One evident finding when searching for a definition of patient-centered care is the lack of a standard definition that is agreed on. Indeed, the term itself is not uniformly adopted. Other terms such as person-centered care and people-centered care are also used. Although these terms are sometimes used interchangeably with patient-centered care, discussions suggest that the terms are not equivalent and that the term person-centered care should be adopted to refer to the care of the whole individual.
The table provided lists definitions published by the National Academy of Medicine (formerly known as the Institute of Medicine), International Alliance of Patients’ Organizations, International College of Person-Centered Medicine, and World Health Organization.1-4 Most recently, the American Geriatrics Society Expert Panel on Person-Centered Care published its definition of person-centered care. According to the expert panel:
Person-centered care means that individuals’ values and preferences are elicited and, once expressed, guide all aspects of their health care, supporting their realistic health and life goals. Person-centered care is achieved through a dynamic relationship among individuals, others who are important to them, and all relevant providers. This collaboration informs decision-making to the extent that the individual desires.5
In addition to providing a definition of person-centered care, the expert panel discusses eight elements deemed essential to realizing person-centered care:
- An individualized, goal-oriented care plan based on the person’s preferences
- An Ongoing review of the person’s goals and care plan
- Care supported by an interprofessional team in which the person is an integral team member
- One primary or lead point of contact on the health care team
- Active coordination among all health care and supportive service providers
- Continual information sharing and integrated communication
- Education and training for providers and, when appropriate, the person and those important to the person
- Performance measurement and quality improvement using feedback from the person and caregivers
Barriers to implementing person-centered care practices are cited by the expert panel to include:
- Inconsistent terminology
- Traditional approaches to clinical practice
- Physician workload
- Misaligned incentives
- Identifying appropriate indicators
- Provider concerns for risk and safety
- Lack of advance care planning
- Lack of payment structures that span health care and community-based organizations
- Lack of continuity in health records
The expert panel also discusses communication, team-based care, coordination, and environment as characteristics of patient-centered care that support its effective implementation.
As pharmacists increasingly expand their scope of practice to include patient- or person-centered care, it is important to be cognizant of the key elements of and barriers to successfully implementing such practices. Although the statement published by the expert panel of the American Geriatrics Society focuses on older adults, it also provides a concise, yet comprehensive summation of key elements of, barriers to, and other considerations that support the implementation of patient- or person-centered care.
Table. Definitions of Patient-, Person-, and People-Centered Care by Select Organizations
Organization |
Definition |
National Academy of Medicine (NAM) |
Patient-centered care is “providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.”1 |
International Alliance of Patients’ Organizations (IAPO) |
“The essence of” patient-centered healthcare is “that the healthcare system is designed and delivered to address the healthcare needs and preferences of patients so that healthcare is appropriate and cost-effective. By promoting greater patient responsibility and optimal usage, patient centred healthcare leads to improved health outcomes, quality of life and optimal value for healthcare investment.”2 |
International College of Person-Centered Medicine (ICPCM) |
Person-centered medicine (PCM) is “a holistic, multidisciplinary and relational perspective aimed at promoting the highest attainable level of health both for individuals and people collectively. PCM encompasses a wide range of concepts, tasks, technologies and practices which aim to place the whole person in context at the center and as the goal of clinical practice and public health. To this effect, PCM articulates science and humanism for a bio-psycho-socio-cultural understanding of health and for the undertaking of health care actions from individual interventions to general health policy.”3 |
World Health Organization (WHO) |
People-centered health services are “an approach to care that consciously adopts the perspectives of individuals, families and communities, and sees them as participants as well as beneficiaries of trusted health systems that respond to their needs and preferences in humane and holistic ways.” People-centered care “requires that people have the education and support they need to make decisions and participate in their own care. It is organized around the health needs and expectations of people rather than diseases”4
Person-centered care is “care approaches and practices that see the person as a whole with many levels of needs and goals, with these needs coming from their own personal social determinants of health.”4
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Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. 2001. Available at www.nationalacademies.org/hmd/Reports/2001/Crossing-the-Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx#sthash.9OwPoBcZ.dpuf. Accessed April 27, 2016.
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International Alliance of Patients’ Organizations. Declaration on Patient-Centred Healthcare. 2006. Available at http://iapo.org.uk/sites/default/files/files/IAPO_declaration_English.pdf. Accessed April 27, 2016.
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International College of Person-Centered Medicine. 2013 Geneva Declaration on Person-centered Health Research. Available at www.personcenteredmedicine.org/doc/2013_Geneva_Declaration_on_Person_Centered_Health_Research.pdf. Accessed April 27, 2016.
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World Health Organization. WHO Global Strategy on People-Centred and Integrated Health Services. 2015. Available at http://apps.who.int/iris/bitstream/10665/155002/1/WHO_HIS_SDS_2015.6_eng.pdf?ua=1. Accessed April 27, 2016.
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American Geriatrics Society Expert Panel on Person-Centered Care. Person-centered care: a definition and essential elements. J Am Geriatr Soc 2016;64:15-8.