Personalised care planning for adults with chronic or long-term health conditions

Abstract

Background Personalised care planning is a collaborative process used in chronic condition management in which patients and clinicians identify and discuss problems caused by or related to the patient's condition, and develop a plan for tackling these. In essence it is a conversation, or series of conversations, in which they jointly agree goals and actions for managing the patient's condition. Objectives To assess the effects of personalised care planning for adults with long-term health conditions compared to usual care (i.e. forms of care in which active involvement of patients in treatment and management decisions is not explicitly attempted or achieved). Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, ProQuest, clinicaltrials.gov and WHO International Clinical Trials Registry Platform to July 2013. Selection criteria We included randomised controlled trials and cluster-randomised trials involving adults with long-term conditions where the intervention included collaborative (between individual patients and clinicians) goal setting and action planning. We excluded studies where there was little or no opportunity for the patient to have meaningful influence on goal selection, choice of treatment or support package, or both. Data collection and analysis Two of three review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. The primary outcomes were effects on physical health, psychological health, subjective health status, and capabilities for self management. Secondary outcomes included effects on health-related behaviours, resource use and costs, and type of intervention. A patient advisory group of people with experience of living with long-term conditions advised on various aspects of the review, including the protocol, selection of outcome measures and emerging findings.

Person Centered Care and Personalized Medicine: Irreconcilable Opposites or Potential Companions?

“…This risk becomes visible when reflecting on the strong element of having professionals adapt to whatever patients may find of importance, although such preferences may often themselves result from the patient being disempowered or incapacitated by circumstances and structural factors. 4 This may apply to cases of non-adherence when the outcome of treatment depends on so-called lifestyle. In such cases, a patient's unwillingness to adjust living conditions may have an uninhibited kind of PCC produce decisions that mainly serve to reinforce the factors underlying the patient's initial lack of power and capacity [8,19].…”

“…From the PCC side, similar conceptual appropriation is visible. A recent Cochrane report by leading PCC advocates referred to typical PCC approaches as being about ''personalized care planning'' [4], and other contributions have introduced personalization as a given part of the PCC package, e.g. talking about ''individualized care […] personalized to one person'' [27], and similar positionings [43].…”

New approaches to measurement and management for high integrity health systems

“…This is true for surgery and other technical services, but medicine is a knowledge intensive service industry, in which the smallest replicable unit of service comprises the health professional or multidisciplinary team, the patient together with family and carers, and the bidirectional exchange of intelligence and support that is essential to coproduce value. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] Medical interactions often occur at the most trying of times, when professionals are stressed by competing demands on their time, and patients are feeling vulnerable and afraid. Next generation reforms will entail new models of service delivery by teams who are aware of the limitations as well as the benefits of medical interventions.…”

“…Design principles for engagement of patients at the front lines are the foundation of a high integrity health system. [17][18][19][20] …”

The experience of being a participant in one’s own care at discharge and at home, following a severe acute exacerbation in chronic obstructive pulmonary disease: a longitudinal study

“…In Denmark, this is put into practice through formalized cooperation between general practice, hospitals and municipalities in accordance with the “Chronic Care Model” guidelines for an integrated health system (Lange, 2012; Wagner, 1998). The model advocates an active role for patients, who are encouraged to become more self-managing and more actively involved in decisions about their care (Coulter et al, 2015). Taking the changing and unpredictable situation after an AECOPD into consideration, a further exploration of patients’ experiences related to the clinical pathway towards everyday life with COPD seems to be warranted.…”