The changing face of internal medicine: Patient centred care

Kramer, Mark H. H.; Bauer, W. W.; Dicker, Dror; Durusu-Tanriover, Mine; Ferreira, Faustino; Rigby, S.; Roux, Xavier; Schumm–Draeger, Petra–Maria; Weidanz, Frauke; Hulsteijn, J.H. van

doi:10.1016/j.ejim.2013.11.013

Cited by 39 publications

(17 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…1,2 PCC has been argued as a basic human right, 3 and centers on the concept of "no decision about me, without me". 4 PCC in clinical practice has been found to improve clinical outcomes, [5][6][7] provider satisfaction, 8 resource utilization, 8,9 and health service delivery. [8][9][10][11] In Canada, healthcare services are publicly funded, 12 where a single-payer system exists and the government pays for healthcare costs as opposed to private insurers.…”

Section: Introductionmentioning

confidence: 99%

Using patient value statements to develop a culture of patient-centred care: a case study of an Ontario, Canada hospital

Bridge¹,

Law²,

Narushima³

2016

Patient Experience Journal

View full text Add to dashboard Cite

Patient-centred care (PCC) is not a new concept; however, in recent years it has garnered increasing attention in the research literature and clinical practice. PCC in clinical practice has been found to improve clinical outcomes, resource allocation, and the patient experience. In response to the need for PCC and quality in healthcare, the Ontario, Canada government developed the Excellent Care for All Act (ECFAA) in 2010. The ECFAA imposes six obligations to Ontario hospitals, one of which is developing and publishing a Patient Declaration of Values (PDoV). The purpose of this study was to explore how a leading patient-centred Ontario hospital operationalized their patient value statement in policy and practice. The objectives of this research were to: a) understand what role the patient value statement played in policy and practice within a leading Ontario hospital and b) to examine how a leading Ontario hospital incorporated these values into their overarching organizational structures. This was a qualitative case study, which took place in a leading patient-centred Ontario hospital. The study included 18 interviews with employees and patient/family advisors. The analysis found a five-step process including: 1) setting the stage, 2) inspiring change, 3) organizational capacity, 4) barriers, and 5) reflection and improvement. This study has highlighted the role of a patient value statement within a leading Ontario hospital. The findings provide a five-step process with 12 core strategies for creating change in a healthcare organization; to embed a culture of patient-centred care.

show abstract

Section: Introductionmentioning

confidence: 99%

Using patient value statements to develop a culture of patient-centred care: a case study of an Ontario, Canada hospital

Bridge¹,

Law²,

Narushima³

2016

Patient Experience Journal

View full text Add to dashboard Cite

show abstract

“…Our interviews with the health-care providers highlighted that the tenets of the biomedical model for which the OAT is based, run counter to patient-centered care, the gold standard of care summarized by the phrase, "No decision about me, without me" (Kramer et al, 2014). When clients are the focus of the health-care system, they and their providers meet as equals (Brookman, Jakob, DeCicco, & Bender, 2011).…”

Section: Implications For Practicementioning

confidence: 99%

“…When clients are the focus of the health-care system, they and their providers meet as equals (Brookman, Jakob, DeCicco, & Bender, 2011). The provider commits to doing what is right for the patient based on trust (Kramer et al, 2014;Mead & Bowen, 2000). However, OAT programs grant health-care providers unilateral decision-making power to determine the fate of clients on treatment.…”

Section: Implications For Practicementioning

confidence: 99%

Exploring health-care providers’ experiences in the care of clients on opioid agonist treatment in two western Canadian clinics

et al. 2019

View full text Add to dashboard Cite

Introduction Prescribing methadone as part of opioid agonist therapy is a common treatment approach to manage opioid use disorder. Unfortunately, many clients prematurely discontinue opioid agonist therapy because of restrictions attached to the therapy. Purpose The purpose of this study was to explore health-care provider experiences as they worked with clients on opioid agonist therapy in a western Canadian city. Methods In this descriptive, qualitative study, we interviewed 18 health-care providers working in an opioid agonist therapy setting. The focus of the interviews was on the organization of opioid agonist therapy care at their clinic, their personal experiences and challenges faced when providing care to their clients. Interviews were recorded electronically and transcribed verbatim and thematic analysis was completed using NVIVO software. Results The following three themes emerged from the data relate to the care organization and health care provider (HCP)-clients dynamics. These are: (1) fragmentation of care for a complex problem, (2) enforcing compliance to treatment, and (3) the importance of a therapeutic alliance to improve overall care. Conclusion The opioid agonist therapy model is biocentric and emphasizes abstinence which can create tension between providers and clients. Making the model of care more patient centred might help to improve client retention rates and successful treatment outcomes.

show abstract

“…Understanding patient preferences and values are important to effective communication and facilitating informed and shared decisions that recognise the variation in tolerance of risk. [18][19][20] While preferences reflect an individual's tastes (likes or dislikes) and ideals ( personal values and commitments), they will also reflect their reference point (such as having experienced dialysis or not), psychological traits (imaginative capacity, optimism, inertia), social influences (norms and laws, influence of family and friends) and beliefs (understanding of the likelihood and consequences of an outcome). 21 22 In the context of a complex and longterm treatment that involves trade-off between potentially debilitating side effects and adverse outcomes of immunosuppression and graft dysfunction, clinicians can have a substantial influence on patient preferences through the content and style of communication.…”

Section: Introductionmentioning

confidence: 99%

Eliciting patient preferences, priorities and trade-offs for outcomes following kidney transplantation: a pilot best–worst scaling survey

et al. 2016

View full text Add to dashboard Cite

ObjectivesEliciting preferences and trade-offs that patients may make to achieve important outcomes, can assist in developing patient-centred research and care. The pilot study aimed to test the feasibility of a case 2 best–worst scaling survey (BWS) to elicit recipient with kidney transplantation preferences after transplantation.DesignPreferences for graft survival and dying, cancer, cardiovascular disease, diabetes, infection and side effects (gastrointestinal, weight-gain and appearance) were assessed in recipients with transplantation using a BWS (20 scenarios of nine outcomes). Participants chose ‘best’ and ‘worst’ outcomes. Responses were analysed using a multinomial logit model. Selected participants were interviewed.OutcomesAttribute coefficients and survey completion error rates.Results81 recipients with transplantation were approached, and 39 (48%), mean age 50.5 years, completed the BWS. 4 (10%) surveys were invalid with major errors and of 35 remaining, 7 of 1400 (0.5%) choices were missing. –23 (59%) took >20 min to complete the survey. 1 was unable to finish, and 1 did not understand the survey. 2 (5%) found it very hard and 14 (35%) moderately hard. Most attribute coefficients were significant (p<0.05) and showed face validity. Graft survival was most important with normalised coefficients from 1 (95% CI 0.89 to 1.11) to 0.06 (95% CI −0.03 to 0.16) for 30 and 1 year duration, respectively. Attribute level coefficients decreased with increasing risk of adverse outcomes. Error rates of 20% and 2% were estimated for dominant attributes ‘100% risk of dying’ and ‘30 years graft survival’, respectively. 7 participants were interviewed regarding counterintuitive selection of ‘100% risk of dying’ as a ‘best’ outcome. Misunderstanding, not linking dying to graft survival and aversion to dialysis were reasons given.ConclusionsRecipients with transplant recipients successfully completed a complex case 2 BWS with attribute coefficients having face validity with respect to duration of graft survival and risk of adverse outcomes. Areas for refinement to reduce complexity in design have been identified.

show abstract

The changing face of internal medicine: Patient centred care

Cited by 39 publications

References 12 publications

Using patient value statements to develop a culture of patient-centred care: a case study of an Ontario, Canada hospital

Using patient value statements to develop a culture of patient-centred care: a case study of an Ontario, Canada hospital

Exploring health-care providers’ experiences in the care of clients on opioid agonist treatment in two western Canadian clinics

Eliciting patient preferences, priorities and trade-offs for outcomes following kidney transplantation: a pilot best–worst scaling survey

Contact Info

Product

Resources

About