Problem: Current medical care often uses a reductionistic biomechanic viewpoint. Although such a viewpoint may be of value in highly specialized care in patients with one disease, such an approach may not be optimal in chronic, elderly patients with signs of vulnaribility. Vulnerability has its core expressions in functional disturbances, co- and multimorbidity, polyfarmacy, low health literacy and social deprivation.
These types of patients are regarded as ‘complex’ because there is no simple technical quick fit to deal with the multiple interacting problems.
How should these patients be encountered?
The solution(s): Integrated care that is attuned to the wishes, needs and possibilities of patients (and their informal care providers) may be a solution. Within that model of integrated care ‘patient-oriented’ consultation types, based on a revised holistic BioPsychoSocial (BPS) design and the principle of coproduction may prevent unwanted care and influences triple aim outomes with more positive experiences and resulting in better health at lower costs.
Methodology: From the start of this programme patients were involved in all activities. We opted for an integrated mixed methods approach surpassing tribal domains. From a literature search on patient oriented care, several focus groups (with patients, care providers, managers and payers), rapid reviews of themes that ocurred, an administered survey on patient-oriented care, qualitative experiments (interviews and observations) and research experts discussions a value driven and person centered consultation model was constructed.
Results: On the bases of the review, the survey, the coproduction and the Social Quality Model, the experiences of care providers (especially GP’s) and patients an adapted and evolving consultation intervention was designed.
The consultation themes that emerged were:
1- an active listening attitude
2- determining mutual value, goals and possibilities resulting in shared decision making regarding diagnostics, treatment and follow-up
4- reminder (by recorded teach back) of mutual goals agreed upon
5- positive health aspects.
To implement the patient oriented consultation model, communication training with video reflection feedback is used. Patients are informed of the five patient-oriented steps and can take one or more cards (offered to them in the waiting room) that depicts the themes to handover to the GP and saying: ‘this is that I would like you to pay special attention to’.
Limiting conditions are time, lack of an empathic and activating attitude of the care provider and insufficient fit with the patient needs and possibilities (especially in case of health illiteracy).
From the number and type of cards handed over, we will estimate patient preferences with consultation types.
Experiences with the positive health applications suggest a reduction in referals and better experiences of care providers and patients.
Discussion: We did not opt for a classical intervention tested in an experimental design, but for a gradually developing pre-post learning codesigned bundle with variable approaches according to patient preferences in GP practices. Although experienced valuable, the integrated approach met many barriers (especially time constrains).
Wollersheim, H., Gruisen, W. and van de Venne, M., 2019. Coproducing value within the clinical encounter. International Journal of Integrated Care, 19(4), p.205. DOI: http://doi.org/10.5334/ijic.s3205
Wollersheim H, Gruisen W, van de Venne M. Coproducing value within the clinical encounter. International Journal of Integrated Care. 2019;19(4):205. DOI: http://doi.org/10.5334/ijic.s3205
Wollersheim, H., Gruisen, W., & van de Venne, M. (2019). Coproducing value within the clinical encounter. International Journal of Integrated Care, 19(4), 205. DOI: http://doi.org/10.5334/ijic.s3205
Wollersheim H, Gruisen W and van de Venne M, ‘Coproducing Value Within the Clinical Encounter’ (2019) 19 International Journal of Integrated Care 205 DOI: http://doi.org/10.5334/ijic.s3205
Wollersheim, Hub, Wiro Gruisen, and Martine van de Venne. 2019. “Coproducing Value Within the Clinical Encounter”. International Journal of Integrated Care 19 (4): 205. DOI: http://doi.org/10.5334/ijic.s3205
Wollersheim, Hub, Wiro Gruisen, and Martine van de Venne. “Coproducing Value Within the Clinical Encounter”. International Journal of Integrated Care 19, no. 4 (2019): 205. DOI: http://doi.org/10.5334/ijic.s3205
Wollersheim, H., et al.. “Coproducing Value Within the Clinical Encounter”. International Journal of Integrated Care, vol. 19, no. 4, 2019, p. 205. DOI: http://doi.org/10.5334/ijic.s3205