Open Access Highly Accessed Research article

A patient-centred approach to health service delivery: improving health outcomes for people with chronic illness

Masoud Mirzaei12*, Clive Aspin27, Beverley Essue26, Yun-Hee Jeon3, Paul Dugdale4, Tim Usherwood5 and Stephen Leeder2

Author Affiliations

1 Yazd Cardiovascular Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 Menzies Centre for Health Policy, University of Sydney, Sydney, Australia

3 Sydney Nursing School, University of Sydney, Sydney, Australia

4 Centre for Health Stewardship, College of Medicine and Health Sciences, Australian National University, Canberra, Australia

5 Discipline of General Practice, University of Sydney, Sydney, Australia

6 The George Institute for Global Health, Sydney, Australia

7 Poche Centre for Indigenous Health, University of Sydney, Sydney, Australia

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BMC Health Services Research 2013, 13:251  doi:10.1186/1472-6963-13-251

Published: 3 July 2013



The Wagner Model provides a framework that can help to facilitate health system transition towards a chronic care oriented model. Drawing on elements of this framework as well as health policy related to patient centred care, we describe the health needs of patients with chronic illness and compare these with services which should ideally be provided by a patient-centred health system. This paper aims to increase understanding of the challenges faced by chronically ill patients and family carers in relation to their experiences with the health care system and health service providers.


We interviewed patients, carers and health care professionals (HCPs) about the challenges faced by people living with complicated diabetes, chronic heart failure or chronic obstructive pulmonary disease.


Patients indicated that they had a range of concerns related to the quality of health care encounters with health care professionals (HCPs), with these concerns being expressed as needs or wants. These included: 1) the need for improved communication and information delivery on the part of HCPs; 2) well organised health services and reduced waiting times to see HCPs; 3) help with self care; 4) greater recognition among professionals of the need for holistic and continuing care; and 5) inclusion of patients and carers in the decision making processes.


In order to address the challenges faced by people with chronic illness, health policy must be more closely aligned with the identified needs and wants of people affected by chronic illness than is currently the case.