Delivering person centred care in long term conditions

Abstract

Delivering person centred care in long term conditionsTransforming care for people with long term conditions, including support for self management, requires comprehensive reform of health systems largely geared to provide acute care. Simon Eaton, Sue Roberts, and Bridget Turner explore the barriers to change, arguing that the success of new approaches will depend on whole system change and strong leadership Long term conditions are a major challenge to the sustainability of health services globally. 1 Their increasing prevalence is associated with growing rates of preventable complications and premature mortality, resulting in soaring costs (box 1).2-5 These factors, coupled with higher expectations among patients and the public, 6 create an urgent need to redesign health services, which are still largely geared to providing episodic acute care. Definitions of long term conditions as "health problems that require ongoing management over a period of years or decades" 9 fail to reflect the personal, social, and economic burden on the individual, their families, and wider community. Nor do they acknowledge that people with long term conditions spend just a few hours a year interacting with clinicians and healthcare services and more than 99% of their lives managing their conditions themselves. The challenges they face vary widely depending on their personal circumstances; the number, nature, and stages of their conditions; the need for lifestyle, specialist, and technical interventions; and their capacity to self manage effectively.10 11 Individual priorities and goals also differ and may often extend beyond a condition specific or health focus, particularly for the increasing percentage of people living with multimorbidity or frailty.It is widely agreed that person centred services for people with long term conditions should be coordinated; support self management; engage people in decisions; provide effective prevention, early diagnosis, and intervention; and offer emotional, psychological, and practical support.6 More needs to be done to realise the untapped potential of patient led care through increasing tailored information, education, and training; access to new technologies; and peer and community support. 13Accumulating evidence and experience shows that people who are "activated"-that is, have the knowledge, skills, and confidence to manage their health effectively-are more likely to adopt healthy behaviours and have better health outcomes and care experiences.11 This may lead to better use of resources. 11Thus, health services need to provide a comprehensive and coordinated range of interventions for populations but organised to provide a tailored response for each person. This requires fundamentally new ways of thinking about service delivery and relationships, recognising that whole system approaches are needed with support for self management as the central component, as set out in the chronic care model. 14 Recent comprehensive programmes of care, such as TEAMcare in the United States 15 and the Fli...

Barriers and facilitators to the implementation of person‐centred care in different healthcare contexts

“…Authors call for a joined‐up approach to PCC, involving patients, professionals and managers, with an emphasis on patients’ priorities and goals in the context of routine care 10, 28, 29, 30, 31. Our study shows how professionals from diverse clinical backgrounds collaborate with professionals and patients to employ person‐centred research.…”

“…Evidence suggests that PCC can be delivered effectively 8, and patients with long‐term conditions benefit from this approach 9, 10, 11. Moreover, researchers report that PCC can be facilitated through effective leadership 12, 13 and by knowledgeable professionals with sound communication skills 7.…”

Clinical care in the home and population health management: improving the care of patients with long-term health conditions

“…This section of the population accounts for 70% of health and social care spend, more than 70% of inpatient bed days, 65% of outpatient appointments and 50% of all general practice appointments [3]. These statistics, however, are not the total picture of a person living with an LTC and fail to reflect the impact such health problems have on individuals, their families and wider Society, or the variation of impact of LTCs based on people's individual circumstances, their care needs, their capability to selfmanage their conditions, their lifestyle and personal goals [4]. How these multiple factors combine in any one person creates that person's individual care profile.…”

Emerging Trends and the Way Forward in Design in Healthcare: An Expert’s Perspective

“…The move form patient-centred to person-centric healthcare is starting to emerge in the literature and relevant reports (Royen et al, 2010;Peek et al, 2007;Price, 2006;Eaton et al, 2015;Raleigh et al, 2015;The Health Foundation, 2014). Within this context the challenge and opportunity for design in healthcare is to place the person as an active agent in all aspects of healthcare, from the promotion to the delivery and treatment.…”