Week 1
Lecture 1: Introduction to PCCD
Patient centered care delivery
There is consensus on the importance of patient centered care in research and healthcare
organizations. However, patient centered care is not easy.
In the Netherlands 94% of patients wants to participate, 48% of them find it hard to take an active
role in their care and 22% find it extremely hard
Healthcare professionals’ views about PCCD
- Very often patients are not supported to set their own goals; it is the doctor telling them
- When they (patients) tell their story to different people, different information comes out
- Bad communication, not ineffective and miscommunication is probably the most significant
reason why errors happen
In Europe, 47% of the population has trouble understanding healthcare information communication
between professional and patients, leaflets, medication/treatment prescriptions. In the Netherlands
30% is unable to use the information that was handed to them.
Lower educated people, lower income level, old people and people who often use healthcare have
more difficulty understanding the information. As a result, diverse care is needed for the different
groups in the population.
Patient centered care is hard, we know it works but are clueless to what it looks like. Studies show
positive relationships between patient centered care and more positive outcomes (better
organization and patient outcomes).
In research it is shown that out of 3000 medical treatments in the hospital setting, 11% was proven
to be effective, 24% was probably effective, 7% had both positive and negative effects, 8% is likely
not effective and 50% is unknown. Concluding, there is a lack of evidence for many interventions.
Besides, evidence is not the same for all patient groups. It takes longer to diagnose patients with a
lower educational level as they have more difficulties in explaining their problems. In the Netherlands
life expectancy is 7 years lower for lower educated compared to higher educated individuals and
they live longer in a poorer health status.
Movement from authority-based care to evidence based care to context based medicine
There is a movement going on from authority based care in which the professional took all the
decisions themselves based on their authority to evidence based medicine in which the same care is
given to all patient populations based on the evidence now leading to context based medicine in
which care should differ for different populations. It is very important to take all needs and wants of
patients into account and make decisions together > context matters.
Diversity in care delivery is needed; there is not 1 type of care that fits all patient groups in society.
1
,Social production function theory
Patient centered care is a growing movement in healthcare organizations to improve healthcare.
Overall wellbeing exists out of physical well-being and social well-being, which exist of instrumental
goals.
- Comfort: the presence of a safe, pleasant environment and the absence of physiological
needs (pain, hunger, thirst)
- Stimulation: to have a physical or mental activity to prevent boredom
- Affection: friendship, intimacy and emotional support from relatives
- Behavioral confirmation: living according to relevant others’ or own norms
- Status: social ranking based on occupation, lifestyle
The social production function is based on the concept that people make diverse efforts to improve
their living conditions with the aim of achieving physical and social well-being
Defintition patient centered care
Patient centered care is healthcare that establishes a partnership among practitioners, patients, and
their families (when appropriate) to ensure decisions respect patients’ wants, needs, and preferences
and that patients have the education and support they need to make decisions and participate in
their own care.
2
,The 8 dimensions of patient centered care
- Respect for patient preferences – the interaction between healthcare professionals and
patients. Professionals and patients need to treat patients and professionals with dignity and
respect. Professionals should ask about needs, wants and preferences of patients as
healthcare is more effective when adjusted to those preferences. Patients set their own
treatment goals; not only about the physical aspect but also quality of life.
- Access to care – it should be easy to schedule an appointment in a care organization. But it is
not only about the physical accessibility, but also the setting; are there clear directions in the
hospital (do you know where to go), easy access for those who are blind, speak foreign
language, appointments online/ by phone, acceptable waiting times.
- Emotional support – when being severely/terminally ill, not only the physical state needs
attention but the emotional state as well; depressed about what has happened, anxious
about what to come. Mental quality of life is important as well. Physicians need to pay
attention to the mental state as well; not always their part of the job and not always able to
but they can refer to professionals that are able to offer the support needed.
- Physical comfort – helping people in their daily living needs; pain management (patient self
in illness), setting of organizations (hygiene, comfort (chair), privacy, chemo garden
- Family and friends – when having chronic conditions or being a child, the illness impacts
patient, but family and friends as well as they need to adjust their lives to the condition.
Professionals need to take into account the needs and questions of relatives as well, how
they can support patients best, what to do to help them.
- Information and education – patients need to be in charge of their own care and therefore
need to be informed and understand it. Everyone needs to understand the given
information, and therefore it needs to be provided in different ways depending on the
patient. Communication skills are very important. For example the use of decision aids to see
what treatment options exist and read about it and what suits them best. Those aids are
rarely used as patients don’t always understand it as medical jargon is hard.
- Continuity and transition – multiple professionals are often used in the care process
(specialist, GP, psychologist). Patient information need to be transferred well between all
professionals involved to ensure continuity and transition. When patients are transferred to
other professionals they need to know why, where they need to go etc. Different physicians
of different organizations.
- Coordination of care – multiple professionals of one organization are often involved
(coordination between providers of one organization). For example in a GP practice the GP
and nurse practitioner. Here it is about multi-disciplinary meetings or having case managers
that patients know where to go when having questions (first point of contact). Different
physicians within the organization.
Investment and improvement on all the different dimensions is needed in order to become more
patient centered taking. It is important to invest in all of these 8 domains to improve patient
centered care delivery > better outcomes for patient and organization greater social and physical
well-being and satisfaction with care
Different barriers to delivering patient centered care
- Time – consultation hour is only 10 minutes, making it difficult to ask about other things
(emotional, anxiety etc.) than their problem for which they are visiting the professional.
- Money – investments have to be made in order to deliver good patient centered care;
communication trainings for professionals, information system between healthcare providers
to increase continuity.
- Patient characteristics – care is surrounded around the patient and therefore everything
should be adjusted to the patient. When not knowing the preferences of patients, what their
background is etc. it is hard to adjust the care to the patient.
3
, Conceptual model of Rather
Conceptual model Rathert the processes (eight dimensions of patient centered care) have a positive
influence on the patient and organizational outcomes
- Patient satisfaction
- Patient clinical outcomes (QoL – Quality of Life, well-being)
- Organizational outcomes (job satisfaction, quality of care, safety)
In this model there are moderators:
- A moderator is a third variable that affects the strength of the relationship between a
dependent and independent variable (age, patient conditions, expectations)
In this model there are mediators:
- Help explain how or why a relationship exists between an independent variable and
outcome; when taking all patient preferences into account in the treatment decision patient
adherence will be higher. Influencing the outcome > they may explain significant variance in
patient outcomes. A mediator explains the mechanisms that underlies an observed
relationship between an independent variable and a dependent variable (patient activation,
adherence)
This model may be applied by physicians. When two patients get the same treatment but differ in
outcomes, it may be interesting to look what is moderated and mediated to look for the reason why.
Interesting for the physician as they may use the process for other patients as well to increase
outcomes. More usable on micro level
4
Lecture 1: Introduction to PCCD
Patient centered care delivery
There is consensus on the importance of patient centered care in research and healthcare
organizations. However, patient centered care is not easy.
In the Netherlands 94% of patients wants to participate, 48% of them find it hard to take an active
role in their care and 22% find it extremely hard
Healthcare professionals’ views about PCCD
- Very often patients are not supported to set their own goals; it is the doctor telling them
- When they (patients) tell their story to different people, different information comes out
- Bad communication, not ineffective and miscommunication is probably the most significant
reason why errors happen
In Europe, 47% of the population has trouble understanding healthcare information communication
between professional and patients, leaflets, medication/treatment prescriptions. In the Netherlands
30% is unable to use the information that was handed to them.
Lower educated people, lower income level, old people and people who often use healthcare have
more difficulty understanding the information. As a result, diverse care is needed for the different
groups in the population.
Patient centered care is hard, we know it works but are clueless to what it looks like. Studies show
positive relationships between patient centered care and more positive outcomes (better
organization and patient outcomes).
In research it is shown that out of 3000 medical treatments in the hospital setting, 11% was proven
to be effective, 24% was probably effective, 7% had both positive and negative effects, 8% is likely
not effective and 50% is unknown. Concluding, there is a lack of evidence for many interventions.
Besides, evidence is not the same for all patient groups. It takes longer to diagnose patients with a
lower educational level as they have more difficulties in explaining their problems. In the Netherlands
life expectancy is 7 years lower for lower educated compared to higher educated individuals and
they live longer in a poorer health status.
Movement from authority-based care to evidence based care to context based medicine
There is a movement going on from authority based care in which the professional took all the
decisions themselves based on their authority to evidence based medicine in which the same care is
given to all patient populations based on the evidence now leading to context based medicine in
which care should differ for different populations. It is very important to take all needs and wants of
patients into account and make decisions together > context matters.
Diversity in care delivery is needed; there is not 1 type of care that fits all patient groups in society.
1
,Social production function theory
Patient centered care is a growing movement in healthcare organizations to improve healthcare.
Overall wellbeing exists out of physical well-being and social well-being, which exist of instrumental
goals.
- Comfort: the presence of a safe, pleasant environment and the absence of physiological
needs (pain, hunger, thirst)
- Stimulation: to have a physical or mental activity to prevent boredom
- Affection: friendship, intimacy and emotional support from relatives
- Behavioral confirmation: living according to relevant others’ or own norms
- Status: social ranking based on occupation, lifestyle
The social production function is based on the concept that people make diverse efforts to improve
their living conditions with the aim of achieving physical and social well-being
Defintition patient centered care
Patient centered care is healthcare that establishes a partnership among practitioners, patients, and
their families (when appropriate) to ensure decisions respect patients’ wants, needs, and preferences
and that patients have the education and support they need to make decisions and participate in
their own care.
2
,The 8 dimensions of patient centered care
- Respect for patient preferences – the interaction between healthcare professionals and
patients. Professionals and patients need to treat patients and professionals with dignity and
respect. Professionals should ask about needs, wants and preferences of patients as
healthcare is more effective when adjusted to those preferences. Patients set their own
treatment goals; not only about the physical aspect but also quality of life.
- Access to care – it should be easy to schedule an appointment in a care organization. But it is
not only about the physical accessibility, but also the setting; are there clear directions in the
hospital (do you know where to go), easy access for those who are blind, speak foreign
language, appointments online/ by phone, acceptable waiting times.
- Emotional support – when being severely/terminally ill, not only the physical state needs
attention but the emotional state as well; depressed about what has happened, anxious
about what to come. Mental quality of life is important as well. Physicians need to pay
attention to the mental state as well; not always their part of the job and not always able to
but they can refer to professionals that are able to offer the support needed.
- Physical comfort – helping people in their daily living needs; pain management (patient self
in illness), setting of organizations (hygiene, comfort (chair), privacy, chemo garden
- Family and friends – when having chronic conditions or being a child, the illness impacts
patient, but family and friends as well as they need to adjust their lives to the condition.
Professionals need to take into account the needs and questions of relatives as well, how
they can support patients best, what to do to help them.
- Information and education – patients need to be in charge of their own care and therefore
need to be informed and understand it. Everyone needs to understand the given
information, and therefore it needs to be provided in different ways depending on the
patient. Communication skills are very important. For example the use of decision aids to see
what treatment options exist and read about it and what suits them best. Those aids are
rarely used as patients don’t always understand it as medical jargon is hard.
- Continuity and transition – multiple professionals are often used in the care process
(specialist, GP, psychologist). Patient information need to be transferred well between all
professionals involved to ensure continuity and transition. When patients are transferred to
other professionals they need to know why, where they need to go etc. Different physicians
of different organizations.
- Coordination of care – multiple professionals of one organization are often involved
(coordination between providers of one organization). For example in a GP practice the GP
and nurse practitioner. Here it is about multi-disciplinary meetings or having case managers
that patients know where to go when having questions (first point of contact). Different
physicians within the organization.
Investment and improvement on all the different dimensions is needed in order to become more
patient centered taking. It is important to invest in all of these 8 domains to improve patient
centered care delivery > better outcomes for patient and organization greater social and physical
well-being and satisfaction with care
Different barriers to delivering patient centered care
- Time – consultation hour is only 10 minutes, making it difficult to ask about other things
(emotional, anxiety etc.) than their problem for which they are visiting the professional.
- Money – investments have to be made in order to deliver good patient centered care;
communication trainings for professionals, information system between healthcare providers
to increase continuity.
- Patient characteristics – care is surrounded around the patient and therefore everything
should be adjusted to the patient. When not knowing the preferences of patients, what their
background is etc. it is hard to adjust the care to the patient.
3
, Conceptual model of Rather
Conceptual model Rathert the processes (eight dimensions of patient centered care) have a positive
influence on the patient and organizational outcomes
- Patient satisfaction
- Patient clinical outcomes (QoL – Quality of Life, well-being)
- Organizational outcomes (job satisfaction, quality of care, safety)
In this model there are moderators:
- A moderator is a third variable that affects the strength of the relationship between a
dependent and independent variable (age, patient conditions, expectations)
In this model there are mediators:
- Help explain how or why a relationship exists between an independent variable and
outcome; when taking all patient preferences into account in the treatment decision patient
adherence will be higher. Influencing the outcome > they may explain significant variance in
patient outcomes. A mediator explains the mechanisms that underlies an observed
relationship between an independent variable and a dependent variable (patient activation,
adherence)
This model may be applied by physicians. When two patients get the same treatment but differ in
outcomes, it may be interesting to look what is moderated and mediated to look for the reason why.
Interesting for the physician as they may use the process for other patients as well to increase
outcomes. More usable on micro level
4
