A patient-centred approach to health service delivery: improving health outcomes for people with chronic illness

TLDR

The Wagner Model offers a framework to guide health systems toward a chronic‑care oriented model. The paper describes the health needs of chronically ill patients and their carers, comparing them with ideal patient‑centred services to deepen understanding of the challenges they face in the health care system. The study interviewed patients, carers and health care professionals about the challenges faced by those with complicated diabetes, chronic heart failure or COPD. Patients reported concerns about the quality of care—including better communication, organized services, self‑care support, holistic recognition, and involvement in decision‑making—highlighting the need for health policy to align more closely with these identified needs.

Abstract

The Wagner Model provides a framework that can help to facilitate health system transition towards a chronic care oriented model. Drawing on elements of this framework as well as health policy related to patient centred care, we describe the health needs of patients with chronic illness and compare these with services which should ideally be provided by a patient-centred health system. This paper aims to increase understanding of the challenges faced by chronically ill patients and family carers in relation to their experiences with the health care system and health service providers. We interviewed patients, carers and health care professionals (HCPs) about the challenges faced by people living with complicated diabetes, chronic heart failure or chronic obstructive pulmonary disease. Patients indicated that they had a range of concerns related to the quality of health care encounters with health care professionals (HCPs), with these concerns being expressed as needs or wants. These included: 1) the need for improved communication and information delivery on the part of HCPs; 2) well organised health services and reduced waiting times to see HCPs; 3) help with self care; 4) greater recognition among professionals of the need for holistic and continuing care; and 5) inclusion of patients and carers in the decision making processes. In order to address the challenges faced by people with chronic illness, health policy must be more closely aligned with the identified needs and wants of people affected by chronic illness than is currently the case.