Patient-centred care – a gulf between theory and practice?

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The health sector, both in Australia and internationally is increasingly being pushed to do more with less, provide for disparate populations and meet the increasingly complex needs of people who use our health systems. One of the ways that this can be done is through patient-centred health care.

The benefits of patient-centred care are well recognised within the Australian health sector. Putting patients at the centre of their care benefits them through an increased level of trust and confidence in services; provision of services that offer personalised healthcare and value for money; recognition of their right to equitable access to healthcare and increased rates of health literacy. It benefits to health services and practitioners through an increased perception of public value; robust and enduring partnerships between all stakeholders; and patients being more compliant with treatment regimens. Finally, the benefits to the wider health system include: efficiency gains and consequently a reduction in overall healthcare costs; outcomes that patients value; improved health outcomes; and improved patient satisfaction.

Despite these well recognized benefits, however, the extent to which patients are at the centre of the Australian healthcare workforce remains unclear. Health Workforce Australia’s 2013 review of Australian government health workforce programs noted that when health workforce programs are considered, policy and practice regularly become too focused on the needs of practitioners and institutions, rather than those of patients and consumers. While attempts have been made to change this, such as the Australian Commission on Safety and Quality in Health Care’s development of a guide for health service organisation boards to help them engage with their national standards, the understanding of how central patients are to the Australian health workforce remains unclear.

In an attempt to change this CHF undertook a survey in August 2016 of 55 health workforce professional organizations (the full report can be seen here). The areas that were investigated included organisations’ attitudes toward and understanding of patients as partners in care and the policies, practices and procedures of the organisations regarding patients as partners in care. Twenty of the 55 organisations responded to the survey.

Respondents strongly agreed with the values behind and benefits that can be gained from patient centred care.

The entire sample agreed that patient-centred care is associated with decreased mortality and improved adherence to treatment regimes. Endorsement of the other listed clinical benefits (decreased hospitalisation rates, decreased rates of healthcare acquired infections and reduced length of stay) varied between 90 and 95 per cent of respondents, with no respondents disagreeing to any of the statements.

Agreement with the impact of patient-centred healthcare to a better patient experience was similarly high. All respondents agreed that patient- centred healthcare contributes to a better patient experience through services and treatment approaches being tailored to patient’s individual needs and experiences, increased access to health services and more effective communication between practitioners and patients. Ninety per cent of respondents agreed that patient-centred health care contributes to increased access to health services. The only item in this group which any respondents disagreed with (15%) was that patient-centred health care contributes to a reduction in time spent in the health system.

The benefits to the health system which result from patient-centred healthcare were endorsed by the majority of participants.

Over 90 per cent of respondents agreed that patient-centred health care benefits the health system through reduced health system complaints, increased trust in the health system and more appropriate use of services by patients. The least endorsed statement from any of the above sets of statements was that patient-centred healthcare benefits the health system overall through decreased costs, which 80% of respondents agreed with.

Despite the high level of recognition of the benefits of patient-centred care, however – only 50% of respondents felt that they had access to adequate resources from either internal or external sources to assist in supporting a patient-centred model of care. This was also reflected in the extent to which patient-centred care is enshrined in organizational policy. 45% of organizations reported that patient-centred care is a stated objective in their code of conduct or professional standards and 40% reported that their organization had a patient engagement policy.

When asked how this was operationalised within organisations respondents reported that consumers are involved in their organisations in varied ways. As the graph below shows the most frequent way that patients were involved in organizations was through survey consultations on specific issues relevant to the organizations (65% of respondents). The least frequent way that organisations involved patients was as members of a consumer advisory or critical friends group (25%).

The results of this survey show that the values of patient centred care are well accepted amongst professional health organisations. There can be little doubt that the professional organisations surveyed are in favour of and understand the values of patient-centred care. However despite that, organisations are not in practice comprehensively including patients throughout their work. Further investigation is warranted to better understand why this is occurring with a view to supporting organisations in doing this better. Consumer groups and advocates, including CHF, have a role to play in helping organisations understand how to include consumers throughout their work.

Respondents to the workforce survey were:

Audiology Australia
Australian and New Zealand Arts Therapy Association
Australian College for Emergency Medicine
Australiasian College of Podiatric Surgeons
Australasian College of Dermatologists
Australian College of Nurse Practitioners
Australian Dental Association
Australian Diabetes Educators Association
Australian Music Therapy Association
Australian Primary Health Care Nurses Association
Australian Psychological Society
Exercise and Sports Science Australia
Faculty of Radiation Oncology RANCR
Occupational Therapy Australia
Osteopathy Australia
Pharmaceutical Society of Australia
Royal Australasian College of Physicians
Rural Health Workforce Australia
Rural and Remote Allied Health Professionals and Students
Speech Pathology Australia