Patient-Centered Primary Care

Book excerpt: There have been great strides made in designing the administrative structures of patient-centered care, but it is still difficult to design truly patient-centered clinical routines that the entire healthcare team can enact. The kind of partnership, in which patients are fully part of the team that guides their own care, goes against so much of the training and socialization of health professionals and, for that matter, the expectations of many patients. This is particularly true for patients we sometimes call “complex.” In other contexts, we call them “high utilizers,” “disadvantaged,” “heartsink patients,” or “people with trauma histories.” Blount calls them “multiply-disadvantaged” patients. To successfully serve these patients requires our best versions of team-based care, including behavioral health and care management team members, though every member of the team needs help in engaging these patients and mutual support in adapting to the rapid changes in roles that new team approaches are creating. This book offers a summary of the approaches that are currently in growing use, such as health literacy assessment, motivational interviewing, appreciative inquiry, shared decision making, minimally disruptive care, trauma informed care, enfranchisement coaching, relationship-centered care, and family-informed care. Finally, it offers a transformative method, based on familiar elements, that is Transparent, Empowering, Activating, and Mutual: the T.E.A.M. Way.