Person-centred Care: The Leading Approach to Tomorrow’s Healthcare? Inger r Ekman man PhD, professo sor, r, directo ector University of Gothenburg, centre for person-centred care SWEDEN www.gpcc.gu.se www.gpcc.gu.se
www.gpcc.gu.se http://www. facebook.com/gpcc.gu Blogg: Person-centredness http://gpccpeople.com/ Twitter:@symptomsonthego @tdjeanette www.gpcc.gu.se
A human being – a person Personcentredness Needs Capacities Sen A. 1993, “Capability and Well - being,” in Nussbaum and Sen (eds.), The Quality of Life, Oxford: Clarendon Press www.gpcc.gu.se
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Effects in hospital care Reduced uncertainty in illness Reduced pain Reduced medical complications 30 % - 50% reduction in hospital days 40% reduction of costs Olsson L-E et al: Journal of Orthopaedic Surgery and Research, 2006 Olsson LE et aI: Journal of Advanced Nursing, 2007 Olsson LE, et al: Journal of Advanced Nursing, 2009 Ekman I, et al: European Heart Journal, 2011 Dudas K, et al Eur J Cardiovasc Nurs. 2013 Hansson E, et al Eur J Cardiovasc Nurs 2016. . • www.gpcc.gu.se
Effects of PCC in out-patient care Reduced fatigue Increased muscle strength Increased self-efficacy Increased self-reported health Feldthusen C et al. Arch Phys Med Rehabil. 2015 Oct Larsson A, et al. Arthritis Res Ther. 2015; 18;17:161. www.gpcc.gu.se
Effects – over the whole care chain Three times increased chance after an event of acute coronary syndrome to: Return to previous activity (e.g work) Not experience a cardiovascular event or death Increased self efficacy Fors A, et al. Int J Cardiol . 2015 May 6;187:693-9. www.gpcc.gu.se
Effecs of PCC in palliative home care Improved quality of life Reduced symptom burden Reduced number of hospitalizations Brännström M & Boman K. Effects of person-centred and integrated chronic heart failure and palliative home care. Eur J Heart Fail 2014;16:1142-51 www.gpcc.gu.se
What about staff ? Work strain Person-centred care Satisfaction with work Psycho-social climate Sjögren K, Lindkvist M, Sandman PO, Zingmark K, Edvardsson D. To what extent is the work environment of staff related to person-centred care? J Clin Nurs. 2015 May;24(9- 10):1310-9 www.gpcc.gu.se
What is a person? • Someone who has capacities • Someone who has self-respect • Someone who is interacting with others Sen A. 1993, “Capability and Well -being ,” The Quality of Life , Oxford: Clarendon Press Kristensson Uggla Bengt: (2011) Homo Capax . Ricoeur Paul (1992). Oneself as another . Chicago: University of Chicago Press. ; Smith, S. (2010). What is a person? Chicago: University of Chicago Press. www.gpcc.gu.se
person WHO patient WHAT www.gpcc.gu.se
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Building partnership Initiating the partnership – patient (and relative) narrative Working the partnership – mutual understading och creation of a health plan Safeguarding the partnership - documenting the agreed goals and a health plan • Ekman I, Swedberg K, Taft C, et al. Person-Centred Care – Ready for Prime Time. Eur J Cardiovasc Nurs . 2011;10(4):248-51. • Ekman I, Hedman H, Wallengren C, Swedberg K. Person-centred care, - the Swedish initiative. BMJ 2015;350:h160 www.gpcc.gu.se
Signs – medical evidence Symptoms Self-esteem Social relations Will www.gpcc.gu.se
Person-centred care process pre and during hospital care Usual care … etc Adding Adding Medical Adding Adding Discharge data- data Data-collection data data when possible Ambulance Emergency department Person-centred care Patient ´ s narrative Teamdecision Discharge Follow up Medical data- Care plan agreed on according to the Care plan collection between Care plan patient and professionals www.gpcc.gu.se
The personal health plan The patient ´ s goal Activities to reach the goal The patient ´ s capacities What support is needed?? www.gpcc.gu.se
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Implementation of p erson-centred care in an internal medicine ward Mean hospital stay in days 7 6.4 6 5.6 5 4.4 4 3 2 1 0 2011 2012 2013 www.gpcc.gu.se
Patients experience questionnaire 87 86 80 77,5 74 73 73 66 62 58 PUK (0-100) 2010 2012 Reception Participation Over all Information Mean value Questionnaire from: Jenkinson C, Coulter A, Bruster S: The Picker Patient Experience Questionnaire: development and validation using data from in-patient surveys in five countries. Int J Qual Health Care 2002, 14(5):353 – 358. www.gpcc.gu.se
Micro level attempt to change … Henbest J & Stewart MA. Family Practice 1989; 6:249-254 www.gpcc.gu.se
Concordance Compliance Professionals Professionals listen, informs and instructs coatch and mentor Patients explain, consider and discuss Patients obey www.concordance.org www.gpcc.gu.se
Summary • In a person-centred approach a patient and relatives are capable partners • A person-centred approach is feasable in all conditions • Person-centred care make patients more satisfied with care and is cost-effective www.gpcc.gu.se
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