1. Yung-En Chung, Julie Abelson, Sabrina T
Yung-En Chung, Julie Abelson, Sabrina T. Wong, Julia Langton, Sharon Johnston
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Public Reporting of Performance Indicators of Self-Management Support (SMS) in Primary Care
Background
As performance measurement and reporting increases in primary care (PC), it is important to understand patients’ perspectives on what information they value being reported back to them. Self-management support (SMS), a key dimension of primary care performance, empowers patients to maintain wellness and manage illness.
Objective:
In the context of a larger study investigating patient’s perspectives on the value of PC performance reports, we sought to elucidate the findings specific to SMS.
Methods
Six day-long deliberative dialogue sessions were held in 3 regions in Canada: British Columbia, Ontario, and Nova Scotia.
Participants (n=56) included English or French speaking adult patients, with no chronic conditions and with 3 or more chronic conditions, recruited from PC waiting rooms. Participants were introduced to concepts of PC
performance measurement and were asked to explore which PC performance indicators would be most useful to publicly report.
Session transcripts were reviewed and coded for themes relating to SMS. Emerging themes were discussed with the research team to iteratively interpret the findings.
Results
Access to care, though not a direct measure of SMS, was valued as a foundational aspect of all PC.
Patients felt that the following aspects of PC would better enable them to manage their health and should thus be reported back to the public: patient-centredness and whole-person care, care beyond the office visit, and access to personal health records.
There was debate about the value of some current measures of SMS in primary care such as healthy diet counselling. Some felt this was appropriate, as providers have a responsibility to facilitate healthy lifestyles. Others felt that professionals in the broader PHC setting (e.g. dieticians and nutritionists) can provide this service.
Conclusions
Findings from this work will be taken into developmental consideration for the TRANSFORMATION PC performance measurement and reporting framework.
Acknowledgements
This work is funded by:
Table 1. Patient priorities for PC performance reports: Select aspects that capture SMS
Key Findings
Illustrative Quotes
Access as a foundation to all aspects of care
Though access is not traditionally considered an indicator of SMS, patients emphasized the primacy of access to all aspects of PC.
“If you can’t get access, how do you evaluate the other priorities?”
“Without access I don’t think you have—so, I think access is the main, because, yeah, you don’t have a doctor, none of this other stuff applies.”
Patient-centred
& whole-person
care
Many highlighted the importance of the patient-provider relationship: respect, adequate time, and shared decision-making.
“…it’s a balance, I think, of showing again, this idea that you’re not just an average. You’re not just, you know, it’s a number and on you go with an appointment. It’s caring about the whole patient.”
“As a patient, in order for you to be empowered and to move forward in your life, you have to understand what is happening.”
Care beyond
the office visit
Timely follow-up from providers after lab tests and procedures and for management of chronic conditions facilitates SMS.
“…Why don’t people get that in the healthcare system? A phone call, you know, ‘You recently went through quite a procedure, Mr. [Smith]’...”
Patient access to personal health records
Seen as fundamental to managing health (e.g. keeping track of their own medical history and current health status).
“I don’t know if that exists for me, but that was something that I think I’d be interested in knowing as far as the access to my own personal records. And to be able to take that to my other service providers, my healthcare providers, my physiotherapists...”
Provider’s role in
healthy diet counselling
Some did not see this as the PC provider’s responsibility.
Others felt that PC providers have a “global role to play” in facilitating healthy lifestyles.
“I don’t think it’s really important that I know that the nurse and the doctor talk to some of their patients about their nutritional choices because there are so many other resources out there that are doing that anyway.”
“…It’s not just about prescribing medications. It’s not just about doing a surgery after the fact. It’s about how to help people live healthy lifestyles... To me it’s just as important.
MEASURING AND IMPROVING THE PERFORMANCE OF PRIMARY HEALTH CARE IN CANADA