Consumer-Centered, Collaborative, and Comprehensive Care

DiClemente, Carlo C.; Norwood, Amber E. Q.; Gregory, W. Henry; Travaglini, Letitia E.; Graydon, Meagan M.; Corno, Catherine M.

doi:10.1097/jan.0000000000000120

Cited by 23 publications

(18 citation statements)

References 1 publication

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“…These frameworks emphasize respect for client diversity, an empowerment of people using substances and provider understanding of the varied impact that trauma and ethnicity/culture have on treatment expectations and experiences [4, 5, 20]. In addition, there are emerging interests in the design of patient-centered approaches for substance use disorder treatment (see for example [21–25]). Patient-centered care (PCC) has been widely recommended to strengthen the quality of health care [4, 26, 27] as it can be universally applied across treatments, settings and providers.…”

Section: Introductionmentioning

confidence: 99%

Conceptualizing patient-centered care for substance use disorder treatment: findings from a systematic scoping review

Marchand

Beaumont

Westfall³

et al. 2019

Subst Abuse Treat Prev Policy

140

110

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Background Despite ongoing efforts aimed to improve treatment engagement for people with substance-related disorders, evidence shows modest rates of utilization as well as client-perceived barriers to care. Patient-centered care (PCC) is one widely recognized approach that has been recommended as an evidence-based practice to improve the quality of substance use disorder treatment. PCC includes four core principles: a holistic and individualized focus to care, shared decision-making and enhanced therapeutic alliance. Aims This scoping review aimed to explore which PCC principles have been described and how they have defined and measured among people with substance-related disorders. Methods Following the iterative stages of the Arksey and O’Malley scoping review methodology, empirical (from Medline, Embase, PsycINFO, CINAHL and ISI Web of Science) and grey literature references were eligible if they focused on people accessing treatment for substance-related disorders and described PCC. Two reviewers independently screened the title/abstract and full-texts of references. Descriptive analyses and a directed content analysis were performed on extracted data. Findings One-hundred and forty-nine references met inclusion from the 2951 de-duplicated references screened. Therapeutic alliance was the most frequent principle of PCC described by references (72%); this was consistently defined by characteristics of empathy and non-judgment. Shared decision-making was identified in 36% of references and was primarily defined by client and provider strategies of negotiation in the treatment planning process. Individualized care was described by 30% of references and included individualized assessment and treatment delivery efforts. Holistic care was identified in 23% of references; it included an integrated delivery of substance use, health and psychosocial services via comprehensive care settings or coordination. Substance use and treatment engagement outcomes were most frequently described, regardless of PCC principle. Conclusions This review represents a necessary first step to explore how PCC has been defined and measured for people accessing substance use disorder treatment. The directed content analysis revealed population and context-specific evidence regarding the defining characteristics of PCC-principles that can be used to further support the implementation of PCC.

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Section: Introductionmentioning

confidence: 99%

Conceptualizing patient-centered care for substance use disorder treatment: findings from a systematic scoping review

Marchand

Beaumont

Westfall³

et al. 2019

Subst Abuse Treat Prev Policy

140

110

View full text Add to dashboard Cite

show abstract

“…Our study supports previous findings indicating that the lack of standardised processes and evidence-based guidelines widens the gap between theory and practice among PHC units. [ 7 ] Therefore, there is a negative impact on continuity, coordination, comprehensiveness and quality of PHC services for all patient categories [ 15 , 17 ]. A systematic review by Van der Klauw and colleagues (2014) suggested that effective IT systems constitute a core element for operational integration within PHC [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the country’s rapidly aging population, along with the high incidence of mental health disorders [ 14 ] and the growing burden of chronic diseases, [ 15 ] necessitate immediate actions towards an integrated, multidisciplinary network of well-coordinated and cost-effective services. Lack of integration can result in fragmentation of care and poor health outcomes, [ 16 ] as well as in problems related to funding, planning, effectiveness and operation of the healthcare system[ 17 ]. Substantial healthcare budget cuts and prolonged delay of major reform are jeopardising the NHS, putting it at risk of becoming unsustainable and ultimately, obsolete [ 18 ].…”

Section: Introductionmentioning

confidence: 99%

Operational integration in primary health care: patient encounters and workflows

Sifaki-Pistolla

Chatzea

Markaki

et al. 2017

BMC Health Serv Res

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BackgroundDespite several countrywide attempts to strengthen and standardise the primary healthcare (PHC) system, Greece is still lacking a sustainable, policy-based model of integrated services. The aim of our study was to identify operational integration levels through existing patient care pathways and to recommend an alternative PHC model for optimum integration.MethodsThe study was part of a large state-funded project, which included 22 randomly selected PHC units located across two health regions of Greece. Dimensions of operational integration in PHC were selected based on the work of Kringos and colleagues. A five-point Likert-type scale, coupled with an algorithm, was used to capture and transform theoretical framework features into measurable attributes. PHC services were grouped under the main categories of chronic care, urgent/acute care, preventive care, and home care. A web-based platform was used to assess patient pathways, evaluate integration levels and propose improvement actions. Analysis relied on a comparison of actual pathways versus optimal, the latter ones having been identified through literature review.ResultsOverall integration varied among units. The majority (57%) of units corresponded to a basic level. Integration by type of PHC service ranged as follows: basic (86%) or poor (14%) for chronic care units, poor (78%) or basic (22%) for urgent/acute care units, basic (50%) for preventive care units, and partial or basic (50%) for home care units. The actual pathways across all four categories of PHC services differed from those captured in the optimum integration model. Certain similarities were observed in the operational flows between chronic care management and urgent/acute care management. Such similarities were present at the highest level of abstraction, but also in common steps along the operational flows.ConclusionsExisting patient care pathways were mapped and analysed, and recommendations for an optimum integration PHC model were made. The developed web platform, based on a strong theoretical framework, can serve as a robust integration evaluation tool. This could be a first step towards restructuring and improving PHC services within a financially restrained environment.Electronic supplementary materialThe online version of this article (10.1186/s12913-017-2702-5) contains supplementary material, which is available to authorized users.

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“…The lack of recovery-oriented system in mental healthcare in Cyprus may also explain the way the participants perceived themselves during the illness [ 119 ]. The descriptions they chose to portray themselves were mainly negative ones, for example “bad person” or “tormented person”.…”

Section: Discussionmentioning

confidence: 99%

“…The data reported herein with regard to the way participants experience their living with the illness and subsequent therapy, call for the reorganization of the culture of mental healthcare policy in Cyprus towards a more recovery-oriented approach in both community and hospital organizations. Empowerment of the resilience of people living with SMI, participation in decision-making and planning for their own care, along with effective management of pharmacotherapy, need to be the ultimate focus of mental health services [ 119 , 123 ]. Unfortunately, within the mental healthcare system of Cyprus there still exists disease – centered approaches, characterized by limited involvement of mental health services consumers in the design of the therapeutic plan [ 61 ].…”

Section: Discussionmentioning

confidence: 99%

The experience of Greek-Cypriot individuals living with mental illness: preliminary results of a phenomenological study

et al. 2016

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BackgroundResearch evidence shows that healthcare professionals do not fully comprehend the difficulty involved in problems faced by people living with severe mental illness (SMI). As a result, mental health service consumers do not show confidence in the healthcare system and healthcare professionals, a problem related to the phenomenon of adherence to therapy. Moreover, the issue of unmet needs in treating individuals living with SMI is relared to their quality of life in a negative way.MethodsA qualitative methodological approach based on the methodology of van Manen phenomenology was employed through a purposive sampling of ten people living with SMI. The aim was to explore their perceptions and interpretations regarding: a) their illness, b) their self-image throughout the illness, c) the social implications following their illness, and d) the quality of the therapeutic relationship with mental health nurses. Participants were recruited from a community mental health service in a Greek-Cypriot urban city. Data were collected through personal, semi-structured interviews.ResultsSeveral main themes were identified through the narratives of all ten participants. Main themes included: a) The meaning of mental illness, b) The different phases of the illness in time, c) The perception of the self during the illness, d) Perceptions about the effectiveness of pharmacotherapy, e) Social and personal consequences for participants following the diagnosis of mental illness, f) Participants’ perceptions regarding mental health professionals and services and g) The therapeutic effect of the research interview on the participants.ConclusionsThe present study provides data for the enhancement of the empathic understanding of healthcare professionals regarding the concerns and particular needs of individuals living with SMI, as well as the formation of targeted psychosocial interventions based on these needs. Overall, the present data illuminate the necessity for the reconstruction of the provided mental healthcare in Cyprus into a more recovery- oriented approach in order to address personal identity and self-determination issues and the way these are related to management of pharmacotherapy. Qualitative studies aiming to further explore issues of self-identity during ill health and its association with adherence to therapy, resilience and self-determination, are also proposed.

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Consumer-Centered, Collaborative, and Comprehensive Care

Cited by 23 publications

References 1 publication

Conceptualizing patient-centered care for substance use disorder treatment: findings from a systematic scoping review

Conceptualizing patient-centered care for substance use disorder treatment: findings from a systematic scoping review

Operational integration in primary health care: patient encounters and workflows

The experience of Greek-Cypriot individuals living with mental illness: preliminary results of a phenomenological study

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