Implementation and evaluation of patient centred care in experimental studies from 2000-2010: systematic review

Main Article Content

Federica Amati
Andrea Marie McDonald
Azeem Majeed
Elizabeth Dubois
Salman Rawaf

Abstract

Background: Key areas have been identified in the British National Health Service where patient centred care is not achieved. Although patient centred care is an effective as well as an innovative way to improve multiple aspects of health services, it is unclear how exactly it should be defined and thus how it should be implemented and evaluated.   Objective: To investigate how patient centred care interventions are currently implemented and evaluated in experimental studies and see if there has been any recent development in the approach.     Methods: A systematic literature review was conducted to identify experimental studies investigating the impact of patient centred care on outcomes including clinical indicators and patient satisfaction scores. Studies were required to have a suitable control or comparison group and be published between August 2000 and July 2010.   Results: Each of the eligible studies used different methods to implement and evaluate patient centred care. Study quality was mixed and although there was frequently statistical significance, several studies lacked clinical relevance. Patients did not appear to be involved in designing the implementation or evaluation of patient centred care.   Conclusion: The standardisation of a patient centred approach will make the implementation and evaluation of a future patient centred NHS a much more achievable goal. A combination of study methods is required and any attempt at a consensus of patient centred care indicators must include input from patients. 

Article Details

Section
Regular Articles
Author Biographies

Andrea Marie McDonald, Imperial College London

Research Assistant, WHO Collaborating Centre Public Health Education and Training, Imperial College London

Azeem Majeed, Imperial College London

Professor of Primary Care and Head of the Department of Primary Care & Public Health at Imperial College London

Elizabeth Dubois, Imperial College London

Research Assistant, WHO Collaborating Centre Public Health Education and Training, Imperial College London

Salman Rawaf, Imperial College London

Director of the WHO Collaborating Centre for Public Health Education and Training, Imperial College London

References

Richards NC, A. (2007) Is the NHS Becoming more patient-centred? Trends from the national surveys of NHS patients in England 2002-07. Oxford: Picker Institute Europe.

Lewin S, Skea Z, Entwistle V, Zwarenstein M, Dick J. (2002) Interventions for providers to promote a patient-centred approach in clinical consultations (Cochrane Review). The Cochrane Library.2.

Ouwens M, Hermens R, Hulscher M, Vonk-Okhuijsen S, Tjan-Heijnen V, Termeer R, et al. (2010) Development of indicators for patient-centred cancer care. Supportive care in cancer. 18(1):121-30.

Henderson M. (2010) Cancer patients to be offered personalised drug therapies. The Times. June 3:15.

Rose D. (2009) The hidden death toll from errors by NHS staff. The Times. December 11.

Hunter GL, A. (2010) Local empowerment for public services. The Guardian.

Little P, Everitt, Hazel, Williamson, Ian, Warner, Greg, Moore, Michael, Gould, Clare, Ferrier, Kate & Payne, Sheila. (2001) Preferences of patients for patient centred approach to consultation in primary care: observational study. BMJ.468.

Schattner A. (2009) The silent dimension: expressing humanism in each medical encounter. Archives of Internal Medicine. 1095-9.

UK Department of Health (2010) White Paper: Equity and excellence: Liberating the NHS.

Dahlgren G, Whitehead M. (1991) Policies and strategies to promote social equity in health.

Hartzband P, Groopman J. (2009) Keeping the Patient in the Equation - Humanism and Health Care Reform. The New England Journal of Medicine. 361(6):554.

Irwin RSR, N. D. (2006) Patient-focused care: Using the right tools. Chest. 73S-82S.

Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, et al. (2001) Observational study of effect of patient centeredness and positive approach on outcomes of general practice consultations. BMJ. (323):908-11.

Longtin Y, Sax, Hugo, Leape, Lucian L., Sheridan, Susan E., Donaldson, Liam & Pittet, Didier. (2010) Patient Participation: Current Knowledge and Applicability to Patient Safety. Mayo Clinic Proceedings. 53-62.

Davis K, Schoenbaum, S. C. & Audet, AM. (2005) A 2020 Vision of Patient-Centered Primary Care. Journal of General Internal Medicine. 953.

Kidd J, Marteau, T. M., Robinson, S., Ukoumunne, O. C. & Tydeman, C. (2004) Promoting patient participation in consultations: a randomised controlled trial to evaluate the effectiveness of three patient-focused interventions. Patient Education and Counseling. 107-12.

Critical Appraisal Skills Programme. 10 questions to help you make sense of randomised controlled trials. [cited 2011]; Available from: http://www.sph.nhs.uk/sph-files/casp-appraisal-tools/rct%20appraisal%20tool.pdf.

Moher D, Liberati A, Tetzlaff J, Altman DG. (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of internal medicine. 151(4):264.

Fremont AM, Cleary, P. D., Lee Hargraves, J., Rowe, R. M., Jacobson, N. B. & Ayanian, J. Z. (2001) Patient-centered Processes of Care and Long-term Outcomes of Myocardial Infarction. Journal of General Internal Medicine. 800-8.

Wolf D, Lehman, L., Quinlin, R., Rosenzweig, M., Friede, S., Zullo, T. & Hoffman, L. (2008) Can nurses impact patient outcomes using a patient-centered care model? The Journal of Nursing Administration. 532-40.

Chenoweth L, King, M. T., Jeon, Y. H., Brodaty, H., Stein-Parbury, J., Norman, R., Haas, M. & Luscombe, G. (2009) Caring for Aged Dementia Care Resident Study (CADRES) of person-centred care, dementia-care mapping, and usual care in dementia: a cluster-randomised trial. Lancet Neurology. 317-25.

Meulepas MA, Braspenning, J. C., de Grauw, W. J., Lucas, A. E., Wijkel, D. & Grol, R. P. (2008) Patient-oriented intervention in addition to centrally organised checkups improves diabetic patient outcome in primary care. Quality & Safety in Health Care. 324-8.

Alamo MM, Moral, R. R. & Perula de Torres, L. A. (2002) Evaluation of a patient-centred approach in generalized musculoskeletal chronic pain/fibromyalgia patients in primary care. Patient Education and Counseling, 23-31.

Ockene JK, Reed, G. W. & Reiff-Hekking, S. (2009) Brief patient-centered clinician-delivered counseling for high-risk drinking: 4-year results. Annals of Behavioral Medicine : A Publication of the Society of Behavioral Medicine. 335-42.

Nobili MP, Piergrossi, S., Brusati, V. & Moja, E. A. (2007) The effect of patient-centered contraceptive counseling in women who undergo a voluntary termination of pregnancy. Patient Education and Counseling. 361-8.

Stewart M. (2001) Towards a global definition of patient centred care. BMJ. 322(7284):444.

Baldwin AS, Cvengros, J. A., Christensen, A. J., Ishani, A. & Kaboli, P. J. (2008) Preferences for a patient-centered role orientation: association with patient-information-seeking behavior and clinical markers of health. Annals of Behavioral Medicine : A Publication of the Society of Behavioral Medicine. 80-6.