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Open Access Research article

Group medical visits can deliver on patient-centred care objectives: results from a qualitative study

Josée G Lavoie1*, Sabrina T Wong23, Meck Chongo1, Annette J Browne3, Martha LP MacLeod4 and Cathy Ulrich5

Author affiliations

1 University of Northern British Columbia, School of Health Sciences, TLC building 10-3516, 3333 University Way, Prince George, BC V2N 4Z9, Canada

2 University of British Columbia Centre for Health Services and Policy Research, Vancouver, Canada

3 University of British Columbia School of Nursing, Critical Research in Health and Health Care Inequities, Vancouver, Canada

4 University of Northern British Columbia, School of Nursing, Prince George, Canada

5 Northern Health Authority, British Columbia, Prince George, Canada

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Citation and License

BMC Health Services Research 2013, 13:155  doi:10.1186/1472-6963-13-155

Published: 29 April 2013

Abstract

Background

Patient-centred care emerged in the late 1960s as a framework to guide providers and decision-makers towards the provision of more effective health care and better outcomes. An important body of literature has since emerged, reporting mixed results in terms of outcomes. To date, assessments of the effectiveness of patient-centred approaches have focused one-on-one consultations. The purpose of this article is to explore dimensions identified as key in the patient-centred literature in the context of primary health care services delivered in a group setting. Group Medical Visits (GMVs) offer a novel format for the delivery of patient-centred primary health care services, especially for patients living with complex morbidities.

Methods

Drawing on a large study of GMVs, we report on key format and process-oriented elements identified in GMVs, and on their link to improved outcomes. For the purpose of this study, we interviewed 34 providers and 29 patients who have been engaged in GMVs, delivered in rural, northern and First Nation communities in British Columbia, Canada.

Results

Our analysis shows that the delivery of PHC in a group format results in a shift in the role of the provider, from that of an adjudicator involved in imparting norms of self-care, to that of a facilitator who assists the group in defining norms of self-care that are based on medical knowledge but also on the broader context of patients’ lived experience and on their pragmatic experience. In a group process, peer-patients take on the role of promoting these norms to other patients. This results in a significant shift in the role of the provider, increased trust, increased knowledge for the providers and the patients and better patient self-management. Our results also show increase satisfaction for patients and providers.

Conclusions

GMVs offer an alternative format for the provision of PHC that brings together the benefit of a group process and of a clinical encounter. This format can successfully deliver on the promises of patient-centred care.

Keywords:
Primary health care; Clinical encounter; Self-management; Effectiveness; Chronic diseases