Principles of person-centred practice for prescribing

Introduction

The Royal College of General Practitioners defines person-centred care as “holistic, empowering” care that “tailors support according to the individual’s priorities and needs”​[1]​. Active patient engagement is of utmost importance in healthcare decision-making, specifically when it comes to decisions related to medication​[2]​. By prioritising the needs, preferences and values of the individual, person-centred practice ensures that prescribing decisions align with their overall wellbeing. 

Research examining the integration of person-centred care into the practice of pharmacists has indicated positive outcomes, including enhanced medication adherence, improved health communication and stronger patient-provider relationships​[3]​. These studies have demonstrated that patients are actively engaged in consultations, especially in discussions about their treatment plans, and demonstrate increased motivation to self-manage their chronic illnesses​[4]​.

This article will explore the rationale behind adopting a person-centred approach to prescribing, consider the external environment and provide examples of how person-centred approaches can be incorporated into individual prescribing practice and across teams in the context of pharmacy.

It is recommended that you read this article in conjunction with these resources from The Pharmaceutical Journal:

• ‘How to demonstrate empathy and compassion in a pharmacy setting‘;
• ‘How to build and maintain trust with patients‘;
• ‘How to provide patients with the right information to make informed choices‘.

To help further expand your prescribing skills, additional related articles are linked throughout. You will also be able to test your knowledge by completing a short quiz at the end of the article.

Principles of person-centred care

Unpacking the different components of personhood is complex. Different models and frameworks have been developed to help healthcare professionals understand the underlying principles of person-centred care and support its implementation into practice. The Picker Institute Europe, a non-profit organisation dedicated to developing a patient-centred approach to healthcare, has conducted extensive research — including focus groups with patients, family members, caregivers and clinicians — to develop eight principles of person-centred care (see Figure)​[5]​. These principles focus on factors that matter most to all those who use care services and define the important elements that should remain non-negotiable in the delivery of care​[6]​. Organisations are encouraged to implement these principles to advocate for the continued placement of people at the centre of care provision. There is an increasing need to move away from paternalistic approaches where patients are told what treatment they will be receiving, towards collaborative relationships where the knowledge, values, preferences and specific circumstances of everyone is taken into account when jointly deciding how to manage their care. 

The Pharmaceutical Journal

The Health Foundation has also developed a framework that identifies four principles of person-centred care​[7]​: 

1. Affording people dignity, compassion and respect; 
2. Offering co-ordinated care, support or treatment; 
3. Offering personalised care, support or treatment; 
4. Supporting people to recognise and develop their own strengths and abilities to enable them to live an independent and fulfilling life.

Person-centred approaches in practice

Person-centred prescribing is influenced by the external environment in which it is practiced. Consider how different the experience will be for patients receiving treatment in a busy hospital ward compared with a one-to-one consultation carried out at their home. The external environment may not be something prescribers can change but, by considering its potential impact on the person, it may be possible to identify opportunities to make small but effective accommodations (e.g. moving a conversation to a quieter or more private setting).

Person-centred care requires multidisciplinary approaches recognising the individual’s capacity to manage and improve their own health​[9]​. Effective implementation of person-centred practice also places different demands on prescribers, staff and the health system; it requires excellent communication skills and the capacity to respond flexibly to individual needs. Active listening, empathy and the ability to provide clear explanations of treatment options are crucial when facilitating shared decision making.

The method of communication should be tailored to the patient demographic and the setting in which you are working. For example, the communication style adopted during a remote consultation will be different from when a patient is seen in a face-to-face clinic setting. Similarly, where the patient may present with impaired capacity, how you communicate with them or their carer will differ to someone who is fully cognisant. This topic can be explored in greater depth by reading ‘Pharmacy consultations with patients with learning disabilities’.

For person-centred practice to be successful, it should be embraced at all levels of the healthcare system, as well as by policymakers, educators and the public. A good example of wide-scale adoption of person-centred practice is the ‘Hello My Name is’ campaign. This grassroots initiative serves as a reminder to healthcare professionals of the importance of simple gestures and that a proper introduction is an important first step in establishing meaningful trusted relationships with patients.

The prescriber will be unable to provide effective person-centred care without a strong knowledge base and clinical competence. Prescribers need to provide patients with accurate and up-to-date information to enable an informed discussion of treatment options. 

The four principles outlined below briefly describe ways that person-centred practice can be incorporated into prescribing:

1. Understand the person

Recognising the differences among individuals is essential for fostering a productive and personalised shared decision-making process. For example, a patient’s cultural beliefs and values, language proficiency, socioeconomic status and personal views can significantly influence their health-related choices and attitudes towards medications​[10,11]​. Healthcare professionals should avoid making assumptions and approach each patient with an open mind, ensuring that care is tailored to individual needs and preferences. By taking the time to comprehend these diverse aspects, healthcare professionals can tailor their approach and engage in meaningful conversations about care. For example, a Muslim patient will need specific support managing their medication when fasting during Ramadan. Similarly, for Hindu patients, considerations will need to be made for their dietary requirements when prescribing treatments that may contain animal products. 

By understanding and respecting these differences, healthcare providers can collaboratively design a care plan that aligns with the patient’s values, resulting in improved adherence and better outcomes. Embracing patient diversity and actively engaging with patients on an individual level fosters a patient-centred care model that prioritises both the physical and emotional well-being of the patient. The case-based learning article ‘Insulin intensification in a Hindu patient with type 2 diabetes mellitus‘ explores how this can be applied to a practice example.

2. Assess the impact of socio-economic factors

The impact of social determinants on an individual’s health outweighs the influence of the quality and quantity of healthcare they receive​[12]​. Factors such as employment status, overall wellbeing, living conditions and income play a significant role in shaping health outcomes. These non-medical factors have a profound effect on a person’s overall health and should be given due consideration in the context of person-centred prescribing. This includes assessing factors, such as affordability of medication, access to healthcare resources and social support systems. Prescribers may need to explore medication assistance programs or provide information on more affordable alternatives to ensure patients can access and adhere to their prescribed medications. Non-pharmacological interventions with support from social prescribers may be required to provide a holistic approach to patient care that is much more tailored to their needs and targets underlying factors contributing to their ill health.

A full discussion of the social determinants of health is beyond the scope of this article but further reading has been identified at the end of the article.

3. Facilitate shared-decision making

Treatment options should be clearly explained to patients, including the benefits and risks associated with each choice. By considering the patient’s preferences, values and beliefs, shared decision-making can lead to treatment plans that align with the patient’s goals and enhance their adherence to medication regimens. 

The ‘Year of Care’ initiative serves as an excellent illustration of efforts to implement shared decision-making for individuals with long-term conditions​[13]​. It emphasises the use of personalised care and support planning to ensure that interactions between patients with long-term conditions and healthcare professionals are meaningful and impactful with healthcare that focuses less on ‘fixing’ a patient’s illness and more on supporting them to manage their condition independently. 

4. Collaborate with the multidisciplinary team

Person-centred prescribing relies on the full involvement of the multidisciplinary team. Involving physicians, nurses and other allied healthcare professionals can enhance the quality of care provided to patients and ensure that the individual preferences and circumstances of the patient are understood by the full team.

An evidence-based approach developed by academics at King’s College London, known as ‘Experience-Based Co-Design’ (EBCD), offers a method for enhancing people’s healthcare experiences​[14]​. It involves gathering feedback and experiences from both patients and staff and using this information to collaboratively develop service improvements. By adopting the EBCD approach, healthcare professionals are encouraged to reframe their perspectives and view healthcare from the patients’ standpoint. This enables them to work alongside patients in identifying and implementing often small yet impactful changes that significantly enhance the overall patient experience of care. 

The following case study explores how a prescribing pharmacist can adopt a person-centred approach during a routine consultation:

Case in practice

Patient profile: Mrs Smith, aged 65 years, is visiting a pharmacist prescriber in their hypertension clinic at a GP practice. She had been asked to monitor and record her blood pressure over the previous two weeks. Mrs Smith currently takes no medication and enjoys going out with her friends and family. She loves playing with her two-year old grandchild and plays tennis every week.

Background: The prescribing pharmacist has discussed Mrs Smith’s recent blood pressure results. The results Mrs Smith has brought in today indicate she has consistently raised blood pressure and could benefit from the prescription of a new antihypertensive medication. 

When discussing the blood pressure results, the pharmacist has informed the patient about the risks of leaving high blood pressure untreated and explained the medical options available that can help manage the risk of stroke and heart attack. Mrs Smith agrees to start on a new antihypertensive medication but is concerned about the potential side effects and the impact on her daily life, as she values her independence and enjoys an active lifestyle.

Reflective questions: How can incorporating person-centred care principles support Mrs Smith as she considers the use of antihypertensive medication? 

What strategies would you employ to establish rapport and create a comfortable environment for open communication with the patient?

Reflecting on the shared decision-making process, what challenges are you likely to encounter during the discussion and how would you address them to ensure the patient’s involvement and satisfaction with the treatment decision?

What additional patient-centred approaches can be incorporated into the care plan for the patient?

Answer guidance is available at the end of the article.

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