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Managing Diabetes Magazine - diabetes

Patient-Centred Care
Health care that respects your choices

What is patient-centred care and what does it mean for managing your diabetes with your pharmacy team? The Institute of Medicine defines patient-centred care as being respectful and responsive to individual patient preferences. As the patient, your values are meant to guide all clinical decisions. While you may not get what you want all of the time, your care team – which includes your pharmacist - should take your preferences into account.

According to the Canadian Interprofessional Health Collaborative, patient-centred care involves four strategies.

1 Patient-centred care balances the professional knowledge of the care provider with the personal knowledge of patients and families

You and your family know your situation best, while your pharmacist brings years of education and practical experience in understanding how medications work. Practicing patient-centred care means combining this knowledge to tailor an individual strategy. By taking the time to understand your goals, your pharmacist can provide information on which medications may be most suited for you. Your care might also include recommendations on lifestyle adjustments, such as increasing physical activity or options to improve nutrition.

2 Patient-centred care ensures the patient is listened to, valued, and engaged in conversations and decisions about their own health care.

Good communication is essential to your relationship with any health care provider. The type of question your pharmacist asks can support that communication.

Closed-ended questions can be answered with yes or no. For example:

  • Have you experienced any side effects from this medication?
  • Do you have any questions?
  • Do you take your medication every day?

Sometimes a closed-end question is necessary and appropriate. However, many people often automatically answer no to this type of question. The conversation ends and it can feel awkward to ask anything else. In contrast, open-ended questions leave space for detail about your experiences and personal situation. For example:

  • What side effects have you experienced?
  • What questions do you have?
  • What might help you to remember to take your medication?

By asking an open-ended question, your pharmacist can understand more about your specific condition, needs and goals for managing your own diabetes.

Health care professionals should also ask about what concerns you most at the moment. Your diabetes may not be at the top of the list if you have had a headache for several days or your arthritis is flaring up. By focusing on more than diabetes, your current needs can also be identified and addressed – a significant part of the patient-centred partnership.

3Patient-centred care focuses on patient goals as well as the professional expertise of the team.

You may be used to having a health care professional identify goals for you, instead of the other way around. For instance, you may have been told to keep your blood glucose within a set range, or your A1C below a specific number. Research has identified that certain goals offer the best chance of effectively managing diabetes and leading a healthy life, now and in the future. Health care professionals are likely to recommend taking action toward those goals.

However, patient-centred care also takes your personal goals into account. Perhaps you want to have more energy, or to manage diabetes care with the pressures of a demanding job, or include more activity so you can play with your children or grandchildren. Discuss these goals to your pharmacist and other health care team members. With this understanding, your team can structure diabetes management in a way that allows you to achieve them.

Your pharmacist can work with you to help achieve goals in ways that are meaningful for you. Let’s say that you know you should be testing your blood glucose twice each day, but only test once a week. It is far better for you to share that information, so your team can help devise a more realistic plan. Perhaps you might agree to vary the time and day of week that you do that one test, or test more than once on one or two days each week. By working with your pharmacist (or other health care professionals) to set goals that are both beneficial and realistic to achieve, you can improve your health outcomes.

It is important that you are involved in setting goals that you feel confident you can reach.

4 Patient-centred care adds knowledge from all team members into the patient’s self-knowledge and self-awareness.

Do you find yourself repeating the same information when dealing with the health care system? Even if you have visited the same pharmacy for years, you may have to deal with a new pharmacist on duty or a team member whom you have never met. It can be frustrating to have to start over with someone who doesn’t know you.

Technology can help, as documentation standards continue to change and advance. In many provinces, pharmacists can view and in some cases add to your provincial health profile. This allows better connection of care, and helps each health care professional to focus on their area of expertise. Being able to see the big picture helps your pharmacist to ensure you receive medications that are appropriate to your situation. That being said, it is amazing how often repeating the story can bring out subtle new details.

Community pharmacists can also work with you on developing care plans or medication reviews personalized to you. Often, this involves making an appointment and having a one-on-one discussion with the pharmacist about your diabetes goals. Your medications will be assessed to ensure you are getting the greatest benefit. How are you taking them? When are you taking them? Do you know why you are taking them? This information helps decide whether adjustments are needed. Perhaps several medications could be combined in one, or a new medication might be more effective. Your pharmacist may also ask about adult immunizations and other preventative needs. Perhaps you are due for a flu shot, or need your tetanus vaccination updated. When these details are documented in your care plan, the next member of your care team involved in your care is able to quickly see where your plan was left off and start working with you on next steps. In some provinces pharmacists may be able to initiate medication changes to better improve your health. Speak to your own pharmacist and ask about the professional services available to you.

One key outcome in centering care around patients is to help more people to meet their treatment plans. Part of this challenge involves what is called adherence. Adherence is defined by the World Health Organization as “the degree to which the person’s behavior corresponds with the agreed recommendations from a health care provider.” The word ‘agreed’ is important in this concept. In patient-centred care, you and your health care provider should agree on what you must do to manage your diabetes effectively. Agreeing to take your metformin three times per day but only taking it once per day is an example of non-adherence. At one time, your pharmacist might have simply told or reminded you to take the tablets three times each day. Today’s patient-centred care might involve asking questions to understand why it is difficult for you to take your metformin regularly. Are there cost concerns? Do you forget? Are the tablets hard to swallow? Do you have side effects?

With more understanding, your pharmacist can work with you to provide strategies that fit into your overall life goals. More support may help you better adhere to taking your metformin regularly. No matter what your goal is, patient-centred care works the same way, from how often you check your blood glucose or A1C to how much physical activity you get and how often you choose nutritious foods. Research shows that adhering to your diabetes care goals improves your health and lowers your chances of experiencing complications.

Your community pharmacist has always been an accessible, knowledgeable partner in your health care. Adding in patient-centred care strategies allows us to support you more fully. If you have questions about patient-centred care, your pharmacist is on hand to help answer them.

FAMILY HEALTH is written with the assistance of:
College of Family Physicans of Canada
Alberta College of Family Physicians
FAMILY HEALTH is written with the assistance of:
College of Family Physicans of Canada
Alberta College of Family Physicians
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physician promptly. © Copyright 2018, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 0S1 [DI_MDcd19]
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