Supporting Patient-Centred Care by General Practitioners

Abstract

Patient-centred care (PCC) is an essential aspect of high-quality health care. Broadly, PCC is defined as care that is respectful and responsive to the needs and wishes of patients. The concept of PCC is embedded within primary health care policy throughout the world because of its potential to reduce the burden of disease and illness. The widespread policy-based advocacy towards PCC has resulted in many primary care organisations endorsing PCC and clinical teams enacting PCC. General practitioners (GPs), also referred to as family physicians, are positioned at the front-line of the primary health care system and are typically the first port of call for patients seeking health care services. There are several challenges for GPs to enact PCC holistically, such as lack of skills and knowledge regarding PCC, a lack of agreement in the literature of what constitutes GP-delivered PCC, and a lack of tools to support GPs with PCC. Supporting GPs to enact PCC is essential to achieve better patient outcomes from GP-delivered chronic disease management, preventative care and holistic care. The overarching aim of this PhD program was to build upon the understanding of GPdelivered PCC and research ways to support GPs to enact PCC. The sequential, multiphased design allowed the researcher to identify and subsequently address key gaps requiring further exploration. The aims within this doctoral research program were to synthesise literature relating to PCC delivered by GPs; explore patients’ and GPs’ perceptions and experiences of PCC; develop and evaluate a new model of PCC; develop and evaluate a tool kit to support GPs with PCC; and explore the perceptions and experiences of PCC within general practice teams during the COVID-19 pandemic. These aims were addressed in four phases of research. The research was within the pragmatic paradigm, qualitatively driven, and guided by assumptions from constructivist and interpretivist epistemological beliefs. In phase one, an integrative systematic literature review was conducted to identify studies that that related to GP-delivered PCC. Four main themes of GP-delivered PCC were identified, and these informed a new theoretical model with four components: 1) understanding the whole person, 2) finding common ground, 3) experiencing time, and 4) aiming for positive outcomes. The review identified several gaps in the literature, including a lack of qualitative studies involving both GPs and patients, which guided the subsequent research in conjunction with the updated theoretical model of GP-delivered PCC. In phase two, qualitative focus group interviews were conducted with patient advocates and GPs to explore perceptions and exp riences of PCC. Five themes emerged: 1) understanding of PCC is varied and personal, 2) valuing humanistic care, 3) considering the system and collaborating in care, 4) optimising the general practice environment and 5) needing support for PCC that is embedded into training. Findings suggested that more work was needed to create novel interventions with capacity to expose GPs to feedback from patients, promote GP self-reflection on PCC and support GPs to assess the patient-centeredness of the practice environment. Next, the model of GP-delivered PCC developed in phase one was qualitatively tested in the same focus groups. The data was synthesised to produce an updated model of PCC consisting of six inter-related elements, called Putting Patients First: A Map for Patient-Centred Care. Qualitative testing among GPs and patient advocates supported the credibility of the model and enhanced its applicability to ‘real world’ practice. In phase three, co-creation and action research informed the development of an innovative tool kit to support holistic PCC among general practice teams. This tool kit consolidates the new knowledge on PCC generated within this PhD and can be used in practice to support the understanding and delivery of PCC by general practice teams. The worldwide pandemic occurred during the research program and changed the anticipated direction of the final study to the delivery of PCC under pandemic conditions. One-on-one semi-structured interviews with practice representatives from five Australian general practice clinics who had been recognised for their pursuit of quality care. Key findings were that the pandemic altered the perceptions and experiences of PCC within general practice teams and created new barriers to enacting PCC. However, general practice teams who have previously been recognised for their ability to deliver high quality care, have maintained their focus on PCC. Strong leadership, patient-focused practice culture, new technology and infrastructure enabled PCC. This innovative PhD research contributes novel and important findings to support GPs with PCC. Collectively, the studies within the PhD informed a multifaceted understanding of GP-delivered PCC and described novel strategies to enact PCC. The concept of PCC has persevered despite the influence of the COVID-19 pandemic on the health system, and PCC should continue to be a focal point for research, policy, and practice. The understanding of PCC is varied among patients, GPs and between patients and GPs. Strategies to enhance PCC should emphasise the translation of complex PCC research, and harness the tools produced within this PhD to generate a uniform understanding of PCC between patients and general practice teams. The tools developed within the PhD can also provide a foundation for future research striving to enhance the levels of PCC in general practice; and inform policymakers and general practice organisations seeking to promote and sustain PCC. This work ensures that all patients and general practice teams have access to tools that can inform PCC.