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Abstract Both patient-centered and person-focused care are important, but they are different. In contrast to patient-centered care at least as described in the current literature with assessments that are visit-basedperson-focused care is based on accumulated knowledge of people, which provides the basis for better recognition of health problems and needs over time and facilitates appropriate care for these needs in the context of other needs.
That is, it specifically focuses on the whole person. Proposed enhancements and innovations to primary care do not appear to address person-focused care. Tools to assess person-focused care are available and deserve more widespread use in primary care.
Patient-centered is a term in widespread use; in the US, for example, the recent movement toward reforming primary care is known as the patient-centered medical home. The preponderance of the literature assesses patient-centered care by focusing on visits involving care of generally chronic diseases, whereas person-focused care is provided to patients over time independent of care for particular diseases 2 Table 1.
Assessing quality of problem recognition requires documenting the problems and how they change in response to what clinicians do. Diagnoses are professional interpretations of observations and, increasingly, of laboratory values.
A few primary care researchers in various countries have been trying at least since the late s to understand the relationship between presenting problems and eventual diagnoses. Patient-Centered Care Most studies of patient-centeredness are carried out in settings involving visits. The literature on primary care-oriented health systems postulates that one of the mechanisms for benefit results from a greater focus on patients as they transition from one health problem to another.
To be person-focused, it must be accessible, comprehensive dealing with all problems except those too uncommon to maintain competencecontinuous over time, and coordinating when patients have to receive care elsewhere. The essence of person focus implies a time focus rather than a visit focus.
It extends beyond communication because much of it relies on knowledge of the patient and of the patient population that accrues over time and is not specific to disease-oriented episodes. Physicians and patients working together to reach mutual decisions often require a long-standing relationship.
A specialty dominance dictates that interest is mainly in individual diseases, chosen because they are costly or because they are thought to cause considerable premature mortality. Contrary to conventional wisdom, the main determinant of high costs of care is not the presence of chronic illnesses.
They appreciate the importance of costs and severity of condition which is difficult to judge in clinical settings, except in the case of acute conditionsbut they identify three additional issues: Good primary care is not the sum of care for individual diseases.
Although most PCPs and some specialists think of their work as person-focused, reimbursement policies and the thrust of medical education toward professionally specified diagnoses do not reward or facilitate attention to patient-defined problems.
Whether current enhancements to and innovations in primary care will change the current reality is an open question. Several of these approaches are currently in vogue: Guidelines Adhering to guidelines, although often very helpful to physicians, predisposes them to emphasize the management of specific diseases because clinical guidelines focus on diseases.
Many common diseases are syndromes—that is, common manifestations of diverse processes set in motion by interacting influences on health.
Despite this reality, guideline supporters continue to develop algorithms for management in primary care that are based on an outmoded concept of health problems in populations: Clinical trials do not identify the nature and extent of the health problems experienced by people participating in them or the extent to which problems experienced by the participants are resolved by the intervention being tested.
Person focus is not realized when likely adverse events are not systematically recorded and studied. Guidelines, although generally applied only in primary care not specialty practice are not developed with consideration of the nature of primary care settings.
PCPs are in the best position to know what types of problems should receive priority for guideline development, but they are rarely either consulted or in control over the selection of problems for guideline development, the interpretation of the results of trials, or the applicability of their results to their practice.
The fact that these are more likely in deprived populations makes most payment-for-performance schemes antithetical to fostering equity in delivering health services. Performance measurement is increasingly being extended to interventions that have only a small clinical benefit at the same time that many important aspects of care are being neglected.
The ethical aspects of pay for performance have been addressed by a major US primary care medical society, which proposed an ethics manifesto. Quality measures should identify excellent comprehensive care.
They must recognize successful management of multiple complex chronic conditions, meeting the counseling and communication needs of patients, and providing continuity of care and other attributes of comprehensive care. All measures must sustain and enhance appropriate patient care and the physician-patient relationship.
It deviates from primary care in its application. Chronic has been interpreted as if it referred to chronic disease. This makes it inherently incompatible with primary care, which is person-focused.
All of the implementations of chronic care management are disease-oriented, and they have all of the problems of disease-oriented care. The literature is replete with evaluations purporting to show benefit, but the vast majority have focused only on one condition mostly diabetesand none have evaluated the effectiveness of the intervention on improvement in person-focused morbidity or mortality.
Of reviewed articles, only 82 were in primary care settings. Most were from the US.Welcome to the home of The Person Centred Association, the UK's organisation for everyone interested in the person centered approach, including practioners, counsellors, psychotherapists, researchers and .
Person-Centered Expressive Arts practitioners can be therapists, social workers, educators, creativity coaches, consultants, pastoral counselors, nurses or individuals working .
Person-centred care has been identified as the ideal approach to caring for people with dementia. Developed in relation to long stay settings, there are challenges to . Person centred planning is a collection of tools and approaches based upon a set of shared values that can be used to plan with a person – not for them.
These tools can be used to help the person think about what is important in their lives now and also to think about what would make a good future. Person-Centered Expressive Arts practitioners can be therapists, social workers, educators, creativity coaches, consultants, pastoral counselors, nurses or individuals working .
What is Person Centered Planning? Planning from a person-centered perspective seeks to listen, discover and understand the individual. It is a process directed by the person that helps us to learn how they want to live and describes what supports are needed to help them move toward a life they consider meaningful and productive.