"Perceptions of Patient-Centered Care Amongst Practitioners and Patients in a Free-of-Cost Tertiary Care Facility in Karachi, Pakistan"

Background and Purpose:

In the plethora of challenges that global healthcare systems are burdened with, Patient-Centered Care (PCC) is one that is largely neglected, particularly in low- and middle income countries (LMIC). PCC is conceptualized as care offered by medical practitioners that is emphatic, compassionate and responsive to the expressed needs, values, and patient preferences. Although healthcare systems may believe their systems to be patient-centered, in reality PCC is often not implemented and care continues to be delivered in a disease or physician-centered manner. This study aims to investigate perceptions of patients and practitioners on PCC delivered within an  Orthopedic Department of a free-of-cost tertiary care facility in Karachi, Pakistan.

Methods:

Six focus groups were conducted from a purposive sampling of 18 patients and 18 practitioners (1 Physiotherapist; 6 Nurses; 8 Residents;3 Consultants. A semi-structured interview guide was developed using key dimensions of PCC: 1) respecting patients’ preferences, values, needs; 2) coordination and integration of services; 3) education and communication; 4)  physical comfort; 5) emotional support; 6) family involvement; 7) access to care and services. Patients and practitioners attended separate focus groups to maintain confidentiality. Focus group recordings were transcribed verbatim and translated from Urdu to English. Researchers used constant comparision analysis to explore variability and similiarity among and between patients and practitioners. To ensure rigor, “memoing” techniques and member check comparison across coders were used until 100% agreement was achieved on themes and corresponding quotes. 

Results:

Patients and practitioners reported that care was delivered in an emphatic, respectful and compassionate manner. Practioners and patients stated that realistic recovery timeframes and lifestyle changes post-treatment were well communicated to patients. Practitioners encouraged patients who spoke a different language or were illiterate to be accompanied by a caregiver during clinic visits. To ensure patients made informed medical decisions, doctors educated patients on different treatment options using visual aids and practical demonstrations. Practitioners believed in the need to be firm to ensure treatment adherence. Patients observed a lack of communication among nurses, doctors, attendants and dressers. Patients reported the need for a point-person for patient queries post-discharge and better education on opost-discharge care. Patients recognized that being a free hospital, there was greater patient influx and hence extended waiting times. Patients and practitioners reported limited referals to external social and medical agencies.

Conclusions & Implications:

Our study offers a nuanced perspective of practitioners and patients on PCC within a free-of-cost tertiary care facility in a LMIC country. There is a need for practitioners to be trained on inter-professional collaboration to foster better communication and coordination. Our findings underscore that competent practitioners who are respectful and empathetic compensate for extended wait times. Medical practitioners ought to make a conscious effort to engage in shared decision-making with patients while understanding their psychosocial needs (financial status, education, mental status) when developing and executing treatment plans, and make referrals to social services when warranted. Within complex healthcare systems, it is necessary to infrom patients  a point person who can address queries subsequent to surgical procedures.