Patient-Centered Care in Orthopaedics and the African Challenge

Azeez Olalekan Tella

Department of Orthopaedics/Traumatology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi Nigeria

*Correspondence to: Azeez Olalekan Tella, Department of Orthopaedics/Traumatology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi Nigeria.

Copyright © 2022 Azeez Olalekan Tella. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Ever since the Institute of Medicine (IOM) published its landmark report in 2001, Crossing the Quality Chasm: A New Health System for the 21st Century, the concept of patient-centered healthcare has become popular and engaging around the world. Clinicians of diverse professional background have embraced the concept and institutions and governments are directing policies of healthcare delivery along the new concept. The vast majority view it as an innovative approach that emphasizes the participation of patients and families in decisions about their care in a mutually beneficial manner.

Patient-centered healthcare is a new applied science in healthcare, defined as the provision of care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions [1]. It is patient-driven care rather than physician-driven and key components include consultation, information, communication, and shared decision-making, between the patients and the clinicians, all geared towards improving the patient experience of the care delivered [2]. The concept has generated a lot of research interest in different fields of medical practice, including Orthopedics. It is widely believed that the direct participation of the patients in decision-making about their own health improves patient experience which ultimately improves outcome of treatment [3].

Clinical outcomes, in Orthopaedics and Traumatology, are more relevant to the surgeons than the patients, as patient-reported outcomes are seen as subjective [4]. However, the patient-centered approach to care gives more credence to patient-reported outcomes and satisfaction by ensuring active participation of patients through shared decision-making in the entire process of care. The psychological impact of trauma, for example, may be difficult to measure clinically but patient will often report lack of satisfaction which should prompt the Orthopaedic surgeon to ask further questions. The success or failure of orthopaedic care should be seen beyond images, and subjective reporting of the patient should drive outcomes. The clinicians should take a clue during initial evaluation and determine what is relevant to the patient before proceeding with intervention

While the rest of the world is making significant progress in adopting patient-centered mode of healthcare, there is dearth of research into the new concept in Africa [2]. Unfortunately, there are peculiar challenges in Africa’s health systems that will make it difficult for patient-centered healthcare to thrive. They include the following:

1. The concept of patient-centered healthcare is still evolving around the world. This makes it less popular in Africa among healthcare professionals as many clinicians are either not aware of the concept or simply not interested.
2. The delivery capacity of healthcare services in Africa is still at variance with the needs of the people. Africa still lags in not having a healthcare system that specifically address the healthcare needs of the people and multiple factors are responsible for this. They include poor coordination of care from the Primary Healthcare level up to the Specialized centers, absence of medical insurance making access to quality healthcare difficult, medical brain drain to mention a few [5].
3. The regulatory role of the government in Africa is still poor. Government everywhere is expected to drive appropriate healthcare policy that will lead to improvement in healthcare delivery, but this has not been the case in Africa. For instance, in 2018, the Nigerian government launched The Patients’ Bill of Rights (PBoR), which is an aggregation of the rights (and responsibilities) of patients as they seek healthcare across the country. While the government seem committed to this policy documentation, the structures to enable adequate implementation of the policy are grossly lacking.
4. Limited resources in Africa have hampered delivery of high-quality healthcare. Most of the health institutions are ravaged with problems ranging from lack of hospital equipment or shortage in supply of essential drugs to inability to train healthcare professionals to improve the care of their patients [5].
5. Wrong perception of healthcare in Africa is another barrier to this concept [5]. Many health users in Africa do not understand their role in shared decision-making, which is a key component of patient-centered care. Closely related to this is ignorance on the part of the patients about their rights and responsibilities as they seek healthcare.
6. Limited research interest in the concept of patient-centered healthcare. To improve the awareness and knowledge about the concept of patient-centered healthcare, there must be a strong interest among healthcare professionals in related research and policy makers need to prioritize this as well.

Patient-centered care is about individualization of care and increasing participation of the patients and families in the care process. The essence is to improve the relationship between the patients and their healthcare providers, which is known to guarantee improvement in patient outcomes and lead to greater patient satisfaction with care [6]. In addition, clinicians need to focus more on what are relevant outcomes to the patient; like pain, mobility, satisfaction as well as quality of life [7].

Orthopaedic surgeons and other healthcare professionals around the world particularly in Africa must therefore open more discussion about the concept and encourage research into it, to deliver better and more effective care to the patient population.

Bibliography

1. Institute of Medicine (2001). Crossing the Quality Chasm. A new Health system for the 21st Century. Washington DC.
2. International Alliance of Patients' Organizations. What is Patient-Centered Health Care? A Review of Definitions and Principles. Second ed. London: IAPO, June 2007.
3. Kate Lorig (2012). Patient-Centered Care: Depends on the Point of View. Health Education & Behavior., 39(5), 523-525.
4. Daniel Christensen, L., Jonathan Dickens, Brett Owens, Benjamin Potter, K., et al. (2018). Patient-Reported Outcomes in Orthopaedics. J Bone Joint Surg Am., 100(5), 436-442.
5. World Health Organization (2012). Health Systems in Africa: Community Perceptions and Perspectives. The Report of a multi-country study. Brazzaville: World Health Organization, Regional Office for Africa, (Pp. 1-97).
6. Rickert, J. (2014). How patient-centered care is changing orthopaedics. Bone & Joint, 360, 3(1).
7. Swiontkowski, M. F., Buckwalter, J. A., Keller, R. B. & Haralson, R. (1999). The outcomes movement in orthopaedic surgery: where we are and where we should go. JBJS Am., 81(5), 732-740.