A wholistic approach to patient-empowered care: a quality improvement report

An updated medical model for wholistic and patient-centred care that adds elements of prevention and management of long-term medical conditions to the old biomedical model is a necessary response to current understanding of health and wellbeing. The capacity to adapt and self-manage is central to health, and important domains or pillars to consider are physical, psychological, social/emotional, and spiritual. The challenge for this model is applying it in a resource-constrained primary care environment.

The value of an enhanced model of care in a general practice setting was tested. Elements of the model were relevance and applicability to New Zealand general practice, equity considerations, and validated tools for delivering messages and measuring outcomes. Components were facilitated group video modules to educate and support participants in self-efficacy within domains of physical, psychological, emotional, and spiritual wellbeing, followed by extended one-on-one consultations between participants and their GP at 6-monthly intervals for 1 year.

Self-Efficacy and Patient Activation Measure scores increased throughout the study. Quality of Life scores and consideration of the four domains of wellbeing indicate patient ability for self-management and adaptability in the face of changing medical conditions, without decline in wellbeing.

A shift in locus of control favouring the patient, with use of validated tools to enhance a wholistic approach in patient-clinician interactions, results in meaningful health improvements. Such tools and education resources are accessible and can be incorporated into existing systems of care without substantial disruption and offers a realistic opportunity for positive change.