Hoorcolleges en kennisclips – Patient centered care delivery
Thema 1 (05-09) – Introduction to PCCD
College
Person-centered care
“Providing care that is respectful of and
responsive to individual patient preferences,
needs, and values and ensuring that patient
values guide all clinical decisions.”
It has become a trend over the years.
Organizing person-centered care is
not easy. We need to address a lot of
things.
If you have a chronic illness. It’s not only the
physical well-being, but also it has impact on
your social life.
8 dimensions of patient-centered care
Patient preferences
o What does the patient want.
o Know what their goals are and stimulate them to set and achieve treatment goals.
o The values of the patient should guide the treatment choices.
o Examples: care is often centered about weight. But this is not always the main treatment
outcome.
Information and education
o It is important that we make sure that the patient is in charge. You need the information to
make the right choices.
o Cross information in the right way to the patient.
o Example: some patients who might be hoping on weightless, they have tried diets. They won’t
be helped with simple lifestyle education. The information won’t match their needs.
Access to care
o Healthcare needs to be accessible. Waitlists not too long, financial accessible.
o Insurance.
o Example: some providers lack to give the right care for people with obesity.
Physical comfort
o We pay attention to the physical effects of an illness of disease. The physical well-being.
o It’s not only the comfort connected to the illness, also to the care provider.
o Privacy, clean and comfortable waiting rooms.
o Example: major risk factor for developing other chronic illnesses. Cause a lot of discomfort.
Emotional support
o Having an illness is often combined with anxiety or sadness.
o It’s important as a professional to give attention and emotional support.
o Recognizing that something is going on is important.
o Example: emotional stress. People have different needs in care and support.
1
, Hoorcolleges en kennisclips – Patient centered care delivery
Family and friends
o An illness does not only have an impact on the patient, but also on the family. Addressing the
questions and needs of family is important.
o Examples: people with obesity sometimes don’t feel the support in their environnement.
Coordination of care
o Whitin 1 healthcare organization
o Communication between care professionals has to be good. For example with diabetes (2x a
year to the GP, 3x a year to the nurse).
Continuity and transition
o When multiple healthcare organizations are involved
o Besides the nurse and GP, also physiotherapist for example.
o Multidisciplinary meetings
You need a certain level of all the levels to become more patient-centered.
Model van Rathert (2012)
If you organize care to the order of the 8 dimensions of patient-
centered care, it will lead to better outcomes.
Organizing patient-centered care is not easy. A lot of
organizations want to work that way.
Barriers to patient-centered care (3 levels)
Patient differences in patient needs and health
literacy.
o Every patient is different and different needs.
Organization Differences in education, motivation
and skills of healthcare professionals/organizations
o In order to deliver person-centered care, an
organization has to be motivated.
o Differences in skills of professionals
National restrictive information sharing and a lack of supportive financial structures.
o Not all information systems work together.
o For example, changes in medication are not possible to connect in all systems.
o It’s not always doable to work patient centered. Financial wise.
Person-centered care for people living with obesity.
Obesity has been recognized as a chronic and relapsing disease. It’s often difficult to reverse.
2
, Hoorcolleges en kennisclips – Patient centered care delivery
Underlining causes of obesity in adults
Some causes are very rare. Other factors are more common involved.
A physical environment is important to know. Is healthy food affordable. Financial concerns? Hormonal causes.
This figure is to show the complexity of obesity, and how hard it is that a one-size-fits-all approach would fail.
A lot of treatment can be disappointed cause it does not work. It is mainly focused on weight loss.
Weight stigma
= Discrimination or bias towards individuals because of their weight or size.
Also, prevalent (negative experience) in healthcare settings
o Example: Professionals making negative assumptions about their weight. Patients been
treated unfairly.
A barrier to the provision of PCC for patients living with obesity.
o Example: patients are getting less time in their appointment.
Thema 2 (08-09) – Co-creating care delivery: interactions between
professionals and patients, shared dicision-making
College
S(M)DM: what?
Huge amount of literature on the subject since ca. 1982
Decision-making model situated on a continuum between two extremes: paternalism (the physician is
the one who decides what kind of treatment the patient is getting) and consumerism (informed choice,
the patient decides)
Numerous definitions and descriptions of shared decision making. Essentials: define/explain problem,
present options, discuss pros/cons (benefits, risks, costs), patient values/preferences, discuss patient
ability/self-efficacy, doctor knowledge/recommendations, check/clarify understanding, make or
explicitly defer decision, arrange follow-up.
o The decision is made together.
SDM is a 3 step process.
Briefly:
o There is exchange of information between a patient and his doctor, medical and personal
information included (choice talk).
Physician has medical expertise, and the patient also knows what he wants and how
to deal with the disease.
o Possible options and outcomes are discussed and considered by patient and doctor (option
talk)
During the option talk, the physician is presenting the options. And the patient is
going to access them.
o Doctor and patient reach consensus about what need to be done (decision talk).
Both doctor and patient are going to decide what’s next.
Please note that there does not seem to be one route.
S(M)DM: why?
From different expertise is a view on SDM.
Ethicists:
o The right of patients to determine what happens to their bodies is self-evident. S(M)DM
increases autonomy. It enables patient to make their own choices.
Economists:
o Increase in consumer power is a means to subject health care providers to market discipline.
S(M)DM will increase cost effectiveness.
o Less hospitalization
Epidemiologists:
3
Thema 1 (05-09) – Introduction to PCCD
College
Person-centered care
“Providing care that is respectful of and
responsive to individual patient preferences,
needs, and values and ensuring that patient
values guide all clinical decisions.”
It has become a trend over the years.
Organizing person-centered care is
not easy. We need to address a lot of
things.
If you have a chronic illness. It’s not only the
physical well-being, but also it has impact on
your social life.
8 dimensions of patient-centered care
Patient preferences
o What does the patient want.
o Know what their goals are and stimulate them to set and achieve treatment goals.
o The values of the patient should guide the treatment choices.
o Examples: care is often centered about weight. But this is not always the main treatment
outcome.
Information and education
o It is important that we make sure that the patient is in charge. You need the information to
make the right choices.
o Cross information in the right way to the patient.
o Example: some patients who might be hoping on weightless, they have tried diets. They won’t
be helped with simple lifestyle education. The information won’t match their needs.
Access to care
o Healthcare needs to be accessible. Waitlists not too long, financial accessible.
o Insurance.
o Example: some providers lack to give the right care for people with obesity.
Physical comfort
o We pay attention to the physical effects of an illness of disease. The physical well-being.
o It’s not only the comfort connected to the illness, also to the care provider.
o Privacy, clean and comfortable waiting rooms.
o Example: major risk factor for developing other chronic illnesses. Cause a lot of discomfort.
Emotional support
o Having an illness is often combined with anxiety or sadness.
o It’s important as a professional to give attention and emotional support.
o Recognizing that something is going on is important.
o Example: emotional stress. People have different needs in care and support.
1
, Hoorcolleges en kennisclips – Patient centered care delivery
Family and friends
o An illness does not only have an impact on the patient, but also on the family. Addressing the
questions and needs of family is important.
o Examples: people with obesity sometimes don’t feel the support in their environnement.
Coordination of care
o Whitin 1 healthcare organization
o Communication between care professionals has to be good. For example with diabetes (2x a
year to the GP, 3x a year to the nurse).
Continuity and transition
o When multiple healthcare organizations are involved
o Besides the nurse and GP, also physiotherapist for example.
o Multidisciplinary meetings
You need a certain level of all the levels to become more patient-centered.
Model van Rathert (2012)
If you organize care to the order of the 8 dimensions of patient-
centered care, it will lead to better outcomes.
Organizing patient-centered care is not easy. A lot of
organizations want to work that way.
Barriers to patient-centered care (3 levels)
Patient differences in patient needs and health
literacy.
o Every patient is different and different needs.
Organization Differences in education, motivation
and skills of healthcare professionals/organizations
o In order to deliver person-centered care, an
organization has to be motivated.
o Differences in skills of professionals
National restrictive information sharing and a lack of supportive financial structures.
o Not all information systems work together.
o For example, changes in medication are not possible to connect in all systems.
o It’s not always doable to work patient centered. Financial wise.
Person-centered care for people living with obesity.
Obesity has been recognized as a chronic and relapsing disease. It’s often difficult to reverse.
2
, Hoorcolleges en kennisclips – Patient centered care delivery
Underlining causes of obesity in adults
Some causes are very rare. Other factors are more common involved.
A physical environment is important to know. Is healthy food affordable. Financial concerns? Hormonal causes.
This figure is to show the complexity of obesity, and how hard it is that a one-size-fits-all approach would fail.
A lot of treatment can be disappointed cause it does not work. It is mainly focused on weight loss.
Weight stigma
= Discrimination or bias towards individuals because of their weight or size.
Also, prevalent (negative experience) in healthcare settings
o Example: Professionals making negative assumptions about their weight. Patients been
treated unfairly.
A barrier to the provision of PCC for patients living with obesity.
o Example: patients are getting less time in their appointment.
Thema 2 (08-09) – Co-creating care delivery: interactions between
professionals and patients, shared dicision-making
College
S(M)DM: what?
Huge amount of literature on the subject since ca. 1982
Decision-making model situated on a continuum between two extremes: paternalism (the physician is
the one who decides what kind of treatment the patient is getting) and consumerism (informed choice,
the patient decides)
Numerous definitions and descriptions of shared decision making. Essentials: define/explain problem,
present options, discuss pros/cons (benefits, risks, costs), patient values/preferences, discuss patient
ability/self-efficacy, doctor knowledge/recommendations, check/clarify understanding, make or
explicitly defer decision, arrange follow-up.
o The decision is made together.
SDM is a 3 step process.
Briefly:
o There is exchange of information between a patient and his doctor, medical and personal
information included (choice talk).
Physician has medical expertise, and the patient also knows what he wants and how
to deal with the disease.
o Possible options and outcomes are discussed and considered by patient and doctor (option
talk)
During the option talk, the physician is presenting the options. And the patient is
going to access them.
o Doctor and patient reach consensus about what need to be done (decision talk).
Both doctor and patient are going to decide what’s next.
Please note that there does not seem to be one route.
S(M)DM: why?
From different expertise is a view on SDM.
Ethicists:
o The right of patients to determine what happens to their bodies is self-evident. S(M)DM
increases autonomy. It enables patient to make their own choices.
Economists:
o Increase in consumer power is a means to subject health care providers to market discipline.
S(M)DM will increase cost effectiveness.
o Less hospitalization
Epidemiologists:
3
