Family Medicine

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World Book of Family Medicine – European Edition 2015 Andrée Rochfort, MD andree.rochfort@icgp.ie 1 – Patient Empowerment for Patient Self-Management Wonca Europe 20th Anniversary Project 2015 Andrée Rochfort, MD Project Leader: Patient Empowerment – Wonca Europe, Honorary Secretary EQuiP, Director of Quality Improvement, Irish College of General Practitioners, Dublin Project Partners: Tina Eriksson (DK), Ilkka Kunnamo (FI), Jochen Gensichen (DE), Project Manager: Claire Collins (IE) With thanks to members of the EQuiP Wonca Europe Network Patient Empowerment Group and thanks to Project Special Advisers: Ernesto Mola (IT), John Litt (AU) and Susan Smith (IE) At the European Council meeting of WONCA Europe in Warsaw in 2011, Patient Empowerment was adopted as the twelfth characteristic of general practice in the European definition of family medicine (FM) by WONCA Europe, and categorised within the core competency of person-centred care. Core competencies of the FP doctor mean competencies essential to the discipline, irrespective of the health care system in which they are applied. Fig 1 The WONCA TREE – as produced by the Swiss College of General Practitioners (Revised 2011) – Reprinted with permission WONCA Europe: The European Definitions of the Key Features of the Discipline of General Practice 2011 The 2011 revision of the definition of FM gives recognition to the new dynamic between doctor and patient. As social values and healthcare systems continue to change, patients’ expectations are to make choices and decisions in keeping with their autonomy. This recent revision of the definition of FM gives the FP in Europe a new role to harness this patient autonomy and develop the expertise of patients in managing their own health and illnesses. Empowering patients is officially acknowledged as a responsibility of family medicine, which provides an appropriate 10
World Book of Family Medicine – European Edition 2015 environment to promote patient empowerment for self-management of chronic conditions. In 2012 WONCA Europe sought to fund a project with the aim of having a lasting benefit for FM in Europe, and in order to prepare its report for the 20 th Anniversary of WONCA Europe in 2015. The successful bid was submitted by EQuiP, The European Society for Quality and Safety in family medicine, along with three project partners; the Irish College of General Practitioners, the Finnish Medical Society Duodecim, and the Department of Family Medicine at University of Jena, Germany. The project partners sought to explore one aspect of chronic disease management, namely, patient empowerment in self-management of chronic disease. The EQuiP group initially named the project PECC-WE; Patient Empowerment in Chronic Conditions - WONCA Europe, and the project was initiated with the definition of “patient empowerment” (PE) as defined in the European Journal of General Practice (EJGP) article by Ernesto Mola: Patient Empowerment is an educational process to help or support the patient to develop knowledge, skills, attitudes and self-awareness, and to assume effective responsibility for health-related decisions. Definition of Patient Empowerment (E. Mola, EJGP 2008) The value of investing in empowering patients to help themselves seems obvious; however the brainstorming sessions in our project research group revealed that we still have questions about which specific skills, attitudes and behaviours can be taught to primary care clinicians to promote positive patient behaviours and attitudes that improve patient outcomes in chronic conditions. The project partners agreed that the best use of project funds would be to explore whether the education of clinicians in FM to improve patient empowerment for self-management of chronic conditions would improve outcomes for patients compared to patients of clinicians who were not educated in that particular skill. The WONCA Anniversary Project 2015 The role of the family physician (FP) has changed over the last twenty years. Patients’ attitudes to health and healthcare have also changed. The revision of the European definition of general practice is a response to these changes. Patients are more informed now and have access to the same sources of information as medical doctors. Patients in 2015 are less likely to be passive recipients of healthcare and are more likely to have expectations and demands that reflect the psychology of consumer-based societies. 21 st century patients expect to receive high quality, safe care. However, as all members of society are either patients or potential patients, there is an obligation on all citizens to participate in their care and actively manage their own lifestyle factors for optimum health. Once established, chronic diseases are by definition not curable. Multimorbidity and polypharmacy are escalating as people live longer with chronic conditions. Public services funded by taxpayers and privately funded healthcare services, voluntary organisations and charities all contribute finance and other resources towards the management of chronic conditions. These challenges of healthcare provision are intensifying as costs, demands and expectations are apparently infinite, while resources remain finite. Our research shows that one path for assisting patients to improve their health outcomes is through primary care health professionals who are educated and trained in the skills of motivation, goal setting and communication skills appropriate for change management. There are of course many pathways to patient empowerment, and several factors influence patients’ motivation and capacity for self-management. We have evidence that patient self-management has a positive impact on health outcome, though we must acknowledge that incorporating self-management support in routine healthcare is in itself challenging. In conclusion There are a number of findings of this project which will be formally presented at the WONCA Europe Conference in Istanbul, 2015. These include the systematic review report, the online educational tool for health professionals and its evaluation, and the launch of an online hub of resources on patient self-management for health professionals, patients and those who care for them. Our research findings can be regarded as a successful starting point for primary care-based multidisciplinary interventions with capacity to implement quality improvement in management of chronic conditions for the benefit of 11
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Family Medicine

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