profiling, home health, and designated specialists in settings where there was excellent primary care and included all patients (not just those with selected chronic diseases).
The importance of person focus is also recognized in the Primary Care Assessment Tool a suite of comparable instruments for use in population health surveys, patient surveys of their experiences with primary care, clinician surveys of reports of primary care functions, and surveys of managers of health facilities.
Interactions between patients and clinicians are changing. Patient portals, virtual visits, asynchronous consulting, and remote monitoring are becoming increasingly common. They will be useful only to the extent that people are confident in their clinicians’ accumulated knowledge of their problems. Person- centered care over time, not just patient-centered interactions, requires a new strategy to ensure responsiveness to patient’s problems as they experience them, not only as professionals define them.