Multi-Study Spotlight: Patient-Centered Care (PCC) and Engagement

Spotlight on article published in

Medical Care Research and Review

IBI Spotlights call attention to important health and productivity findings from peer-reviewed work by external researchers. Unless otherwise stated, the authors are not affiliated with IBI, nor was the research executed on IBI’s behalf. IBI members are encouraged to obtain the original articles from the copyright holder.

What is the Issue?

There has been a recent increase in the focus on patient-centered care (PCC), particularly for those with chronic illnesses. By focusing on the needs, values and beliefs of patients, PCC promises to help further a holistic approach to care delivery with better outcomes than care delivered in a fragmented fashion. Nevertheless, little systematic research has been conducted on the benefits of PCC for care of the chronically ill and not much is known about the best ways to design and implement PCC for positive patient outcomes including, but not limited to, health. This review summarized what is known from randomized controlled trials about the benefits of PCC for the chronically ill.

What are the findings/solutions?

Overall, there was limited information available on the details of the interventions studies. Where interventional detail did exist, PCC was shown to produce higher patient satisfaction, higher levels of engagement in patient decision-making and higher perceived quality of care when providers were trained around improving communications skills. Future studies should focus on longer time frames and assess whether early gains in emotionally positive outcomes for patients receiving PCC translate into improved health or less functional deterioration over time.

Journal Citation

McMillan, S.S., Kendall, S., Sav, A., King, M.A., Whitty, J.A., Kelly, F. and Wheller, A.J. (2013) Patient-Centered Approaches to Health Care: A Systematic Review of Randomized Controlled Trials. Medical Care Research and Review Vol 70 (6). pp. 567-96.

Objectives

To conduct a systematic review of randomized controlled trials (RCTs) of patient-centered care (PCC) interventions. Assess the types of interventions implemented and the measurement and methods used in each study as well as the summary evidence available across several patient and provider outcomes.

Method

The literature review was conducted across primary health care databases using key search terms related to patient-centered care. The reviewers used the Morgan and Yoder (2012) conceptual review as a framing devise to select PCC interventions that focused on at least one of the following four care domains: holistic, individualized, respectful, empowering. In addition, only studies that were based on data, were RCTs, and measured relevant outcomes for patients were retained. 29 RCTs were selected and reviewed across three broad outcome areas: patient satisfaction, perceived quality of care and health outcomes (including clinical and functional outcomes where work is a functional outcome).

Results

Involving patients in health-related decision-making and better provider communication was associated with improved perceptions of quality of care and higher well-being and less emotional distress. Given the short time-frames assessed for the majority of studies reviewed, it is unclear whether this initial psychological buffering effect might result in improved health status and functioning over time. The short observations periods may also explain that lack of findings around PCC and sustained improvement in clinical indicators.

Conclusion

Promising evidence exists on the benefits of PCC for improved patient engagement, satisfaction and emotional well-being, particularly when the quality of communication with providers is high. Less is known about the potential of PCC for sustained clinical and functional improvement.