- Patients who feel their preferences are respected and heard - that’s the idea behind patient-centred healthcare.
- Your pharmacy team works with you to develop care strategies that fit both your needs and your values.
- This type of care also taps into technology to make the experience easier for you.
What is patient-centred care, and how is your pharmacy team using it to help you manage your diabetes?
The Institute of Medicine explains that patient-centred care respects, and responds to, individual patient preferences and needs. As the patient, your values are meant to guide all clinical decisions. While you may not get exactly what you want all the time, your preferences will be carefully considered when your care team – which includes your pharmacist – provides patient-centred care.
This type of care involves four different parts.
1. Patient-centred care balances the professional knowledge of the care provider with the personal knowledge held by you and your family.
You and your family know your situation best. Your pharmacist brings years of education and practical experience in understanding how medications work. In patient-centred care, we combine this knowledge to tailor a strategy specific for you and your needs. Your pharmacist takes the time to understand your health goals, and gives you information on which medications may be best suited for you. Your care might also include recommendations on lifestyle adjustments, such as getting more physical activity or ways to improve nutrition.
2. Patient-centred care ensures that you are heard, valued, and engaged in conversations and decisions about your own healthcare.
Good communication is key to your relationship with any healthcare provider. The type of questions your pharmacist asks can help.
Closed-ended questions can be answered with yes or no. For example:
- Have you experienced any side effects from this medication?
- Do you have any questions?
- Do you ever forget to take your medication?
Sometimes a closed-ended question is necessary and appropriate. However, many people often automatically answer no to this type of question! The conversation ends, and it can feel awkward to ask anything else.
In contrast, open-ended questions encourage you to provide more detail about your experiences and personal situation. For example:
- What side effects have you noticed?
- What questions do you have?
- What might help you to remember to take your medication? Tell me how you remember to take your medication.
In asking an open-ended question, your pharmacist gathers more information to understand more about your specific condition, and your needs and goals.
Healthcare providers should also ask about what concerns you most at that moment. Your diabetes may not be at the top of the list if you have had a headache for several days or your arthritis is flaring up. Instead of focusing only on diabetes, your current concerns can also be addressed – a significant part of the patient-centred partnership.
3. Patient-centred care focuses on your goals as well as the expertise of the healthcare team.
You may be used to having healthcare providers identify goals for you, instead of the other way around. For instance, you may have been told to keep your blood glucose within a set range, or your A1c below a specific number. Research shows that certain goals offer the best chance of effectively managing diabetes and leading a healthy life, now and in the future. Healthcare providers are likely to recommend working toward those goals.
However, patient-centred care also takes your personal goals into account. Perhaps you want to have more energy. Maybe you need to manage your diabetes well with the pressures of a demanding job. You might want to include more activity so you can play with your children or grandchildren. Describe your goals to your pharmacist and other healthcare team members. Your team examines your goals with you, and structures your diabetes care in a way that allows you to achieve them.
Your pharmacist can work with you to help you achieve goals in ways that are meaningful for you. Let’s say that you have been told that you should be testing your blood glucose twice each day, but you only test once a week. If you share that information, your team can help design a more realistic plan. Perhaps you might agree to vary the time and day of week when you do that one test, or to gradually increase the number of tests you do each week. By working together to set goals that are both helpful and realistic, you can improve your health outcomes. You should be involved in setting goals that you understand, and feel confident you can reach them.
4. Patient-centred care adds knowledge from all team members.
Do you find yourself repeating the same details when dealing with the healthcare system? Even if you have visited the same pharmacy for years, you may have to deal with a new pharmacist on duty or a team member whom you have never met. It can feel frustrating to have to start over with someone who doesn’t know you.
Technology can help. The ability to document your health issues and the care you are receiving continues to improve. In many provinces, pharmacists can see and, in some cases, add to the information on your provincial health profile. This allows for better communication about your health among your care providers. It also helps each health care provider to focus on their area of expertise. Seeing the big picture of your health and the care you are receiving helps your pharmacist to ensure your medications are appropriate for your situation.
Community pharmacists can also work with you to develop a care plan specific for you, and to review the medications you are taking. Often, this involves making an appointment to have a one-on-one discussion with the pharmacist about your diabetes goals. The pharmacist will gather information about your health, including your diabetes management. Each medication will be assessed to ensure you are getting the greatest benefit. How are you taking your medications? When are you taking them? Do you know why you are taking them? With this information, the pharmacist can decide whether adjustments are needed. Perhaps several medications could be combined in one, or a new medication might be more effective. Your pharmacist may also ask about adult immunizations and what you are doing to prevent getting sick. For instance, you may be due for a flu shot or need your tetanus vaccination updated.
When details like these are documented in your plan, the next care provider can clearly see your goals. They can also see where your plan left off, and where to begin work with you on the next steps. In some provinces, pharmacists may be able to initiate medication changes to better improve your health. Speak to your own pharmacist and learn about the professional services available to you.
A key outcome in centring care around patients is helping more people to meet their treatment plans. Even with all the advances in diabetes care over the past decade, there is still a lot of opportunity to improve the health of Canadians living with diabetes. Part of this challenge involves what is called adherence. The World Health Organization defines adherence as “the degree to which the person’s behaviour corresponds with the agreed recommendations from a healthcare provider.”
The word ‘agreed’ is key. In patient-centred care, you and your healthcare team should agree on what you need to do to manage your diabetes effectively. Agreeing to take your metformin three times per day but only taking it once per day is an example of non-adherence. At one time, your pharmacist might have simply told or reminded you to take the tablets three times each day. A patient-centred approach involves finding out why it is difficult for you to take your metformin regularly. Perhaps the medication is costly, or you find the tablets hard to swallow. Maybe you forget to take your tablets, or you don’t take them because of side effects that worry you. With this information, your pharmacist can work with you to provide strategies that fit into your overall life goals. More support may help you to take your metformin regularly. No matter what your goal is, patient-centred care works the same way – from how often you check your blood glucose or A1c to how much physical activity you get and how often you choose nutritious foods. Research shows that meeting your diabetes care goals improves your health and lowers your chances of experiencing complications.
Your community pharmacist has always been an accessible, knowledgeable partner in your healthcare. Adding in patient-centred care strategies allows us to support you more fully. If you have questions about patient-centred care, or wish to develop your own personalised care plan, your pharmacist is on hand to help.
WRITTEN BY: Stacy Johnson, BSc (Pharm), MBA, Director of Pharmacy Programs & Professional Development in Calgary, AB.
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