PS023 - Patient-Centred Health Systems: Good Wishes and Harsh Realities

Representing an estimated 365 million patients the International Alliance of Patients' Organisations (IAPO) is a unique global network that aims to advocate on relevant aspects of healthcare policy, with the goal of influencing international, regional and national health agendas. "Health systems need to be reoriented to people and patients rather than diseases" commented Jeremiah Mwangi, Senior Policy Officer from IAPO. The best way to do that is to promote an approach based on strong values of respect, partnership and equity, coping with principles of patient-centred healthcare such as support for the individual patient, access to accurate, relevant and comprehensive information, promotion of patient responsibility and, if possible, patient involvement in health policy-making. Putting patients needs and self-management at the centre of the healthcare system will lead to a number of advantages in terms of cost-effectiveness and quality of care. One caveat only has to be taken into account: health systems should give patients responsibilities they can assume, and not simply what the system cannot do itself.

"Patient education is not just a nice accessory", added Karin Lörvall, Cardio-Pulmonary Physiotherapist and Patient Educator from Hôpital de la Tour, Geneva, illustrating the Chronic Disease Self-Management Program (CDSMP) developed at Stanford University and now implemented in 12 different countries. "Self-management is a process to change health behaviours (physical activity, coping, communication with doctor, interpretation of symptoms) and health status (fatigue, health distress)", pointed out Dr. Lörvall. The pillar stone of this strategy is an active partnership between trained people living with a life-long disease and health professionals. Similar programs (more or less structured but always evidence-based and not disease oriented) adopted in UK, Austria, Sweden and South America demonstrate that increased self-efficiency helps to significantly decrease the number of hospitalisation days.

The importance of patient participation in reducing healthcare-associated infections (HAI) was also underlined by Didier Pittet, Director Infection Control Program at  the University of Geneva Hospitals. Patient involvement in multimodal hand hygiene promotion strategies has a tremendous potential to reduce medical errors and improve patient safety. HAI is a global issue for patient safety: it affects hundreds of millions of individuals worldwide each year. It can complicate patient care and contribute to unexpected deaths. It affects 5 to 15 per 100 hospitalised patients and can lead to complications in 25 to 50% of those admitted to intensive care units. The risk is 2 to 20 fold higher in developing countries. "No hospital, country or healthcare system in the world can claim to have solved the problem", pointed out D. Pittet. The First Global Patient Safety Challenge "Clear Care is Safer Care", launched by WHO World Alliance for Patient Safety in 2005, is aimed at galvanizing global commitment and action to reduce HAI worldwide with hand hygiene promotion as the cornerstone. New Guidelines on Hand Hygiene in Health Care have been developed by experts and a multimodal implementation strategy is proposed to improve hand hygiene in healthcare settings at all levels of development. One of the recommendations explicitly encourages "partnerships between patients, their families and healthcare workers". Dr. Pittet explained that patient involvement is "a process in which patients understand their role, are given the knowledge and skills by their healthcare provider to perform a task in an environment that recognizes community and cultural differences". Patient empowerment programs must be part of a multimodal approach and must include educational tools, motivational tools and role modeling.

The growing awareness of poor and variable quality of care received by persons living with chronic diseases is leading to increasing efforts to provide patients with quality of care information, so empowering them. But the impact of this effort is unclear. Commissioned by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), the Lewin Group assessed the impact of public reporting initiatives in Europe and North America in order to improve the quality and patient-centeredness received by persons with chronic diseases. Steve Hines, from the Lewin Group, presented the major findings of the model used. "Public reporting efforts are expanding" stated Mr. Hines. "More measures, conditions, and provider types are being included and a number of new funding agencies are interested". The impact of information on healthcare depends on different factors: awareness of information, care options, economic incentives to use information, belief that the information is valid, consumer healthcare literacy, and public and private support for change. Raising consumer awareness requires greater emphasis and leveraging common infrastructure for multiple end users is key to financial viability. To succeed, public reporting efforts must better adapt information for their audience and align their efforts with other strategies.