Person-centered practice in the Portuguese healthcare system: A documentary study

Area of Science:

• Health Services Research
• Public Health Policy
• Healthcare Management

Background:

• Person-centered practice is crucial for modern health systems, yet its clinical integration faces hurdles.
• The macro context, encompassing structural and strategic factors, is vital for sustainable implementation of person-centered care.

Purpose of the Study:

• To analyze the framing of person-centered practice within the Portuguese healthcare system's macro context.
• To identify determinants and challenges in implementing person-centered care in Portugal.

Main Methods:

• Qualitative, descriptive, and retrospective documentary study.
• Systematic literature search of Portuguese healthcare regulatory and policy documents (n=40).
• Lexicometric and factorial analysis using IRAMUTEQ® software, guided by the Person-Centred Practice Framework.

Main Results:

• Five classes emerged, grouped into 'Structural and organizational determinants' (Systemic vision, Organizational culture, Digital transformation, Political vision) and 'Operationalization' (Care approach).
• Discursive patterns revealed disconnects between organizational levels and practice, despite a discourse centered on the health-care-person nucleus.
• Analysis indicated misalignment between organizational strategies and on-the-ground implementation of person-centered care.

Conclusions:

• Portugal demonstrates political and strategic progress in person-centered practice, emphasizing humanized care, health literacy, and digitalization.
• Implementation barriers include a lack of clear guidelines, the persistence of the biomedical paradigm, and insufficient evaluation of care experiences.
• Addressing the identified disconnects and systemic issues is essential for effective person-centered care delivery in Portugal.