Optimising person centred primary care

Even though person-centred care has been advocated by practitioners, patients, researchers and policymakers (“No decision about me, without me”), the patients’ own experiences show that it’s still not implemented in a meaningful way in today’s primary care.

As the contemporary landscape is characterised by increasingly complex healthcare issues and rising incidence of long-term conditions, optimising person-centred care can help healthcare services face these challenges.

In order to achieve this, we need to first understand what person-centred care means, and how it looks like, from the perspectives and experiences of people themselves. Then, it is important to learn how to incorporate patients’ illness experience with the practitioners’ own knowledge and experience, by looking at the healthcare system as a whole, from practice’s organisation to medical education and clinical practice.

A University of Hull funded PhD project was conducted by Dr Myriam Dell'Olio (2017 - 2021) to define person-centred primary care consultations from the perspectives of people with long term conditions. This was carried out using qualitative methods that would provide an in-depth analysis of people’s healthcare experiences. Several local patient participation groups and patient support groups contributed to this study.

Now, we’re starting a new project, Optimal TIMES, which focuses on understanding how health professionals use knowledge in practice. For this project, we will observe how primary care professionals work in practice (e.g., how they interact with patients and colleagues), and conduct focus groups to inquire into the barriers and facilitators to implementing evidence and knowledge in practice. We’re carrying out this project in collaboration with the University of Exeter (Co-Investigator: Professor Chris Fox).

In our first study on person-centred care from the perspectives of people with long-term conditions, we learned that an essential aspect of person-centred care is “epistemic reciprocity”, namely the patient’s and doctor’s mutual effort to share and integrate their knowledge into clinical decision-making.

As we’re working on optimising person-centred care further, we’re now preparing research bids aiming to translate these findings from both patients’ and doctors’ experiences into training programmes and medical education initiatives to further transform the primary are workforce, and advance and support the implementation of person-centred care in today’s clinical practice.

Whereas Optimal TIMES is still ongoing, the PhD project on person-centred care has been completed. The findings of the PhD project contributed to understanding person-centred care through the experiences of people themselves.

Starting from a systematic review that found that person-centred care is achieved through the interplay between organisational, relational and epistemic (knowledge-related) factors, interviews and focus groups with participants showed that a person-centred consultation is made up of three moments: broad exploration, reflexive listening, and reciprocal inquiry. During these moments, it is important that not only doctors, but also patients, engage in a conscious and thoughtful exploration of their own experiential and clinical knowledge, so that both can reach a mutual understanding to support their shared decision-making.

The findings of this study have been presented in various person-centred care and/or primary care conferences, and have been published on two papers:

Dell’Olio, M., Whybrow, P. & Reeve, J. (2023). Examining the knowledge work of person-centred care: Towards epistemic reciprocity. Patient Education and Counseling, 107.

Dell’Olio, M., Pask, S, Seymour, J., & Reeve, J. (2019). What do the healthcare experiences of people with long-term conditions tell us about person-centred care? A systematic review. EJPCH, 7(4), 596-613.

Awards

‘Qualitative Research’ prize awarded by the European Society of Person-Centered Healthcare