Patient-focused care aims to bring more equality into the physician/patient relationship as well as an understanding of the patient, not just their illness. However, models of medical management are generally conceived, tested, and disseminated by medical professionals.
Do patients want patient-focused care? Little et al investigated patients’ preferences for a patient-focused approach in the primary care consultation. These investigators administered a preconsultation questionnaire to 824 patients, 661 of whom also completed a postconsultation questionnaire. Factor analysis identified three groupings of patient preferences: communication (including listening, exploration of concerns, and requirements for information, doctor-patient relationship and a clear explanation); partnership (including specific aspects of communication related to finding common ground, such as exploration, discussion, and mutual agreement about patients’ ideas, the problem, and treatment); and health promotion (including how to stay healthy and reduce the risk of future illness). ventolin inhalers
Most patients agreed that all three aspects of patient-focused care were required; 88 to 99% agreed on the need for good communication, 77 to 87% agreed for partnership, and 85 to 89% agreed for health promotion. Patients who agreed strongly that they wanted good communication or partnership were likely to feel particularly unwell, attend their doctors’ clinic more regularly, and not be in paid employment. In addition, patients who wanted good communication were less likely to be > 60 years of age. Patients wanting health promotion attended their doctors’ clinic more regularly and were worried about their problem. Overall, most patients preferred a patient-focused approach, although it appeared to be even more important to patients who were more vulnerable either due to their illness, their worries, or their socioeconomic situation.
Further evidence to support patients’ preference for a patient-focused approach is provided by an observational study of 2,881 patients visiting 138 family physicians. Using direct observation and statistical cluster analysis, the investigators identified four different physician approaches to the consultation interaction: person focused (49%), biopsychosocial (16%), biomedical (20%), and high physician control (14%). Person-focused physicians concentrated more on the person than the disease, were personable and friendly, were open to the patients’ agenda and negotiated options with patients. Biopsychosocial physicians were more focused on the patients’ disease but elicited psychosocial information.