Patient-Centred Care in Canada: Key Components and the Path Forward

Montague, Terrence J.; Gogovor, Amédé; Aylen, John; Ashley, Lisa; Ahmed, Sara; Martin, Lesli; Cochrane, Bonnie; Adams, Owen; Nemis-White, Joanna

doi:10.12927/hcq.2017.25136

Cited by 43 publications

(46 citation statements)

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“…According to recent studies, patients suffering from multi-morbidities represent 52.1% of the patients who consult their general practitioner (GP) in Switzerland compared to 52.9% in England. We can find similar figures in Canada (more than 50% of patients) [5].…”

Section: Multimorbidity: What Do We Know About the Current Challenges?supporting

confidence: 81%

Understanding and Promoting Clinical Reasoning in Chronic and Multimorbid Conditions: A Call for GPs and Healthcare Professionals

Audétat¹,

Sader²,

Notari³

et al. 2019

Health

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Multimorbidity, defined as 2 or more chronic diseases, is of increasing importance for health professionals. Many factors are at play when it comes to multimorbidity, but we still know very little about how clinicians actually weigh up the different factors-medical, social, and psychological-to reach a particular course of action. Further research is therefore required to explore the ways in which clinical reasoning processes are involved in the follow up of patients suffering from multimorbidities, to highlight their potential risks of errors. A better understanding of these clinical processes will also enrich supervision of trainees and collaboration between healthcare professionals involved in primary care.

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Section: Multimorbidity: What Do We Know About the Current Challenges?supporting

confidence: 81%

Understanding and Promoting Clinical Reasoning in Chronic and Multimorbid Conditions: A Call for GPs and Healthcare Professionals

Audétat¹,

Sader²,

Notari³

et al. 2019

Health

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“…In this complex dynamic of searching for patient centricity in healthcare, a companion imperative for medicare to successively move forward is that partnership, measurement and pan-stakeholder feedback of care practices and outcomes are fostered in order to recognize common risks and opportunities and to ensure that best evidence-based therapies are being applied, resulting in predicted optimal outcomes. Measurement and feedback of practice patterns to patients and practitioners work to close care gaps and improve outcomes (Montague 2004(Montague , 2013(Montague , 2017(Montague , 2018.…”

Section: Going Forwardmentioning

confidence: 99%

Canada’s Evolving Medicare: Patient-Centred Care

Montague¹,

Nemis-White²,

Aylen³

et al. 2019

hcq

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Canada's universal healthcare program, medicare, continues to evolve. An area of care that has gained increasing attention over the past several years is the general concept and specific components of patient centricity in healthcare delivery. This paper compares key measures of patientcentred care practices recorded in the 2013 and 2016 Health Care in Canada (HCIC) surveys, with the most recent preferences of the public and health professionals obtained in the 2018 HCIC survey, including priorities for improved future care. Timely access and caring care were the public's top-supported components of patient-centred care in the 2013 and 2016 HCIC surveys. In the 2018 HCIC survey, the Canadian public's overwhelming choice as the top-priority component of patient-centred care continued to be care readily and timely accessed, provided in a caring and respectful environment and based on need versus the ability to pay. In contrast, the public's lesser-supported option in all surveys was measurement and stakeholder feedback of actual care and outcomes. Among professionals in 2018, timely access and caring care were also rated as the top characteristics of patient-centred care, followed by care supported by research and expert opinion. Also similar to the public, Canadian healthcare professionals in 2018 rated measurement and feedback of delivered care and outcomes at the bottom of their support list. When the public and professionals were asked in the 2018 survey to prioritize their implementation choices for enhanced patient-centred care going forward, both stakeholder groups chose timely access as their first priority. Measurements and feedback of care and outcomes were rated at the lower end of choices in both groups in 2018. In summary, among key stakeholders, healthcare that is not readily and timely accessed remains the perceived greatest impediment to achievement of patient-centred care in contemporary Canadian medicare. The continued reality of undue delay in accessing healthcare in Canada is disturbing. A companion risk going forward is that all other components of patient-centred care will retreat to a level of irrelevance. Measurement and feedback of care, particularly its timeliness of access and outcomes, are necessary to monitor progress, stimulate innovation and ensure the success of Canadian medicare. Things can be better.

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“…The initiation of a national pharmacare program presents a unique opportunity to intentionally consider and build in tools that have been shown to improve medicationtaking behaviours, such as electronic adherence monitoring and feedback to patients in the context of their continuing medical care (Demonceau et al 2013). It demands a call to arms, a dedicated, patient-centred, pro-adherence strategy involving all key players, including professional providers, patients and the general public (Montague et al 2017a(Montague et al , 2017b.…”

Section: Next Stepsmentioning

confidence: 99%

“…The Health Care in Canada (HCIC) partnership and surveys were initiated two decades ago to measure and report the opinions of the Canadian adult public and healthcare professionals regarding key challenges, operational performance and future opportunities surrounding Canada's healthcare system (Montague et al 2016(Montague et al , 2017aNemis-White et al 2014). HCIC members share a common and basic view: measurement and feedback of key data are the best available tools to inform, guide and expedite improved health policies and patient outcomes, particularly in reducing the gaps between usual care and best evidence-based care.…”

Section: Introductionmentioning

confidence: 99%

Non-Adherence to Prescribed Therapies: Pharmacare’s Existential Challenge

Gogovor

Nemis-White²,

Torr³

et al. 2019

hcq

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Pharmacare, a recently proposed addition to Canada's universal medicare program, has become a prominent topic in the public discourse, but funding and leadership have not been established. Repeated Health Care in Canada (HCIC) surveys of the adult public and a broad spectrum of health professionals reveal very strong support for a national system that is easy to access and covers all prescribed pharmaceuticals. Although the practical details of universal pharmacare remain to be established, there is strong support among the public and professionals as well as increasing federal government interest in moving forward and ultimately implementing pharmacare. At the same time, HCIC surveys indicate that a high percentage of patients do not take their medications as directed, both for acute and chronic illnesses. The data suggest that pharmacare's success will be severely challenged by this. Of the four major challenges preventing usual care from being the best care-suboptimal access, non-diagnosis, non-prescription and non-adherence-risk from some form of non-adherence is often ranked first by care professionals. The most commonly reported reasons for non-adherence in clinical settings are patients' forgetfulness and how they feel in the moment on any given day. Costs of therapy, lack of understanding or poor knowledge transfer between prescribers and patients regarding therapeutic risks and benefits are rarely cited causes for poor adherence. These findings from the 2018 HCIC survey are not new. They are very consistent with measurements in the 2016 and other previous HCIC surveys. They do, however, raise practical challenges for the creation and ongoing management of universal pharmacare. Specifically, a patient-centred care component designed to improve non-adherence to prescribed therapies is needed. Ideally, it should include a measurement and feedback component on adherence that shares data with and between patients, health professionals and payers. Things can be better.

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Patient-Centred Care in Canada: Key Components and the Path Forward

Cited by 43 publications

References 0 publications

Understanding and Promoting Clinical Reasoning in Chronic and Multimorbid Conditions: A Call for GPs and Healthcare Professionals

Understanding and Promoting Clinical Reasoning in Chronic and Multimorbid Conditions: A Call for GPs and Healthcare Professionals

Canada’s Evolving Medicare: Patient-Centred Care

Non-Adherence to Prescribed Therapies: Pharmacare’s Existential Challenge

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