The Patient-as-Partner Approach in Health Care

Abstract

The prevalence of chronic diseases today calls for new ways of working with patients to manage their care. Although patient-centered approaches have contributed to significant advances in care and to treatments that more fully respect patients' preferences, values, and personal experiences, the reality is that health care professionals still hold a monopoly on the role of healer. Patients live with their conditions every day and are experts when it comes to their own experiences of illness; this expertise should be welcomed, valued, and fostered by other members of the care team. The patient-as-partner approach embodies the ideal of making the patient a bona fide member of the health care team, a true partner in his or her care. Since 2010, the University of Montreal, through the Direction of Collaboration and Patient Partnership, has embraced this approach. Patients are not only active members of their own health care team but also are involved in research and provide valuable training to health sciences students. Including patients as full partners in the health care team entails a significant shift in both the medical practice and medical education cultures. In this perspective, the authors describe this innovative approach to patient care, including the conceptual framework used in its development and the main achievements of patient partners in education, health care, and research.

Promoting Patient and Family Partnerships in Ambulatory Care Improvement: A Narrative Review and Focus Group Findings

“…Enrollment of patients diagnosed with depression into care management intervention was 96.5% Baker et al [29]US CareSouth outpatient clinicsEducational material design around body mass index after negative initial feedback regarding topic approach; revised pain assessment“A strong collaborative engagement with the patient is likely necessary to achieve high reliability” Bitton et al [27]Hospital- and community-based primary care teaching practices affiliated with Harvard Medical SchoolClinic “transformation teams” encouraged to include patients as core members“Trainees and patients can be agents of change, and their presence provides added motivation for academic faculty to create and support change” Coulter and Elwyn [20]UK policy efforts to involve public in healthcare processesCommunity-health councils, proposed statutory patient forums and commission for patient and public involvement and health, patient advisory and liaison services in each trust, annual patient surveyNo empirical findings reported DiGioia et al [23]University of Pittsburgh Medical Center, US6-step patient- and family-centered care methodology including using Codesign Toolkit and Improvement Team to close gaps between current and ideal care experiences“Refocuses existing resources around the patient and family rather than fitting patients and families around the physician and system. It makes it possible to take any current state and move the care experience toward the ideal—as defined by patients and families” Fontaine et al [28]Minnesota primary care practicesState PCMH certification standard development included patient-advocacy representatives; published standards include “continuous improvement process that included a quality-improvement committee with active patient recruitment and participation”Patient’s positive experiences with PCMH increased practice leaders’ job satisfaction and trust in the processProcess for using patients as PCMH advisors/getting input on PCMH changes from patient partners on change team all correlated significantly ( P  ≤ 0.01) with practice system change (but not clinical outcomes) [33] Karazivan et al [24]Direction of Collaboration and Patient Partnership at the University of Montreal: Implemented by two primary care teams as of 2014Accompany clinical teams in implementation of care partnership continuous improvement approachResults not yet available Loud et al [30]; also described in Armstrong et al [38]Primary care for people with CKD in UKPatient advisory group actively participate...…”

Use of a patient empowerment tool for hand hygiene

“…Current medical education includes patient participation as an important component of the physician-patient relationship. 16 No other studies have examined whether resident and attending physicians’ attitudes about patient empowerment differ. Davis demonstrated that only 41% of providers felt that family member involvement would have a positive effect on the family member-provider relationship.…”

The Evolution of an Interprofessional Shared Decision-Making Research Program: Reflective Case Study of an Emerging Paradigm

“…At the same time, there has been a shift from the paternalistic, doctor-knows-best model of decision-making to the shared decision-making model. These models have been shown to produce better patient outcomes than their predecessors [789]. …”