The need for integrated, people-centered healthcare (original) (raw)
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From "patient" to "person" to "people": the need for integrated, people centered health care
International Journal of Person Centered Medicine, 2012
Background and aim: The development of person-centred care is based on the principle that each human is a unique and autonomous individual, in illness as much as in health. In pursuing healthcare that is directed at people, the interdependence of human beings, and their broader environment are considerations which achieve immediate prominence. This paper proposes a theoretical framework which identifies the major elements of people-centered care. From this framework, "indicator-fields" are identified and a first exercise conducted in order to define specific indicators that could be used to assess the "people-centeredness" of health systems. We hope that our article will intensify the debate on people-oriented care, its components and its possible indicators and that it will contribute to the development of an instrument for the assessment of the actual people-centeredness of a given health system. Methods: This paper builds on a literature-based theoretical exploration of the concept and a series of Delphi rounds with members of the International Centre for Primary Health Care and Family Medicine, Ghent University, a WHO Collaborating Centre on Primary Health Care. Results: Five themes and sub-themes were identified which are essential in the assessment of the people-orientation of care. People-centered care is sensitive to and respectful of differences, while at the same time promoting basic universal rights and values (proportionate universalism), it is available, accessible and affordable for all; it is directed at the comprehensiveness of healthcare services; it considers the relevance and quality aspects of care, such as the responsiveness, adequacy and continuity of healthcare and it empowers individuals and communities through active involvement and participation. Consequently, possible indicators to measure a system's people-centeredness are considered and proposed. Conclusions: Further systematic review of the literature and empirical research on the development of the theoretical framework of people-centered care and useful indicators to assess and measure it are needed to support health policy making.
From 'patientr to 'person' to 'people' : the need for integrated, people-centered healthcare
2012
Background and aim: The development of person-centred care is based on the principle that each human is a unique and autonomous individual, in illness as much as in health. In pursuing healthcare that is directed at people, the interdependence of human beings, and their broader environment are considerations which achieve immediate prominence. This paper proposes a theoretical framework which identifies the major elements of people-centered care. From this framework, "indicator-fields" are identified and a first exercise conducted in order to define specific indicators that could be used to assess the "people-centeredness" of health systems. We hope that our article will intensify the debate on people-oriented care, its components and its possible indicators and that it will contribute to the development of an instrument for the assessment of the actual people-centeredness of a given health system. Methods: This paper builds on a literature-based theoretical exploration of the concept and a series of Delphi rounds with members of the International Centre for Primary Health Care and Family Medicine, Ghent University, a WHO Collaborating Centre on Primary Health Care. Results: Five themes and sub-themes were identified which are essential in the assessment of the people-orientation of care. People-centered care is sensitive to and respectful of differences, while at the same time promoting basic universal rights and values (proportionate universalism), it is available, accessible and affordable for all; it is directed at the comprehensiveness of healthcare services; it considers the relevance and quality aspects of care, such as the responsiveness, adequacy and continuity of healthcare and it empowers individuals and communities through active involvement and participation. Consequently, possible indicators to measure a system's people-centeredness are considered and proposed. Conclusions: Further systematic review of the literature and empirical research on the development of the theoretical framework of people-centered care and useful indicators to assess and measure it are needed to support health policy making.
People-centred primary health care: a scoping review
BMC Primary Care
Background Integrated people-centred health services (IPCHS) are vital for ensuring comprehensive care towards achieving universal health coverage (UHC). The World Health Organisation (WHO) envisions IPCHS in delivery and access to health services. This scoping review aimed to synthesize available evidence on people-centred primary health care (PHC) and primary care. Methods We conducted a scoping review of published literature on people-centred PHC. We searched eight databases (PubMed, Scopus, Embase, CINAHL, Cochrane, PsycINFO, Web of Science, and Google Scholar) using search terms related to people-centred and integrated PHC/primary care services. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist to select studies. We analyzed data and generated themes using Gale's framework thematic analysis method. Themes were explained under five components of the WHO IPCHS framework. Results A total of f...
Same and Different? Perspectives on the Introduction of Person-Centered Care as Standard Healthcare
This thesis examines a collection of cases and situations where efforts are being made to combine and unify the concerns of person-centred care, standardization and evidence-based medicine. Person-centred care is commonly associated with efforts to improve the quality of healthcare by catering for variation and difference while evidence-based medicine and standardized guidelines aim to assure quality by reducing difference and variation. Therefore, this thesis aims to investigate the paradoxes and tensions emerging as person-centred care is introduced as standard healthcare, and the actions taken by healthcare professionals to secure this healthcare reform in practice. The analysis builds on interviews with researchers working at a research centre where a particular standardized model of personcentred care has been developed; interviews with healthcare professionals working with and introducing this standardized model; observations of healthcare professionals applying this standardized model in practice, and related documents and written materials. The thesis builds on a practice oriented approach to personcentred care and adopts a material semiotic sensibility as a theoretical foundation. This approach enables detailed analysis of the messy, relational socio-material practices of person-centred care in action. Using the notions of tinkering and articulation work, the thesis extends the basic lessons of material semiotics by underscoring the importance of reciprocity - interrogating how inventive practices act back on and reshape tools, technologies and standards of person-centred care. Empirically the thesis encompasses four studies. Paper I examines the mundane technologies of person-centred care, the scripts and values inscribed in these technologies and the tinkering needed to balance and bring together potentially contrasting values in practice. Paper II investigates how person-centred care and evidence-based medicine are interwoven in practice and the tensions that emerge when a randomized controlled trial is used to evaluate person-centred care. Paper III draws on the notions of articulation work and invisible work to analyse the efforts involved in sustaining a particular standardized framework of person-centred care. Paper IV identifies the tenacious assumptions embedded in a standardized model of person-centred care and the challenges emerging when this model is introduced in diverse settings. Based on these studies I argue that while person-centred care is often advocated as the anti-thesis to standardized biomedicine this relationship is more complex. The studies in this thesis address attempts to develop a model of healthcare that is at once the same for all patients, yet also different by catering to each individual patient as a unique person. However, modelling care in this way is not without its challenges. One of the foremost challenges of making care recognizing the patient as a person into standard healthcare concerns how this person is actually imagined and enacted. By insisting on particular routines to be followed and specific values to be recognized particular versions of person-centred care risk embedding problematic assumptions of their own. These assumptions are very similar to those it aims to move beyond in the first place. The standardized model of person-centred care, as well as the tensions and challenges it gives rise to, are negotiated and managed in a variety of ways. Caregivers are obliged to make adaptions, translations and become creative mediators in order to enable the standardized model of person-centred care to hold together. They also have to coordinate different tasks, perform complex activities for which they have little prior training, and creatively interpret incomplete instructions in order to compensate for shortfalls in information. However, the thesis concludes that things could be otherwise if person-centred care was able to learn from material semiotics. Instead of conceiving person-centred care as something that has to be implemented and safeguarded in practice, an alternative vision would be to develop person-centred care in its local organizational complexity and thereby transform it from being something ready-made, which care professionals have to adhere to, to something that is an outcome of experimental interventions.
Review of developments in person-centred healthcare
International Practice Development Journal, 2020
In recent years, there has been a shift in orientation towards person-centredness as part of a global move towards humanising and centralising the person within healthcare. Person-centredness, underpinned by robust philosophical and theoretical concepts, has an increasingly solid footprint in policy and practice, but research and education lag behind. This article considers the emergence of person-centredness, including person-centred care, and how it is positioned in healthcare policy around the world, while recognising a dominant philosophical positioning in Western philosophy, concepts and theories. Second, the evolution of person-centred healthcare over the past five years is reviewed. Published evidence of person-centred healthcare developments is drawn on, as well as information gathered from key stakeholders who engaged with the partner organisations in an Erasmus+ project to develop a European person-centred healthcare curriculum framework. Five themes are identified, which underpin the literature and stakeholder perspectives: • Policy development for transformation • Participatory strategies for public engagement • Healthcare integration and coordination strategies • Frameworks for practice • Process and outcome measurement These themes reflect the World Health Organization's global perspective on people-centred and integrated healthcare, and give some indication of development priorities as person-centred healthcare systems continue to be developed.
Same and Different? Perspectives on the Introduction of person-Centred Care as Standard Healthcare
2017
This thesis examines a collection of cases and situations where efforts are being made to combine and unify the concerns of person-centred care, standardization and evidence-based medicine. Person-centred care is commonly associated with efforts to improve the quality of healthcare by catering for variation and difference while evidence-based medicine and standardized guidelines aim to assure quality by reducing difference and variation. Therefore, this thesis aims to investigate the paradoxes and tensions emerging as person-centred care is introduced as standard healthcare, and the actions taken by healthcare professionals to secure this healthcare reform in practice. The analysis builds on interviews with researchers working at a research centre where a particular standardized model of personcentred care has been developed; interviews with healthcare professionals working with and introducing this standardized model; observations of healthcare professionals applying this standardi...
BMJ Global Health
IntroductionPerson-centred care (PCC) is internationally recognised as a critical component of high-quality healthcare. However, PCC evolved in a few high-income countries and there are limited data exploring this concept across the vast majority of countries which are low- and middle-income. This study aimed to appraise and adapt a PCC model across three serious physical conditions in three middle-income countries and generate an evidence-based framework and recommendations for globally relevant PCC.MethodsCross-national, cross-sectional qualitative study. In depth, semistructured interviews conducted with: advanced cancer patients in Jordan (n=50), their caregivers (n=20) and healthcare professionals (HCPs) (n=20); chronic obstructive pulmonary disease patients in South Africa (n=22), their caregivers (n=19) and HCPs (n=22); heart failure patients in Thailand (n=14), their caregivers (n=10) and HCPs (n=12). Data were analysed using framework analysis. Santana et al’s PCC model (20...