Client-centred practice and health efficacy
Being client-centred means the health practitioner views the client as a whole person who has beliefs, values, relationships and priorities. Clients are more than a list of ailments. Supporting the client to be effective in managing his/her own care should be the priority of all health professionals. Approximately 70% of medical encounters are for self-managed chronic disease1 whether clients manage well will be in some part determined by their level of health efficacy2. There are six aspects of client centeredness identified by the Institute of Medicine, America in their 2001 report. These are:
- Respectful to patients’ values, preferences, and expressed needs;
- Coordinated and integrated;
- Provide information, communication, and education;
- Ensure physical comfort;
- Provide emotional support—relieving fear and anxiety; and
- Involve family and friends3.
These measures are essential ingredients in increasing the health efficacy of clients. Outlined below are some procedures that can be incorporated into the practice of a health practitioner interested in improving client-centred care.
Waiting room décor/consultation room layout
Creating a physical environment where the client feels invited, welcome and relaxed ensures that the first impression is positive. Soothing colours, comfortable chairs, approachable and knowledgeable reception staff are the initial interactions a client will have with a practice. The physical layout of the health practitioner’s consultation room will enhance the perception that the client feels equal to and engaged with the clinician1. Seating which ensure no barriers between client and clinician on an equal level ensures that an unspoken message of dominance or disinterest is reduced1. These practices enable the effective delivery of the following processes.
Questioning approach by the practitioner
The health care professional engages the client to determine what is important to him/her, how the client feels about the presenting issue/disease process and what expectations he/she has for future care4. Open, non-judgmental body language and spoken word helps to ensure that the client feels respected and that opinions and values expressed will be considered in treatment5. Goal orientated care that incorporates the client’s priorities and needs, can be achieved in this way. Longer consultations will also ensure the client has time to feel heard and map strategies. Communication is needed to build on client successes and provide support and encouragement at every stage of the medical journey.
Coordination of care across disciplines
The medical landscape is a daunting journey for clients and families when left to navigate numerous specialties that often do not communicate effectively. Coordinated care led by the client’s goals, directed and guided by the clinician can enhance the client’s health efficacy leading to effective self management2. Regular follow-up and assessment support the client in knowing that they have not been left to negotiate the medical landscape alone. Health efficacy is supported in this environment by building on success. Successful negotiation of any situation will build the clients confidence to manage a following situation or event.
Shared Medical Appointments
Group medical visits or Shared Medical Appointments are an individual medical consultation carried out in a group environment. In this situation clients are learning from the experience of other clients, receiving extended time with the medical practitioner and are encouraged to be more proactive in their own care and management6. Clients in these appointments are on a more equal footing with the health care provider in a cooperative setting where the medical professional has greater exposure to the social setting and circumstances of the clients6. These appointments can be clinically specific or heterogeneous across numerous chronic diseases. The advantage of mixed medical groups is that many clients have more than one chronic condition they are managing. Group based education sessions for clients has been shown to also be an effective means of enhancing health efficacy and self-management practices2. Shared medical appointments and group education have the effect of enhancing the client’s ability to develop the skills necessary to manage the numerous disease related problems that arise in day to day living. Being exposed to others who are managing a chronic disease effectively is a principle important in building self and health efficacy2.
Conclusion
Health efficacy is an important aspect of self-management of chronic disease; clients need to feel empowered to ask questions, set goals, find resources and feel respected even if their goals do not align with the medical practitioner. The decisions clients make every day affect the outcomes of their disease process. In an environment that encourages the client to be the ‘expert’ with a supportive medical team they can achieve their own goals and live a fulfilled life.
- Egger G. BA, Rossner S. Life Style Medicine Managing Diseases of Lifestyle in the 21st Century. 2nd ed. Australia: McGraw-Hill Australia Pty Ltd; 2011 2011.
- Marks R, Allegrante JP. A Review and Synthesis of Research Evidence for Self-Efficacy-Enhancing Interventions for Reducing Chronic Disability: Implications for Health Education Practice (Part II). Health Promotion Practice. 2005 April 1, 2005;6(2):148-56.
- Medicine Io. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press; 2001. 360 p.
- Margaret Gerteis SE-L, Jennifer Daley, Thomas L. Delbanco. Through the Patient’s Eyes. San Francisco, California: Jossey-Bass; 1993. 317 p.
- Barry MJMD, Edgman-Levitan SPA. Shared Decision Making — The Pinnacle of Patient-Centered Care. The New England Journal of Medicine. 2012 2012 Mar 01;366(9):780-1. PubMed PMID: 926183252; 22375967. English.
- Lavoie JG, Wong ST, Chongo M, Browne AJ, MacLeod MLP, Ulrich C. Group medical visits can deliver on patient-centred care objectives: results from a qualitative study. BMC Health Services Research. 2013;13:155-. PubMed PMID: 23627609.
This article has been written for the Australasian Society of Lifestyle Medicine (ASLM) by the documented original author. The views and opinions expressed in this article are solely those of the original author and do not necessarily represent the views and opinions of the ASLM or its Board.
