  Patient-centred
health outcome measures
Ongoing monitoring of the condition
should also be based on the person’s own concerns
and goals for health care. Support programs and
clinical trials now often assess quality of life,
functional health status and patient satisfaction to
gain a measure of effects that is meaningful to
patients.
In asthma treatment, traditional
end-points (symptoms, reliever use, forced
expiratory volume in one second per cent predicted,
morning peak expiratory flow, airway
hyperresponsiveness) do not fully capture treatment
benefits from the patient’s point of view.19
More important measures for patients might include
days missed from work due to asthma or ability to
exercise without symptoms.
Develop teamwork with other
services
Teamwork is recognised as an aspect
of patient-centred care.20 One service
provider, e.g. GP, cannot feasibly undertake all
aspects of a person’s care such as comprehensive
motivational interviewing, patient education for
self-management, dietary assessment or coaching to
achieve behavioural change. General practice can
better ensure that a wide range of patients’ needs
are met by working with other providers such as
local asthma educators, local diabetes centres,
allied health professionals, community agencies
(e.g. ancillary community services) and support
groups (e.g. Diabetes Australia, Asthma Foundations
Australia, arthritis foundations).3
Offer referral to self-management
programs
Patients need support to
successfully manage the impact of long-term
conditions on their lives. Self-management programs
specifically developed for people with complex care
needs generally involve these guiding principles:
-
Allow and encourage the patient
to define health problems.
-
Explore options for dealing with
these problems.
-
Offer choice and respect the
person’s choice – rather than directing and
prescribing.
-
Collaboratively set goals and
action plans to address problems or
adopt/maintain health-related behaviours.
Approaches that recognise and act in
partnership to manage patient-defined problems are
the most successful, regardless of the mode of
delivery.21 Well-defined approaches such
as the Stanford Chronic Disease Self-Management
Program and the Flinders Model of chronic disease
self-management are based on these principles.
Health coaching in chronic disease is an emerging
approach based on person-centred care principles.
These models focus on action plans set by the person
with the condition. Coaching generally involves a
health professional, other than the main prescriber
or clinician, who provides individualised support
for self-management. This approach has been applied
mainly in areas of diabetes and cardiovascular
conditions including coronary heart disease.
Conclusion
In all disciplines and
health services, patients benefit where
health professionals pay attention to the
principles of collaborative partnerships
with patients, offering patients an
opportunity to make informed decisions about
their health care based on effectively
communicated medical evidence and setting
mutually agreed goals for care. Many primary
care health professionals are already
practising within such a person-centred
framework, which acknowledges that the
proper focus of health care is the person,
not the condition.
|
