Entete 3

The thematic analysis of patient-centered care: Looking at patients with chronic diseases seen in family medicine

By Catherine Hudon

For the management of patients with multiple chronic conditions, patient-centered care suggests taking a holistic approach to these patients and their health care by considering all aspects of the person’s situation [1-2]. Much patient-centered care evidence in family medicine relies on Stewart et al.’s model [3-5]. Therefore, we decided to present a synthesis of the results of research and discourse lines on main dimensions of patient-centered care in the context of chronic disease management in family medicine, building on Stewart et al.’s model.

We conducted a systematic review of the literature and performed a thematic analysis of the 32 articles included. We identified six majors themes: (1) starting from the patient’s situation; (2) legitimizing the illness experience; (3) acknowledging the patient’s expertise; (4) offering realistic hope; (5) developing an ongoing partnership; (6) providing advocacy for the patient in the health care system.

Our analysis shows that the context of chronic disease management brings forward new dimensions of a patient-centered interaction between the patient and the physician such as legitimizing the illness experience, acknowledging patients’ expertise and offering hope, and proposes the involvement of the family physician in transitions in care as a component of patient-centered care. Chronic disease management also brings a longitudinal component into perspective and all the dimensions of the concept could be better captured with a measure considering a certain period of time, not only the last visit with a physician.

The abstract can be accessed online [6]:

[1] Boyd CM, Fortin M. Future of Multimorbidity research: How Should Understanding of Multimorbidity Inform Health System Design? Public Health Reviews. 2010;32:451-74 (available at http://www.publichealthreviews.eu/upload/pdf_files/8/Boyd_forwebsite.pdf).
[2] Bayliss EA, Edwards AE, Steiner JF, Main DS. Processes of care desired by elderly patients with multimorbidities. Fam Pract. 2008;25:287-93.
[3] Stewart MA, Belle Brown JB, Weston WW, McWhinney IR, McWilliam CL, Freeman TR. Patient-Centered Medicine: Transforming the Clinical Method. 2e ed. Cornwall: Radcliffe Medical Press Ltd; 2003.
[4] Stewart M, Belle Brown J, Donner A, McWhinney IR, Oates J, Weston WW, et al. The Impact of Patient-Centered Care on Outcomes. The Journal of Family Practice. 2000;49:796-804.
[5] Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, et al. Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ. 2001;323:908-11.
[6] Hudon C, Fortin M, Haggerty J, Loignon C, Lambert M, Poitras ME. Patient-centered care in chronic disease management: a thematic analysis of the literature in family medicine. Patient Education and Counseling. 2012;8:170-176.

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