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BUILDING
INTEGRATED HEALTH SERVICE DELIVERY NETWORKS
PEOPLE CENTERED CARE
(IHSDNs Attribute # 6)
July 28 - 30, 2015
Belize
REYNALDO HOLDER
Health Services and Access Unit
Department of Health Systems and Services
Overview
• Definitions:
– Person Centered
– People, Family and Community Centered
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Differences with traditional model
Life Course Approach
Ethnicity and Gender
Self-care & Self-management
Patient Bill of Rights
Definitions
• Person centred care is about 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.
• Hence, to be ‘person-centred’ means being responsive to
holistic needs and to tailor care to individuals’ or group’s
specific characteristics and potential.
Definitions
• People centred care goes beyond a model or care that
confronts common epidemiological population profiles to one
that considers holistic needs and aims of the community in an
evolutionary movement that should strengthens individuals
and communities’ competencies and action towards health
and well-being.
• People centred care also encompasses person-centred care.
People centred care: Key
principles (Montenegro et al,
2010)
1.
Promotion of health and
wellbeing
2. Focus on whole-person
care
3. Care for all people
4. Partnership and
participation
5. Sensitivity to
social/cultural diversity
and context
6. Quality of relationship and
communication between
the system and users
7. Tailored and responsive
care – i.e. to individual
needs
8. Comprehensive
9. Continuous
10. Right and responsibilities
Conventional Ambulatory
Medical Care
People-centered Care
Focus on illness and cure
Focus on health needs
Relationship limited to the moment of
consultation
Enduring personal relationship
Episodic curative care
Comprehensive, continuous and personcentered care
Responsibility limited to effective and
safe advice to the patient at the moment
of consultation
Responsibility for the health of all in the
community along the life course;
responsibility for tracking and
addressing determinants of ill health.
Users are consumers of the care they
purchase
People are partners in managing their
own health and that of the community
they live in.
Innovative Clinical Practices
Variable
Conventional Model
focused on acute conditions
Innovative Model
oriented to acute and chronic
conditions
LENGTH OF THE
INTERVENTION
Short term
Long term or permanent
DIAGNOSIS AND
PROGNOSIS
Usually very precise
Usually uncertain
TIPE OF INTERVENTION
in general, curative
In general, chronic care
Prescription of diagnostic test and
Providing guidance and making alliances with
medications
users and their families
Centered on professional care
Centered on multidisciplinary management and
self-care
ROLE OF HEALTH
PERSONNEL
NATURE OF THE
INTERVENTIONS
CLINICAL KNOWLEDGE
AND INTERVENTIONS
Physician centered
Shared by multi-professional teams and with the
users
ROLE OF THE USER
Follow/comply with prescriptions
The user takes charge of his/her health and works
with the health team
HEALTHCARE DELIVERY
SERVICES
Reactive, episodic and fragmented
Proactive, continuous and integrated
Source: modified from (16) Vilaca, 2012.
The Life Course Approach: Definition
• The Life Course Perspective:
– Looks at how chronological age, relationships, common life
transitions, and social change shape people’s lives from birth to
death.
– Considers how protective and risk factors, and events that occur
earlier in life influence the trajectories and later outcomes across
individual and population life spans.
• Life course theory:
– Helps explain health and disease patterns- including
healthdisparities – across populations and over time
– Is population-focused
– Is firmly rooted in social determinants and social equity models
The Life Course Approach: Implications
• Goals of a life course approach:
– To optimize health across the lifespan for all people
– To eliminate health disparities across populations and
communities
• Change in accountability: responsibilities across cohorts.
• Need to incorporate a whole-person, whole family and whole
community approach – alliance building beyond the usual reach of
public health.
• Need for horizontal linkages and integration between health and
other services.
The Life Course Approach: Implications
• Assure the availability of services and support during critical
or sensitive periods throughout the lifespan.
• Address risk and protective factors today that will influence
tomorrow’s health.
• Focus on health equity from the perspective of the population
and time: going beyond tracking disparities to identify and
address root causes of disparities at the population level.
The Life Course Approach: Implications
• Take into account the broader social and environmental
context in which people live and the connections across the
lifespan, in the design of individual interventions
• Take into account the temporal (longitudinal) aspect of risk
and protective factors in the analysis of health and disease
• Strong emphasis on a healthy start: pre-conception,
antenatal, neonatal periods
Integrated Health Services Delivery Networks
Understanding Integrated Care
Integrated care means different things to different people –
there is no universally accepted definition.
Integrated care is centred around the needs
of service users
• ‘The patient’s perspective is at the heart of any
discussion about integrated care.
• Achieving integrated care requires those
involved with planning and providing services to
‘impose the patient’s perspective as the
organising principle of service delivery’
(Shaw et al, 2011, after Lloyd and Wait, 2005)
Gender issues for consideration
Gender equity and gender equality interact:
1. Equitable coverage of women and men´s differentiated
health needs
2. Going beyond the biological categories:
‘Gender differentials in exposure and vulnerability to health risk
can arise for two main reasons: the interplay of biological sex
with the social construction of gender, and direct impacts of
structural gender inequalities’
(Sen and Ostlin, 2009)
Ethnic issues for consideration
Ethnicity:
o Traditionally excluded group (equity): Requires a targeted approach to
ensure and evaluate universal access and coverage (equal inclusion and
wellbeing for all);
o Specific cultural barriers to health: Require an intercultural approach in
order that all people can access integral, adequate, opportune quality
services that respond to their needs and realities
Ethnic issues for consideration
• Inequities in health:
o Higher levels of infant mortality
o Inequalities in causes of mortality: physical injuries;
infections and parasites
o TB principally affects indigenous population
• Intersections with gender inequalities:
• Higher unmet contraceptive need amongst indigenous
women
• Less prenatal control and skilled attendance at birth for
indigenous and afrodescendent women
Thank you!
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