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Patient-centred care in established rheumatoid arthritis

https://doi.org/10.1016/j.berh.2015.09.007Get rights and content

Abstract

Review of the evidence on patient-centred care (PCC) in rheumatoid arthritis (RA) shows that involving the patient as an individual – with unique needs, concerns and preferences – has a relevant impact on treatment outcomes (safety, effectiveness and costs). This approach empowers patients to take personal responsibility for their treatment.

Because clinicians are only able to interact personally with their patients just a few hours per year, patients with a chronic condition such as RA should be actively involved in the management of their disease. To stimulate this active role, five different PCC activities can be distinguished: (1) patient education, (2) patient involvement/shared decision-making, (3) patient empowerment/self-management, (4) involvement of family and friends and (5) physical and emotional support. This article reviews the existing knowledge on these five PCC activities in the context of established RA management, especially focused on opportunities to increase medication adherence in established RA.

Section snippets

Patient-centred care in established rheumatoid arthritis

In line with rapid changes in our society, health care changes too. Fortunately, the efficacy, efficiency and effectiveness of treatments for chronic diseases more and more result in improvements in the quality of life and survival. Individuals increasingly prefer an active role in shaping their own lives, including how a chronic disease affects them. This process is catalysed by the rapid growth of the Internet, which offers convenient access to a wide range of health information, with

Shift from physician-centred care to patient-centred care

These developments are influencing today׳s health-care systems. For decades, health-care systems were mainly organised from the biomedical perspective. Consequently, the needs of the clinician and the system took priority in the delivery of care to patients. In this model, the health professional was at the centre of the system – he or she had exclusive access to knowledge – and the patient was expected to comply with the instructions given by health professionals [3].

Further, the view on how

Patient as part of the multidisciplinary care team

PCC is defined by the Institute of Medicine (a division of the National Academy of Sciences in the United States) as: ‘providing care that is respectful of, and responsive to, individual patient preferences, needs, and values, ensuring that patient values guide all clinical decisions’ [6]. PCC places each patient at the centre of the health-care system, and it recognises the patient as a whole person with physical, psychological and social needs. Contrary to common belief, patient-centredness

Patients need knowledge, skills and power

By definition of being the owner of their illness, RA patients typically cope with their illness on their own, in their own environment, most of the time in the absence of a clinician. Consequently, they need knowledge, skills, as well as power to be able to monitor and manage their symptoms on a daily basis, and to partner with health professionals in optimising their health ⁎[1], [2], [3] as follows:

  • •

    Patients need knowledge about the disease and symptoms, treatment options and possible

Evidence for effectiveness of PCC

Reviews on the effectiveness of PCC compared with more traditional health care show that the degree to which patients are more involved in their care has a significant impact on the quality of their treatment with regard to safety and effectiveness [7]. It might also benefit the health-care system in terms of financial performance [7]. Summary analyses of studies on interventions to better inform and involve patients in their care show improved experience with health care, lower dependence on

PCC might also increase patient safety

PCC not only improves patient outcomes and satisfaction rate but might also improve patient safety. Although health care in general improves health of patients significantly, sizable numbers of patients are harmed each year because of medical errors [16]. An important contributor to medical errors is inadequate transitional care [17], ⁎[18]. Patients with chronic conditions receive care that is often fragmented, incomplete, inefficient and, consequently, less effective [18]. Particularly in

Barriers for PCC

Although it is widely advocated that PCC should be incorporated in usual care, there are also barriers, which slow down the uptake of PCC in clinical care. Firstly, although PCC seems logically and morally well founded, and the evidence to support PCC is growing, still more evidence is necessary to demonstrate the (cost-) effectiveness of PCC. Secondly, terminology can be a barrier in the implementation of PCC. PCC is a ‘container concept’ for multiple different elements that refer to different

Applying patient-centred care to improve medication adherence

As illustrated in this publication, patient-centred care (PCC) improves clinical quality and outcomes, and it might also decrease health-care costs. Besides, PCC might also decrease one of the underlying problems for poor health-care outcomes: medication adherence [24], [25].

As in all chronic diseases, medication adherence is poor in patients with rheumatoid arthritis (RA). Although disease-modifying antirheumatic drugs (DMARDs) have proven to decrease the disease activity and radiological

Conclusion

PCC integrates the perspectives, understanding and preferences of patients into the delivery of health care. Essential for PCC is an effective clinician–patient partnership in which the clinician׳s recommendations are informed by an understanding of the individual patient׳s values, needs and life context (e.g., home life, job and family relationships). In addition, PCC takes into account the perspectives of the patient׳s family and other informal caregivers, when appropriate.

For the

Conflicts of interest

All authors herewith declare that we have nothing to disclose.

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    Both authors contributed equally to this work.

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