Background

Human behaviour influences health outcomes. Patients and health professionals don’t always agree on what is best. Doctors tend to focus on disease processes, while people focus on their lives – of which disease management is one aspect. People will be influenced by many factors other than their doctor’s advice, including socioeconomic circumstances, ethno-cultural values and beliefs. Unless these are taken into account, the patient and health professional cannot work together effectively. Productive interaction occurs when health professionals see one of their roles as helping people to understand the significance of their conditions within their lives, and to get on with life.

Complex conditions require individualised management. Health professionals working in primary care well understand that disease management guidelines are not necessarily applicable to clinical situations, and that evidence from randomised controlled trials may not be relevant to patients whose situation does not match inclusion criteria.

When the patient’s health problems don’t fit the guidelines, health professionals must use all their skills to offer care that is tailored to the person, not a particular condition.

Long-term conditions with complex management require more complex ways of interacting with the patient to ensure adherence to agreed treatment plans and improve quality of life and clinical outcomes.³

Our health system increasingly relies on patient involvement. It is well recognised that, consistent with global experience, Australian health care is in transition from a system set up to manage acute disease to a system organised for effective prevention and control of chronic conditions.⁴ Around the world, health systems are under pressure and can no longer afford to be structured around diseases rather than patients.⁵ In order to cope with the demands of a growing population of people with chronic disease conditions, health systems require active involvement of individuals in understanding and effectively managing their conditions and lifestyles. Patient organisations consider that this may be the most cost-effective way to improve health outcomes for patients.⁵

Clinical outcomes data support patient-centred approaches. Increasing evidence from around the world shows that clinical and cost outcomes are improved when health care is organised around patients’ needs, rather than around specific disease conditions, the convenience of separate services or the traditions of specific medical disciplines. A system that is designed to integrate various health services and funding mechanisms can achieve more comprehensive and convenient primary care services, significantly shorter waiting times for specialist and hospital services, and a lower requirement for acute hospital services, at a similar per-capita cost as older style systems with lesser outcomes.⁶ Self-management approaches for managing long-term conditions, based on person-centred principles, are gaining popularity in Australia and internationally and a substantial body of evidence demonstrates that they can improve both health and quality of life.⁷

Australian health policy has shifted towards a patient-centred approach. The promotion of person-centred care is a central aim of the improvement in health service delivery outlined in the National Chronic Disease Strategy (NCDS) and the National Service Improvement Frameworks (NSIF) for asthma; cancer; diabetes; heart, stroke and vascular disease; and osteoarthritis, rheumatoid arthritis and osteoporosis. These are intended to guide the activities of all involved in health care system from health service planners and managers to health sector policy makers, funders and providers.