Patient and Family Not Involved in Care Can Cause

• Research article
• Open up Access
• Published: 08 January 2019

The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the principal care setting

• Jane Murray Cramm^ane &
• Anna Petra Nieboer^ane

BMC Health Services Research book 19, Article number:xiii (2019) Cite this commodity

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Abstract

Background

Patients with multi-morbidity have complex care needs that oftentimes make healthcare delivery hard and costly to manage. Electric current healthcare commitment is not tailored to the needs of patients with multi-morbidity, although multi-morbidity poses a heavy burden on patients and is related to agin outcomes. Patient-centered care and co-cosmos of care are expected to improve outcomes, just the relationships among patient-centered care, co-cosmos of care, physical well-being, social well-being, and satisfaction with care among patients with multi-morbidity are not known.

Methods

In 2017, a cantankerous-sectional survey was conducted amid 216 (of 394 eligible participants; 55% response rate) patients with multi-morbidity from eight chief intendance practices in Noord-Brabant, kingdom of the netherlands. Correlation and regression analyses were performed to identify relationships among patient-centered care, co-creation of care, concrete well-existence, social well-being, and satisfaction with care.

Results

The hateful age of the patients was 74.46 ± 10.64 (range, 47–94) years. Less than half (40.eight%) of the patients were male person, 43.iii% were single, and 39.3% were less educated. Patient-centered care and co-cosmos of intendance were correlated significantly with patients' physical well-being, social well-being, and satisfaction with care (all p ≤ 0.001). Patient-centered care was associated with social well-being (B = 0.387, p ≤ 0.001), physical well-being (B = 0.368, p ≤ 0.001) and satisfaction with care (B = 0.425, p ≤ 0.001). Co-creation of care was associated with social well-existence (B = 0.112, p = 0.006) and satisfaction with care (B = 0.119, p = 0.007).

Conclusions

Patient-centered intendance and co-cosmos of intendance were associated positively with satisfaction with care and the physical and social well-being of patients with multi-morbidity in the primary intendance setting. Making care more tailored to the needs of patients with multi-morbidity by paying attention to patient-centered care and co-creation of care may contribute to meliorate outcomes.

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Background

Because of aging populations, the prevalence of multi-morbidity has grown tremendously and is expected to increase even further in the virtually future [ane, ii]. This increase poses a challenge, every bit patients with multi-morbidity have complex care needs that often brand adequate healthcare delivery difficult and plush to manage [three]. Most current healthcare systems are unmarried disease–oriented and thus not adequately responsive to patients with multiple diseases and combinations of complex care needs. Healthcare for patients with multi-morbidity involves following multiple affliction-specific guidelines that do not accept aspects of multi-morbidity into account, resulting in a deficiency of evidence regarding best treatment [4, 5]. Electric current intendance delivery is not tailored to the needs of patients with multi-morbidity [6], despite the heavy burden that multi-morbidity places on these patients. This burden is often related to agin patient outcomes, leading to a greater risk of bloodshed and increased healthcare utilization and cost [7]. As a result, patients with multi-morbidity report lower quality of life and well-being, and less satisfaction with care [3, 8]. Making care more patient-centered may exist the way frontward.

Patient-centered care (PCC) has the potential to make care more than tailored to the needs of patients with multi-morbidity. PCC can be defined as "providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions" [9]. Previous studies accept investigated patients' perspectives on PCC and distinguished eight dimensions: (1) patients' preferences, (2) information and education, (iii) admission to care, (4) emotional support, (5) family and friends, (6) continuity and transition, (7) physical condolement, and (8) coordination of care [10]. Co-ordinate to a systematic review conducted by Rathert and colleagues [xi], organizations that are more patient-centered also have more than positive outcomes, such as greater satisfaction with intendance, greater task satisfaction among healthcare professionals, increased quality and safety of care, and greater quality of life and well-being of patients. All the same, the systematic review included mainly studies conducted in hospital settings; very few were conducted in primary intendance settings and they did not specifically target patients with multi-morbidity. Although PCC is expected to be beneficial for patients with multi-morbidity, the relevance of its 8 dimensions for these patients in the primary care setting is not known. Given that PCC may differ among settings [xi], investigation of its effects on patients with multi-morbidity in the main intendance setting is important.

Co-creation of intendance

In addition to the eight dimensions of PCC, which inform usa how patient-centered organizations are, examination of co-creation of care is important. Co-creation of care is based on the quality of relationships characterized by patient-centered interaction and advice, which is as well important for improving outcomes [12, xiii]. Co-creation of care is the establishment of productive interactions between patients and healthcare professionals [xiii]. Productive interactions are defined as timely, accurate, and problem-solving ways of communication [14]. According to Gittell [14], three relational dimensions are especially of import for establishing such productive interactions: shared goals, shared knowledge, and mutual respect. Co-creation is particularly important in situations characterized past complex tasks, uncertainty, and fourth dimension constraints. A meta-synthesis by Cottrell and Yardley [15] showed that patients, general practitioners (GPs), and medical interns experience the complexity of managing care for patients with multi-morbidity, and they confront difficulties and uncertainties in finding the type of intendance necessary to meet all of these patients' needs and wishes. Moreover, GPs find that care delivery to patients with multi-morbidity is ofttimes time consuming because of single-disease-oriented systems and their accompanying logistics. These difficult and complex issues thus make the co-creation of care potentially valuable in the context of care delivery to patients with multi-morbidity. Co-creation of intendance is expected to lead to better outcomes amongst these patients.

PCC and patient outcomes

Physical and social well-being and satisfaction with care are important outcomes for patients with multi-morbidity [6]. Programs that better the quality of primary care are associated with better outcomes, such equally improved physical well-being, but are non able to forbid the decline in social well-being of patients with chronic illnesses [16]. Making chronic care more patient-centered is expected to enable patients to manage their own health and quality of life, thereby improving their physical and social well-beingness and satisfaction with care [16]. Rathert and colleagues [11] reported positive relationships betwixt PCC and patients' well-beingness and satisfaction with care, but their review did not include studies of patients with multi-morbidity in the primary care setting. The relationships among PCC, co-creation of care, patients' well-being (physical and social), and patients' satisfaction with care remain unexamined among patients with multi-morbidity.

Study aim

Although nosotros hypothesize positive associations amidst PCC, co-creation of care, physical and social well-being, and satisfaction with intendance among patients with multi-morbidity, inquiry supporting these expectations is still lacking. Therefore, this study aimed to explore the current level of PCC delivery to patients with multi-morbidity in the primary care setting and the relationships amid patient-centered care, co-cosmos of intendance, satisfaction with care, and physical and social well-being of patients with multi-morbidity.

Methods

This report included multi-morbid patients from eight primary care practices in Noord-Brabant, holland. All patients with two or more registered chronic weather (n = 413) were eligible to participate. Exclusion criteria were: as well ill to participate or recently moved (and as a result no longer treated by the primary care practices under study). Based on information received from the GP, patient or their breezy caregiver 19 patients were not eligible to participate (death (due north = 4), terminal affliction (n = 2), wrong accost (due north = 5), recent move (north = 2), inability to fill in the questionnaire due to poor cerebral functioning (n = 2), recent stroke (n = ane), or poor eyesight (n = 3)). Questionnaires were sent by post to all remaining participants (north = 394). After a few weeks, reminders were sent to non-respondents. Another few weeks afterwards, 2d reminders and duplicates of the questionnaire were sent to non-respondents. When no response was received afterward the 2d reminder, we called non-respondents for whom telephone numbers were available. In total, 216 patients filled in the questionnaire and consented to participate in the report. Thus, the response charge per unit was 55% (216 out of 394 respondents). A sample size adding revealed that 110 participants would exist required in order to discover small to medium effects with 95% power and a blazon 1 error charge per unit of 5% [17]. Having 216 respondents is therefore sufficient for valid results.

The medical ethics committee of the Erasmus Medical Centre, Rotterdam, the Netherlands, reviewed the research proposal (file number METC_2018_021) and decided that the rules laid down in the Dutch Medical Research Involving Human Subjects Deed did not apply. Our research did non take a RCT design, participants were not subjected to procedures such as taking a claret sample, the research was not carried out with the intention of contributing to medical knowledge (due east.g. etiology, pathogenesis, signs/symptoms, diagnosis) by systematically collecting and analyzing data. The master aim of the research was to investigate experiences of participants with care delivery, a process evaluation to better quality of intendance delivery, which does non fall under the scope of Medical Research Involving Homo Subjects Act (WMO) (come across https://english.ccmo.nl/investigators/legal-framework-for-medical-scientific-enquiry/your-inquiry-is-it-bailiwick-to-the-wmo-or-non). Written consent was obtained from all participants.

Measures

PCC for patients with multi-morbidity in the principal care setting

PCC for patients with multi-morbidity in the primary intendance setting was measured using the 36-item patient-centered primary care (PCPC) instrument, which assesses the 8 dimensions of PCC [eighteen]. The PCPC musical instrument builds on our earlier work, in which we investigated the viii dimensions of PCC in hospital and long-term intendance settings [19,xx,21]. Responses of patients were measured on a 5-signal scale ranging from 1 (totally disagree) to 5 (totally agree), with higher scores indicating greater PCC. Scores for each of the 8 dimensions of PCC were derived by computing the boilerplate score for all items in that particular dimension. The overall score of PCC, in plough, was derived past calculating the average score for the 8 dimensions (mean of the eight subscales calculated in the previous pace). In this study, the Cronbach'due south blastoff value for this instrument was 0.89, indicating skilful reliability.

Well-being

Well-existence was measured with the 15-particular version of the Social Production Function Instrument for the Level of Well-being (SPF-ILs) [22]. Levels of physical (comfort and stimulation) and social (status, behavioral confirmation, and amore) well-beingness were measured. Responses of patients were measured on a iv-signal scale ranging from 1 to 4, with higher scores indicating greater well-being. Scores for physical and social well-being were derived past calculating the average score for all items in that particular subsection of items. In this report, the Cronbach's alpha value for both physical and social well-being, measured with the SPF-ILs, was 0.83, indicating skilful reliability.

Co-creation of care

Co-creation of care was measured with the relational co-production instrument [23]. The instrument consists of 7 items measuring four aspects of advice (timely, accurate, frequent, and problem-solving) and iii aspects of the relationship (shared goals, shared noesis, and mutual respect) between patients with multi-morbidity and the healthcare professionals treating them (GPs, nurse practitioners, and specialists). Responses of patients were measured on a 5-signal Likert-calibration ranging from ane (never) to v (e'er), with higher scores indicating better co-creation of care. Scores for co-cosmos of care were derived by calculating the average score for all items in this instrument. In this study, the Cronbach's alpha value for this musical instrument was 0.93, indicating fantabulous reliability.

Satisfaction with intendance

The adapted version of the Satisfaction with Stroke Care questionnaire (SASC) was used to measure patients' satisfaction with intendance [24]. Although the original 8-item SASC was used among stroke patients, this instrument contains generic questions most satisfaction with care and is not restricted to patients receiving stroke care. The SASC instrument is therefore oftentimes used in various patient populations in the hospital setting [25,26,27,28]. Given that the instrument was developed to assess satisfaction with intendance in the hospital setting, nosotros did slightly adjust items for the master care setting (e.g. 'The doctors have washed everything they can to brand me well again' was changed into 'The staff has washed everything they tin can to make me well once more'). Furthermore, nosotros removed irrelevant or overlapping items (e.g. 'The hospitalization process went smoothly' and 'I have been treated with kindness and respect by the staff at the hospital'), which resulted in a terminal set of 6 items: 'I accept received all the information I desire about the causes and nature of my illness(es)', 'The staff has done everything they can to brand me well again', 'I am satisfied with the type of treatment they have given me (eastward. m. physiotherapy, occupational therapy)', 'I have had plenty therapy (e.m. physiotherapy, occupational therapy)', 'I am happy about the effect treatments had on my disease progression', and 'I am satisfied with the treatment provided by the full general practitioner who I visit'. Responses of patients were measured on a 4-point calibration ranging from 1 (totally disagree) to 4 (totally concur), with higher scores indicating greater satisfaction with care. Satisfaction with intendance scores were derived by computing the average score for all 6 items. In this study, the Cronbach'south alpha value for this instrument was 0.89, indicating expert reliability.

Background characteristics

Patients were as well asked to provide information on background characteristics, such as historic period, gender, education, and marital status. Dummy variables were created for marital status (1, living alone, widowed or divorced; 0, married/living with partner) and education (1, primary education or less; 0, preparatory school for vocational secondary educational activity or college).

Statistical analyses

SPSS software (version 23; IBM Corporation, Armonk, NY, Usa) was used to analyze the data. Descriptive statistics were practical to all variables and involved the calculation of ns, ways, minimums, maximums, standard deviations (SDs), and/or percentages. Pearson correlation analyses were performed to place associations betwixt PCC and background characteristics, co-creation of care, satisfaction with care, and physical and social well-being of patients with multi-morbidity. Regression analyses were performed to investigate multivariate relationships among these variables. Ii-sided p values ≤0.05 were considered to be significant.

As information were missing for some PCC items due to occasional inapplicability, we additionally employed multiple imputation techniques (Markoff chain Monte Carlo) and performed the regression analyses on pooled results based on the five imputed datasets (n = 216 each). Predictive mean matching was used as an imputation model to ensure that imputed values preserved the actual range of each variable.

Results

Table one displays the background characteristics of the patients. Their hateful age was 74.46 ± 10.64 (range, 47–94) years. Less than one-half (twoscore.8%) of the patients were male, 43.3% were single, and 39.iii% had low educational levels.

Table 1 Descriptive statistics (n = 216)

Full size table

The hateful overall score for the level of PCC in the primary intendance practices was 3.84 ± 0.47. PCC dimension scores ranged from 3.45 (SD 0.75) to 3.99 (SD 0.56). The mean scores for the emotional support and family and friends dimensions were relatively low (3.45 and iii.57, respectively). The mean score for co-creation of care was iii.61 ± 0.85. GPs received the highest co-creation of intendance score (three.78 ± 0.88), followed by nurse practitioners (three.63 ± 1.03) and specialists (3.12 ± ane.32). The mean satisfaction with intendance score was three.xiii ± 0.45. The mean scores for social and concrete well-being were 2.71 ± 0.53 and 2.55 ± 0.62, respectively; these scores were lower than those obtained amid patients with chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), and diabetes (see Additional file 1: Table S1).

Tabular array 2 shows the percentage of patients who (completely) agreed with each PCC item (if applicable). About half of patients agreed with the items in the emotional back up dimension. In the patient preferences dimension, about three-fourths of patients agreed with the items "I was helped to determine my own handling goals," "I felt supported to achieve my handling goals," and "I received advice that I really could use." In the concrete comfort dimension, threescore% of patients felt that attending was given to fatigue and indisposition, 74.3% felt that the waiting rooms were comfortable, and 71.5% felt that they had sufficient privacy in the handling room and at the counter. An of import issue in the access to care dimension seems to be waiting fourth dimension; slightly more than 30% of patients felt that they had been waiting too long to be seen by care providers. In the information and education dimension, well-nigh half of the patients felt that their ain data was hands accessible. Finally, in that location is room for improvement in the friends and family unit dimension, particularly apropos the items "attention was given to care and support provided by family members" and "attending was given to possible questions from my family members." When applicable, more than than one-third of respondents were dissatisfied about the manner in which care providers involved family and friends.

Table two Percentages of respondents' agreement with patient-centered care items

Full size tabular array

The results of the correlation analysis are displayed in Table 3. PCC and co-creation of care were correlated significantly with patients' physical well-beingness, social well-being, and satisfaction with care (all p ≤ 0.001). In addition, a weak negative correlation was constitute betwixt satisfaction with care and single marital status (r = − 0.148, p = 0.033). Concrete well-being was correlated negatively with historic period (r = − 0.165, p = 0.016). A weak positive correlation was plant betwixt physical well-being and male gender (r = 0.152, p = 0.029). All 8 dimensions of PCC were correlated significantly with patients' concrete well-beingness, social well-being, and satisfaction with intendance (Table 4). Finally, a positive relationship was establish between PCC and co-creation of care (r = 0.442, p < 0.001).

Table 3 Associations between patients' characteristics, patient-centered care, co-creation of intendance and satisfaction and social and physical well-existence (n = 216)

Full size tabular array

Table 4 Relationships of the viii patient-centered care dimensions and co-cosmos of intendance with satisfaction and social and physical well-being (n = 216)

Total size table

The results of the multivariate regression analyses are presented in Table 5. After decision-making for background characteristics, PCC was associated with social well-being (B = 0.387, p ≤ 0.001), physical well-beingness (B = 0.368, p ≤ 0.001), and satisfaction with care (B = 0.425, p ≤ 0.001). Co-cosmos of care was associated with social well-being (B = 0.112, p = 0.006) and satisfaction with care (B = 0.119, p = 0.007). Although we found a pregnant clan between co-creation of intendance and concrete well-existence in the bivariate analysis, this effect dissipated in the multivariate analysis (B = 0.062, p = 0.249). The pregnant associations of background characteristics with satisfaction with care and concrete well-beingness also dissipated in the multivariate assay.

Tabular array 5 Multivariate relationships of variables with satisfaction with care, social well-being, and physical well-being (n = 216)

Total size tabular array

Give-and-take

This study demonstrated that the eight dimensions of PCC and co-creation of care are of import for satisfaction with care, physical well-being, and social well-existence amidst patients with multi-morbidity in the primary care setting in Noord-Brabant, the Netherlands. Although similar findings take been obtained among patients in hospital settings [11] and for care delivery to people with intellectual disabilities [13], this study is the offset to show the importance of both PCC and co-cosmos of care for patients with multi-morbidity in the primary care setting. This patient population experiences lower levels of social and physical well-being than do patients with single chronic diseases, such as COPD, CVD, and diabetes [29,thirty,31]. Patients with multi-morbidity differ in many other aspects from patients with single chronic diseases. Hopman, Schellevis, and Rijken [32] showed that patients with multi-morbidity are more than often male person and less educated, and that they feel more issues in health domains such as mobility, usual activities, and pain/discomfort. Thus, care needs to exist made more than patient-centered and tailored to the needs of patients with multi-morbidity.

Although the overall level of PCC in the primary care practices included in this study was sufficient, there is room for improvement in two dimensions in detail: family and friends, and emotional support. More than one-quarter of all patients with multi-morbidity in this written report were not completely satisfied with aspects of the interest of family and friends in their care. Moreover, this dimension was not considered to exist applicable for almost half of the report population; 43% of patients were unmarried, which could reflect an absence of family members who could exist involved in the care procedure. Chronically sick patients who are married or have partners are more likely to bring these partners to GP visits [33]. Furthermore, previous studies have shown that two-thirds of care providers endorse barriers to the participation of family and friends in patients' care processes; they are concerned nigh privacy rules, they experience the involvement of family and friends as crushing, and/or they are uncertain about their skills for such involvement [33].

Nearly half of the patients surveyed in this written report did not experience sufficient levels of emotional support from their care providers. Kenning and colleagues [34] revealed a discrepancy between the expectations and experiences of patients with multi-morbidity and their care providers in the primary care setting. Further research should focus on how emotional support should exist provided to meet patients' needs.

In the bivariate analyses, co-cosmos of care was related positively to satisfaction with care, physical well-existence, and social well-being. However, the effect of concrete well-existence dissipated in the multivariate analyses. The stronger association between co-creation of care and social well-existence could be explained by the fact that the onetime focuses mainly on social aspects, namely the quality of a relationship [14]. The central elements of co-creation of care (shared goals, shared knowledge, mutual respect) enable the realization of social well-being goals. To illustrate, common respect betwixt patients and care providers may result in higher levels of status for patients, equally when they receive compliments from intendance providers on how they are dealing with their conditions relative to other patients or compared to how they used to deal with their conditions. Acknowledging a patient's specific care needs may result in more appreciating and trusting interactions with the care provider, fulfilling the patient'southward need for affection and behavioral confirmation. Co-creation of care may add to social well-existence through the quality of patient-centered interaction and communication. However, when a patient's physical health deteriorates, this quality is unlikely to meliorate or modify his/her concrete status. Currently, most researchers do not consider concrete and social well-being separately; rather, they combine the concepts into a single overall well-being or quality of life score. The findings of this written report demonstrate the importance of separately examining physical and social well-being in futurity research on PCC and co-creation of care.

This study has several limitations that should be taken into account when interpreting our findings. First, the cross-sectional design prevented usa from determining the causality of relationships. Second, this report was conducted in Noord-Brabant, a region in the Netherlands; research in other regions and/or countries is needed to confirm our study findings. Third, this study assessed the experiences of patients with multi-morbidity, which does not guarantee the objectivity of observations and measurements; nonetheless, subjective experiences and self-rated health are important predictors of health outcomes, such as morbidity and mortality [35]. The final limitation is the response rate. Although the response rate of 55% might exist considered as low, it is higher compared to other studies in which the respondents also received a questionnaire by post [36, 37] and much higher compared to earlier studies using the aforementioned strategy among chronically ill patients (31% response rate) [38]. Our sample still may be biased which could have affected our study findings; non-responders may have been in poorer wellness compared to those who did fill in the questionnaire.

Conclusion

PCC and co-creation of care are associated positively with satisfaction with care and the physical and social well-being of patients with multi-morbidity in the primary intendance setting. These findings are of import because electric current care delivery is not tailored to the needs of patients with multi-morbidity, although multi-morbidity is oftentimes related to agin patient outcomes. Making care more tailored to the needs of these patients by paying attention to PCC and co-creation of care may contribute to better outcomes.

Abbreviations

COPD:

Chronic obstructive pulmonary affliction

CVD:

Cardiovascular disease

GP:

General practitioner

PCC:

Patient-centered intendance

PCPC:

Patient-centered master care

SASC:

Satisfaction with Stroke Intendance

SD:

Standard departure

SPF-ILs:

Social Production Part Musical instrument for the Level of Well-being

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Acknowledgements

The authors thank all patients for taking the time to fill in the questionnaires.

Funding

We received funding from CZ, a Dutch health intendance insurance visitor. They provided only funding for this report; the results are based solely on the inquiry findings.

Availability of data and materials

The information and surveys used are available upon request.

Author data

Affiliations

1. Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, kingdom of the netherlands

   Sanne Jannick Kuipers, Jane Murray Cramm & Anna Petra Nieboer

Contributions

JC and AN drafted the design for data collection. JC, SK, and AN were involved in subject recruitment and data collection, JC performed the statistical analysis, and JC, SK, and AN interpreted the data. SK drafted the manuscript and JC and AN contributed equally to its refinement. All authors have read and approved the final version.

Respective writer

Correspondence to Sanne Jannick Kuipers.

Ethics declarations

Ethics approval and consent to participate

The medical ethics committee of Erasmus Medical Centre, Rotterdam, the Netherlands, determined that the rules stipulated in the Medical Research Involving Human Subjects Act did non apply to this report (protocol no. MEC-2018-021). Written informed consent to participate in the written report was obtained from all participants.

Consent for publication

Not applicable.

Competing interests

Prof.dr. Anna Petra Nieboer works equally an Associate Editor of BMC Health Services Research. Other than that the authors declare that they accept no competing interest.

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Additional file

Additional file 1:

Table S1 Descriptive statistics of concrete and social well-being in patient populations with multi-morbidity, COPD, CVRM, and diabetes. (DOCX sixteen kb)

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Kuipers, S.J., Cramm, J.G. & Nieboer, A.P. The importance of patient-centered intendance and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting. BMC Health Serv Res 19, 13 (2019). https://doi.org/x.1186/s12913-018-3818-y

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• Received: xix April 2018

• Accustomed: fourteen December 2018

• Published: 08 January 2019

• DOI : https://doi.org/10.1186/s12913-018-3818-y

Keywords

• Patient-centered care
• Co-cosmos of care
• Multi-morbidity
• Primary care
• Physical well-beingness
• Social well-being
• Satisfaction with intendance

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