Patient Centered Care: A Case Study

In a recent discussion paper submission, the Pharmacy Guild of Australia Primary Healthcare Advisory Group stated that keeping elderly people in their own homes as long as possible is a goal key to better health outcomes. It is generally accepted that as a person ages, the number of medicines they take, the number of chronic conditions they live with, and the number of hospital visits they will require, will increase. A concerning statistic is that as many as one in four elderly patients discharged from hospital will experience an adverse health event within thirty days of hospital discharge. These events may have serious outcomes, which may include a need for care in an emergency department, readmission to hospital, admission to a nursing
This concept has transformed the basis of healthcare from an authoritative health authority to that of the empowered individual. Patient centred care is defined by the Australian Commission on Safety and Quality in Health Care as “health care that is respectful of, and responsive to, the preferences, needs and values of patients and consumers”. Although intended to put the patient first, this change in dynamic has introduced new expectations of patients. Rather than the patient putting complete trust in their doctor and complying with their doctor’s directives, the modern patient is expected, at least to some extent, to adopt an active role and provide input into their care. This requires the individual patient to possess skills, confidence, and some level of health literacy about their medications and conditions. This may an unreasonable expectation of some and may result in risky behaviours in
Best practice for discharge and transfer from the hospital has been established. The evidence-based clinical decision support website UpToDate states that four elements should be performed during the discharge process. These include discharge planning, medication reconciliation, preparation of a discharge summary and patient instructions. Several factors are recognised as reducing the likeliness of a successful transition from acute care to primary care. These include adverse events, alterations to the patient’s medications which have not been communicated to the patient, and inadequate planning of the patient’s post-discharge care setting. Additionally, absent or delayed patient follow-up, or failure to hand-off pending tests may also decrease the chances of a successful transition. Finally, patients considered high risk due for other reasons may fail to successfully transition back into the community following hospital