patients centered care.pptx

8/14/2019 patients centered care.pptx

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PATIENT CENTRED CLINICAL

METHOD

M.O. Ogunsanya


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Outline

Overview

Doctor(Dx Oriented) Clinical Methods(DCCM)

Patient Centred Clinical Methods Patient Centred Care

Elements of PCCM

Components of PCCM Patient Centred Consultation

Case Study


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Health professionals do not deal with disease;

they deal with people who are concerned

about their health.

Patient Centred Clinical Method (PCCM) is a

clinical method designed to elicit an

understanding of the patient andhis disease.

PCCM looks at 2 agendas namely, the

Physiciansand the Patients.

Overview


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PATIENT PRESENTS

CUES OF UNWELLNESS

DOCTOR SEARCHESTWO PARALLEL AGENDAS

DOCTORS AGENDA PATIENTS AGENDA

- Hx- PE

- Lab Investigation UNDERSTANDING

ILLNESS EXPERIENCE

DIFFERENTIALDIAGNOSIS

INTEGRATION

The Patience-centered Clinical Method


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Doctor(Disease Oriented) Centred

Clinical Method (DCCM)

Method used by most practitioners and taught

in medical school.

In doctor centred consultations, their medical

skills and knowledge predominate.

They maintain control by using closed

questions and giving the patient directions.

The patients perceptions and preferences are

not explored.


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Patient Centred Clinical Methods

(PCCM)

Focus began in the 1970s when

The two terms DCCM and PCCM were coined

PCCM practiced partially in private settingsthough practitioners unaware of this

Platform for ensuring Patient Centred Care

What then is Patient Centred Care?


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Patient Centered Care

Being patient centered means health care

providers take into account the patients

desire for information and for sharing

decision making.

Patient centered care requires a thorough

explanation of disease to patients and

exploration of their feelings, beliefs andexpectations.


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Patient Centered Care

It is the interaction between the clinician and

the patient, and the clinicians ability to use

the patients knowledge and experiences to

guide the consultation.

Patient centred interviews recognize patients

needs and preferences by encouraging them

to voice ideas and collaborate in theconsultation.


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Patient Centred Care

Patient centred care is not:

- technology centred

- doctor centred- hospital centred

- disease centred

Rather these components revolve around thepatient.


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Why Patient Centred Care?

Enhances patient satisfaction

Improves patient outcomes

Has a positive impact on health care utilizationcosts

Is associated with positive benefits for health

professionals such as greater job satisfaction

Is associated with fewer malpractice claims


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Fundamental Elements of PCC

Elements fundamental to patient centred care

are:

- Respect for the individuals values,

expressed needs and preferences.

- Choicepatients have the right and

responsibility to participate in health care

decisions including treatment and

management.


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Fundamental Elements of

PCC(cont)

- Access to services required by the persons

medical condition, including preventive care.

- Supportacknowledging and addressing the

persons emotional and social needs. This

means involving the persons family and

friends (as the patient desires) and

considering educational, cultural and personalfactors affecting the persons ability to

manage their condition.


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Fundamental Elements of

PCC(cont)

- Education and information that is accurate,

relevant and answers the persons concerns.


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PCCM - Clinical Consultation in PCC

Clinicians skills to customize care to the

specific needs and circumstances of each

individual, that is, to modify care to respond

to the person, not the person to the care.

Clinicians to think about ways of integrating

patients perceptions into consultations

Focus is on the partnership between patients,

families and providers with acknowledgement

of patients treatment and life goals.


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Components of PCCM

Exploring both the disease and illness

experience

Understanding the whole person

Finding common ground regarding

management

Incorporating prevention and health

promotion


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Components of PCCM

Enhancing the doctor-patient relationship

Being realistic about personal limitations and

issues such as the availability of time and

resources


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The Patient-Centred Clinical Method

Six Interactive Components

1. Exploring both the disease and the illness experience:

o history, physical, lab;

o dimensions of illness (feelings, ideas, effects on function and

expectations).

2. Understanding the whole person:

o the person (e.g. life history, personal and developmental issues);

o the proximal context (e.g. family, employment, social support); and

o the distal context (e.g. culture, community, ecosystem).

3. Finding common ground:o problems and priorities;

o goals of treatment and/or management; and


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4. Incorporating prevention and health promotion:

o health enhancement;

o risk avoidance;

o risk reduction;

o early identification; and

o complication reduction.

5. Enhancing the patient-health care practitioner relationship:o compassion;

o power;

o healing; and

o self-awareness.

6. Being realistic:o teambuilding and teamwork


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Patient Centred Consultation

Explore the patients main reason for the visit,

concerns, and need for information.

Explore patients social supports and physical

environment, which may influence their

health (e.g. family attitudes to healthy

behaviour change)

Find common ground on what the problem is

and mutually agree on management.


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Find out whether and to what extent the

person wants to participate in decision-

making. This might be influenced by age,

culture and education.

Find common ground for planning ongoing

management so that the health professional

and the patient can agree on what should bedone.


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Negotiate an agreed individualized written

disease management plan, including specific

strategies for dealing with acute symptomatic

episodes.

Emphasize prevention and health promotion

Ensure the continuing relationship between

the patient and the doctor


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Questions to answer during Patient

Centred Consultation

Who is the patient? What does this patient

want from the doctor - Today and in the long

run?

How does this patient experience this illness?

What are the patients ideas about the illness?

What are the patients main feelings about the

illness, with attention to five common

responses: fear, distrust, anger, sadness, and

ambivalence?


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Clinical Methods

Doctors can refine their skills in ways that

allow them to better attend to the person of

the patient.

Patient activation is an important component

of patient centred interviewing.

It enables the patient to take control within

the consultation and promotes self

management.

- Often a request, tell me about yourself will

suffice.


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A 68-year-old male patient, who hadrecently been operated on for a benignstricture of the sigmoid colon presented fora routine follow-up office visit.

The patient, a retired Roman Catholic

priest, had very recently taken up residencein a retirement home for ageing clergy.

All these facts were known to the doctor.The interaction has been reconstructed in

two ways to illustrate the disease- andpatient-centred methods.

CASE STUDY TO ILLUSTRATE DCCM & PCCM


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CASE STUDY TO ILLUSTRATE DCCM

The Disease-Centred Method

Doctor Hello Father Smith, how are you

today?

Patient Fineexcept for my headaches . . .

Doctor . . . and your operation, how's that

going?

Patient Fine.Doctor Bowels working?

Patient Yes.


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Doctor Appetite?

Patient A bit poorly.

Doctor Have you lost any weight?

Patient No.

Doctor Well, obviously your loss of appetite

hasn't affected anything, so it can't be too

bad? Any nausea or vomiting?

Patient None.


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Doctor Any pain at the operation site?

Patient Not really.

Doctor Are you eating the bran we

recommended?

Patient No.

Doctor You must please stick to our

recommendations. We don't want any

recurrences.

Patient (sighing) Yes.



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Doctor Good, well the operation seems to

have been a success and there don't seem tobe any complications. Have you any other

complaints?

Patient I have this headache.

Doctor Is your vision affected?

Patient No.

Doctor Any weakness or paralysis of yourlimbs?

Patient No.


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CASE STUDY TO ILLUSTRATE DCCMDoctor Where are your headaches?

Patient At the back of my head.

Doctor Do they throb?

Patient Yes.Doctor How long do they last?

Patient About four hours

Doctor What takes them away?Patient I just lie down


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Doctor How often do they come?

Patient About twice a week.

Doctor How long have they been there for?

Patient Ever since I've been at the home.

Doctor Good, well you needn't worryit

can't have anything to do with your operation.

They are tension headaches. Perhaps we can

give you some paracetamol for it. The home

you have just moved into seems to havebeautiful gardens.


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Patient Yes.Doctor It really is good of the church to care

for its elderly and it must be comforting to

have company.

Patient Yes.

Doctor Well good. Come and see me in a

month's time and we'll see how things aregoing. Take care.


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CASE STUDY TO ILLUSTRATE PCCM

The Patient-Centred Method

Doctor Hello Father Smith, how are youtoday?

Patient Fine, except for my headaches.

Doctor What about your headaches?

Patient Well, I've been getting them about

twice a week at the back of my head and they

bother me so I can't do anything, and I have to

lie down.


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CASE STUDY TO ILLUSTRATE DCCMDoctor You can't do anything? What's that

like for you?Patient It's frustrating, they're interfering

with the writing I want to get done and

nobody seems to understand . .Doctor Understand?

Patient All the other priests are so old and

decrepit in that place. All they can talk aboutis their aches and pains. I'm ashamed to say

they make me sick.


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Doctor Why are you ashamed?

Patient Well, I shouldn't really talk that way

about them, they mean no harm . . . I feel so

guilty about it.

Doctor What do you mean guilty?

Patient I feel that my anger is unjustified, I'm

so frustrated that no one understands that I

wish to write.

Doctor It must be frustrating . . .

Patient Yes, it is and my headachesmy

headaches make it worse.


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Doctor When did they first start?

Patient Ever since I've been at the home.

Doctor Why do you think that is?

Patient I . . . don't know, I haven't reallythought about it . . . do you think it's tension?

. . . I mean the people at the home . . . is it

possible?

Doctor What do you think?

Patient Well the whole situation at the

home does trouble me.


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Doctor Would you like to talk about it more?

Patient No, not now, perhaps later.

Doctor Well, feel free to discuss it anytime

you like.

Patient Mmm, mmm, I will.


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Doctor Well, how are things going after your

operation?

Patient It seems okay.

Doctor What do you mean, it seems okay?

Patient Well I don't seem to be eating well

and I can't stand that bran. In fact I have no

appetite for food.

Doctor What do you think that could be due

to?


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Patient I wonder if it's due to the tension I'mfeeling?

Doctor Mmm, mmm.

Patient I will really think about what we'vesaid and come back to see you again.

Doctor Fine, anything else today?

Patient Fine, everything is fine, except I get afunny feeling on my scar.

Doctor A funny feeling?


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Patient Yes, it seems a bit numb . . . I hope

it's not serious.

Doctor It's probably a little nerve that

supplies the skin that was cut during the

operation. Nothing to be concerned about.

Patient I'm glad it's only that. I was quite

worried.

Doctor Anything else you'd like to discuss?

Patient No, everything else is fine.


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Doctor Good, would you like something for

your headaches?

Patient Thank you, but I don't think it's

necessary.

Doctor I'd like to see your wound in a

month's time, but we can get together earlier

if you'd like to.

Patient Fine, I'll be in touch, Doctor.


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Doctor centered (Disease centered) care

Seek after own expectation to establish a biomedical orclinical diagnosis.

Does not enter the patients world.

Misses subtle cues in the patientdoctor interaction.

Patient centered clinical care has

Patient guided interview

Expectations of the patient are discovered

Appropriate facilitative behaviour of the physician ineliciting patients feelings and fears

Any conflicts in both agenda are identified and dealtwith through Dr-Patient negotiation.

SUMMARY


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THANK YOU FOR LISTENING!


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Acknowledgements

Some Slides- courtesy Dr O.O. Imediegwu

(FMCGP)NPMCN Revision Course 2011

Patient Centred Care- Clinical Review

by Monica Bensberg www.dddgp.com.au ;

Accessed on 15/05/2012; 2:20pm


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References

Stewart M. Towards a global definition of

patient centred care. BMJ 2001; 322:444-5.

Brown, J. (2004). Patient-Centred

Collaborative Practice. Ottawa: Health

Canada.

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