Patient-centeredness of integrated care programs for people with multimorbidity. Results from the European ICARE4EU project

Abstract

Introduction: This paper aims to support the implementation of patient-centered care for people with multimorbidity in Europe, by providing insight into ways in which patient-centeredness is currently shaped in integrated care programs for people with multimorbidity in European countries.

Methods: In 2014, expert organizations in 31 European countries identified 200 integrated care practices ('programs') in 25 countries of which 123 were included in our study. Managers of 112 programs from 24 countries completed a questionnaire about characteristics and results of the program, including questions on elements of patient-centeredness. Eight programs that were considered especially innovative or promising were analyzed in depth.

Results: Programs used various methodologies to involve people with multimorbidity in decision-making, such as motivational interviewing and narrative counseling techniques. In 79 programs individual care plans were developed together with patients. Few programs had already been systematically evaluated, but in one program it was shown that working with individual care plans based on patients' goals and resources resulted in increased patient satisfaction with care. Various barriers to deliver patient-centered care were reported, including inadequate knowledge and skills of both patients and professionals.

Conclusion: In many European countries innovative approaches are applied to increase patient-centeredness of care for people with multimorbidity. To assess their potential benefits and conditions for implementation, thorough process and outcome evaluations of programs are urgently needed.

Keywords: Europe; Integrated care programs; Multimorbidity; Patient-centeredness.