Person-centred care -10 years of research and practice

  • View
    1.475

  • Download
    0

Embed Size (px)

Transcript

Slide 1

Getting to person-centred careBuilding and using the evidenceHelen Crisp, Assistant Director Research

1

Conflicts of interest:2I am employed by the Health Foundation

As such, I am paid to attend this conference and to give this talk

This presentation is based on the work of many individuals and institutions, much of it funded by the Health Foundation

I will be publicising free publications and resources that the Health Foundation makes available to promote improvement science and person-centre care

I have no other interests to declare

2

3Thanks to

Colleagues at the Health Foundation: Adrian SieffDarshan PatelEd McKiernan Hannah OMalleyLizzie WrobelMatt TaitNicola PowellShaun Leamon

Who all contributed to the preparation of this presentation

3

Person-centred care as a facet ofImprovement Science4The Health Foundation is committed to building the field of Improvement Science - by which we mean:

The application of a range of basic and applied sciences in order to improve the effectiveness and efficiency of efforts to improve quality of health care for patients and populations

4

Dimensions of quality5The Health Foundation is working to support improvements to health services so that they are:SafeEffectivePatient-centredTimelyEfficientEquitable

Institute of Medicine, 2001

5

Dimensions of quality6The Health Foundation is working to support improvements to health services so that they are:SafeEffectivePerson-centredTimelyEfficientEquitable

6

7

Other models lots of overlap7

What are the aims for person-centred care?8 Better experience of care Better clinical outcomes Better use of health care resources

8

What are the challenges?9 Perceptions of health care staff about person-centred care

We already do this

9

What are the challenges?10 Perceptions of health care staff about person-centred care

We already do thisSurveys in the NHS consistently report that over 40% inpatients would like more involvement in decisions about their care

10

What are the challenges?11 Perceptions of health care staff about person-centred care

The changes require social and cultural changes more than technical solutions

CultureStrategy

11

What are the challenges?12 Perceptions of health care staff about person-centred care

The changes require social and cultural changes more than technical solutions

The evidence base is weak, contested and confusing- Evidence review of shared decision making found 160 different definitions - Many other studies with no definition - Same approaches have very different results

12

Improvement science approach to person-centred care?13Theory-based interventions using tested methods Written up using SQUIRE guidelinesOutcome measures; personal, process, clinicalRobust evaluation using a range of innovative methods

13

Improvement science in action14ResearchEvidence reviewsDeveloping theory

Improvement programmesCo-Creating HealthMAGICChanging relationships projects

Evaluation: independent, qual & quant, published

14

A 10 year journey15

15

A 10 year journey16

16

A 10 year journey

17

18

The Health Foundation has focussed primarily on two areas:19

Self-management supportShared decision making

19

Health Foundation definition20Self-management support is the assistance caregivers give to patients with chronic disease in order to encourage daily decisions that improve health-related behaviours and clinical outcomes.

Important to differentiate between daily self-care - people do this by themselves for 99% of the time

Self-management support is about how health care professionals can work with people to help them better understand their condition and achieve outcomes hat matter to them.

It can be viewed as a portfolio of techniques and tools that help patients choose healthy behaviours; and as a fundamental transformation of the patient-caregiver relationship into a collaborative partnership.

The purpose of self-management support is to aid and inspire patients to become informed about their conditions and take an active role in their treatment.

20

Health Foundation definition21Shared decision making is a process in which clinicians and patients work together to select tests, treatments, management, or support packages, based on clinical evidence and patients informed preferences.

It involves the provision of evidence-based information about options, outcomes and uncertainties, together with decision support counselling and systems for recording and implementing patients treatment preferences.Influenced by clinical practiceGrown out of informed consentFramed by bioethical valuesSeen as a middle ground between paternalist and informed patient modelsResearch aims to understand the core principles that underpin a shared decision

21

What do we know now?22

Person-centred care is an emerging area of practiceNo common definitions of termsConcepts are contested

Based on: 18 research reports results of 3 major improvement programmesplus findings from many small-scale projects

= Some confidence in what we can say

22

What works?

23Self-management support approaches

23

Self-management support approaches24

Counselling-oriented approach to consultations

Aims to shift from medical model to one to one support that facilitates behaviour change

Used in Co-Creating Health to train professionals

a professional life-changing eventTraining in motivational interviewing described as:

24

Self-management support approaches25

Approach to help people more effectively manage long-term conditions

Builds confidence by setting attainable goals that matter to the individual and step by step plans to reach them

Key feature of Co-creating Health

25

Self-management support approaches26

Short courses for groups of people with similar condition to support self-management often led by an individual who has a long term condition

Im happy for starting the group when I did. Learning things, pacing, helped to sort my life. STOP! Project in Dorset: Group sessions to help people live with chronic back pain

26

Self-management support approaches27

Group or one to one support from someone who lives with a similar condition

Underpinned by key value of reciprocity

Ill never be the same person I was before my diagnosis but peer support coaching has made me believe in a future where I can recover and develop the new me

2Gether NHS Foundation Trust: Coaching for recovery:

27

Effective shared decision making28Decision aids evidence basedinclude pros and cons of each optionuse real-life examplesuse diagrams and visuals

All need skills to use and attitude trumps skill

28

29

Evidence basedTwo optionsFAQsOption grid breast cancer surgery

29

30

Decision aid sounds very posh but its not ..This was about involving people in their care, and they had never been asked beforeProject lead, Newham COPD Shine project

I probably havent involved patients as much as I thought in the past havent made them as aware of all the different options. GP, North Shields MAGIC programme

30

Evidence of improved clinical outcomes31Self-management supportType II diabetes Reduced HBA1cReduced fasting glucose Stroke6 studies showed improvement3 studies showed none

31

Benefits to patients

32

More confidence for better day-to-day management of health

Able to make and sustain healthy lifestyle changes

Higher satisfaction with care experience

Better adherence to treatment plans and correct medicine use

32

Benefits to patients

33

More confidence for better day-to-day management of health

Able to make and sustain healthy lifestyle changes

Higher satisfaction with care experience

Better adherence to treatment plans and correct medicine use

Debate about imposition of medical model v. patient goals

33

Benefits for health care system 34Some evidence of:Reduced use of emergency hospital services Diabetes self-management programme

Reduced number of outpatient appointmentsAyrshire & Aran Co-creating Health

Choice of less invasive treatmentRight Care knee pathway project

Links between service use and self-management are very complexCorrelation rather than causation34

Benefits for health care system 35Some evidence of:Reduced use of emergency hospital services

Reduced number of outpatient appointments

No implementation at scale to demonstrate at system level

35

Benefits for health care system 36Some evidence of:Reduced use of emergency hospital services Diabetes self-management programme

Reduced number of outpatient appointmentsAyrshire & Aran Co-creating Health

Choice of less invasive treatmentRight Care knee pathway project

Links between service use and self-management are very complexCorrelation rather than causation36

37What works to support implementation?

37

38What works to support implementation?

38

39What works to support implementation?

39

40

Work with other sectorsWhat works to support implementation?

40

41

Work with other sectors

Fit