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

Main Article Content

Salman Rawaf
Federica Amati
Andrea McDonald
Azeem Majeed
Elizabeth Dubois

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 to determine whether there have been any recent developments 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

Salman Rawaf, WHO Centre at Imperial College London; and St George’s University of London

Salman Rawaf qualified in medicine with subsequent training in paediatrics and public health. Professor Rawaf until January 2009 was the Director of Public Health in NHS Wandsworth, London: a post which he held since 1988 in South West London. He is currently Professor of Public Health and Director of WHO Centre at Imperial College London, Hon. Professor of Public Health at the Middlesex University, Hon Professor of Primary care at Ghent University Belgium, and Senior Lecturer at St George’s University of London. He serves on many national and international committees and groups. He has published more than 120 scientific papers, 2 books (Assessing Health Needs RCP Publishing Group, and Health Improvement Programmes RSM Publishers) and many international reports. He is the Founder and Editor-in-Chief of the journal Public Health Medicine and a member of other editorial boards. He is well known for his international work and his contribution to global health. He is an adviser to the WHO on primary care, public health, health system and medical education. He has been invited to undertake many international assignments in many countries around the world.Professor Rawaf is a Fellow of the Royal Colleges of Physicians London and the UK Faculty of Public Health and Member of the Faculty of Public Health Medicine Ireland. He is the Chair of the International Committee, Faculty of Public Health UK, Executive Member of the International Committee of the Academy of the Royal Medical Colleges, Council Member of Chelsea and Westminster Hospital Foundation Trust, Member of WHO Advisory Committee for Health research, and Programme Leader of the Postgraduate Diploma/MSc in Family Medicine Middlesex University. His contributions to public health and primary care in research and service delivery are well documented. Among the many innovative approaches are young people and addictive behaviour and Staying Healthy: a programme to assess risk factors for chronic diseases in community settings and enable individuals to engage in their own health. Since started his work in 1988 in South West London as a Director of Public Health, he and his team received many awards and recognitions for the works to improve health. At International level is well recognised in his work supporting countries in strengthening their health system including primary and public health. He runs well renowned training programme of health system development both in and outside the UK.   

Federica Amati, Imperial College, London UK

Postgraduate Student, Imperial College, London UK

References

. Richards, N.C. 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. and 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), 121-130.

. 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, G.L.A. (2010). Local empowerment for public services. The Guardian.

. Little, P., Everitt, H., Williamson, I., Warner, G., Moore, M., Gould, C., Ferrier, K. and Payne, S. (2001). Preferences of patients for patient-centred approach to consultation in primary care: observational study. British Medical Journal 322, 468.

. Schattner, A. (2009). The silent dimension: expressing humanism in each medical encounter. Archives of Internal Medicine 169 (12) 1095-1099.

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

. Dahlgren, G. and Whitehead, M. (1991). Policies and strategies to promote social equity in health. Background Document to WHO - Strategy Paper for Europe.World Health Organisation, Geneva.

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

. Irwin R.S.R.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. British Medical Journal (323), 908-911.

. Longtin, Y., Sax, H., Leape, L., Sheridan, S.E., Donaldson, L. and Pittet, D. (2010). Patient Participation: Current Knowledge and Applicability to Patient Safety. Mayo Clinic Proceedings 85, 53-62.

. Davis. K., Schoenbaum, S.C. and Audet, A.M. (2005). A 2020 Vision of Patient-Centered Primary Care. Journal of General Internal Medicine 20 (10), 953-957.

. Kidd, J., Marteau, T.M., Robinson, S., Ukoumunne, O.C. and 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 52 (1), 107-112.

. 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. and Altman, D.G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of Internal Medicine 151(4), 264.

. Fremont, A.M., Cleary, P.D., Lee Hargraves, J., Rowe, R. M., Jacobson, N.B. and Ayanian, J. Z. (2001). Patient-centered Processes of Care and Long-term Outcomes of Myocardial Infarction. Journal of General Internal Medicine 16 (12), 800-808.

. Wolf, D., Lehman, L., Quinlin, R., Rosenzweig, M., Friede, S., Zullo, T. and Hoffman, L. (2008). Can nurses impact patient outcomes using a patient-centered care model? Journal of Nursing Administration 38 (12) 532-540.

. Chenoweth, L., King, M.T., Jeon, Y. H., Brodaty, H., Stein-Parbury, J., Norman, R., Haas, M. and 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 8 (4), 317-325.

. Meulepas, M.A., Braspenning, J.C., de Grauw, W.J., Lucas, A.E., Wijkel, D. and 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 17, 324-328.

. Alamo, M.M., Moral, R.R. and 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 48, 23-31.

. Ockene, J.K., Reed, G. W. and Reiff-Hekking, S. (2009). Brief patient-centered clinician-delivered counseling for high-risk drinking: 4-year results. Annals of Behavioral Medicine 37, 335-342.

. Nobili, M.P., Piergrossi, S., Brusati, V. and Moja, E. A. (2007). The effect of patient-centered contraceptive counseling in women who undergo a voluntary termination of pregnancy. Patient Education and Counseling 65, 361-368.

. Stewart, M. (2001). Towards a global definition of patient centred care. British Medical Journal 322(7284), 444.

. Baldwin, A.S., Cvengros, J.A., Christensen, A. J., Ishani, A. and 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 35, 80-86.