Primary care from the patients perspective

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Primary care from the patients perspective

• Angela Coulter
• Picker Institute Europe
• www.pickereurope.org

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What do patients want?
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What patients want

• Fast access to reliable health advice
• Effective treatment delivered by trusted
  professionals
• Participation in decisions and respect for
  preferences
• Clear, comprehensible information and support for
  self-care
• Attention to physical and environmental needs
• Emotional support, empathy, and respect
• Involvement of, and support for, family and
  carers
• Continuity of care and smooth transitions

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What do patients want?

• Fast access to reliable health advice
• Effective treatment delivered by trusted
  professionals
• Participation in decisions and respect for
  preferences
• Clear, comprehensible information and support for
  self-care
• Attention to physical and environmental needs
• Emotional support, empathy, and respect
• Involvement of, and support for, family and
  carers
• Continuity of care and smooth transitions

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Work in partnership with patients

• Listen to patients and respond to their concerns
  and preferences
• Give patients the information they want or need
  in a way they can understand
• Respect patients right to reach decisions with
  you about their treatment and care
• Support patients in caring for themselves to
  improve and maintain their health
• Good Medical Practice 2006

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Sharing expertise

• CLINICIAN
• diagnosis
• disease aetiology
• prognosis
• treatment options
• outcome probabilities

• PATIENT
• experience of illness
• social circumstances
• attitude to risk
• values
• preferences

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What do they get?

• Listen to patients
• Understand their preferences
• Give information
• Communicate risk
• Share decisions
• Support self-care

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Would have liked more involvement in treatment
decisions (NHS patient surveys, England 2004/5)
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Doctor always gives information about treatment
choices and elicits patients preferences
Commonwealth Fund survey 2005
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Patients with chronic conditions who were given
self-management plans
Commonwealth Fund survey 2005
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Why encourage patient participation?

• To ensure appropriate treatment and care
• To improve health outcomes
• To reduce risk factors and prevent ill-health
• To improve safety
• To reduce complaints and litigation
• To comply with modern professional standards

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Improve information and risk communication

• Doctors are seen as the primary source of
  information
• Personalised information is best
• Communicating risk is a highly skilled task

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Share decisions

• Review benefits, harms and uncertainties
• Explore role preference
• Clarify values
• Make a decision
• Plan next steps

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Support self-care

• Give advice on prevention and risk factors
• Help patients to look after themselves
• Educate patients in how to manage chronic
  conditions
• Give information about medication side-effects
• Encourage self-monitoring

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Competencies for patient partnership

• Clinicians need to learn how to
• Guide patients to appropriate information sources
  
• Educate patients about prevention
• Elicit and understand patients preferences
• Offer choices (providers/treatments)
• Communicate information on risk and probability
• Share treatment decisions
• Provide support for self-care and self-management

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Patient feedback can be used to assess
professional behaviours

• Use well validated standardised questionnaires in
  educational assessment, appraisal and
  revalidation
• Compare results against national benchmarks
• Determine priorities for improvement
• Celebrate success

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The new patient

• Instant telephone / email access to advice
• Access to quality assured websites
• Self-diagnosis, self-medication, self-care
• Control of electronic health records
• Involvement in treatment decisions
• Free choice of provider

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The new professional

• Excellent clinical knowledge and skills
• Educator, facilitator, information broker
• Excellent communication and negotiation skills
• Time for the patient and empathy
• Skilled team-worker
• Partners in care patient is co-producer

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