PATIENT’S CENTERED APPROACH

PENDEKATAN KLINIS BERORIENTASI PASIEN

DEFINISI PATIENT CENTERED

INTRODUCTION •  Caring •  Compassion •  Humanitarian care •  Real reason patient presented to doctor :

Set the stage for exploration of – The breadth of all patient problems :Physical,

social, or psychological – The depth, meaning of patient presentation

McWhinney, 1972

Patient’s Centered Care

•  Explores patient’s – Main reason for the visit – Concerns – Need for information

•  Seeks integrated understanding of patient’s world – The whole person – Emotional needs – Life issues

Patient’s Centered Care •  Finding common ground of what the

problems •  Mutually agrees on management •  Enhances preventing and health promotion •  Enhances continuing relationship between

patient and doctor

Stewart, 2001:445

Patient Centered Clinical Methods

•  Every patient who seeks help has expectation, based on his or her understanding of the illness

•  Understanding the patient’s expectation, thoughts, feelings, and fear is specific for each patient biological and behavioral science

•  Allow as much as possible to flow from the patient, including expression of feeling

•  Attentive listening •  Responsive to those verbal and non verbal

cues

Patient Centered Clinical Methods

•  Ascertain patient’s expectation – Knowing why the patient has come

•  Understanding patient’s feeling •  Make of exclude clinical diagnosis •  Listen to the patient’s story •  Seek common ground – mobilize the patient’s own power of healing

•  Monitor your own feeling

Tn. R, datang untuk konsultasi hasil lab profil lemak yang cukup tinggi

DISEASE EXPERIENCE •  CAD •  Previous MI •  Post CABG •  Hiperkolesterolemia •  Rule out depression

UNDERSTANDING PATIENT’S EXPERIENCE OF ILLNESS

•  Ideas –  Sees himself as disables

•  Feelings –  Fears of another MI or

even death •  Expectation

–  Know how to deal with the diet

•  Function –  Returned to work –  No exercise

Patient Centered Clinical Methods

•  To be patient centered, practitioner must be able to : – Empower the patient – Share the power in the relationship – Balance between the subjective and objective – Bringing together of the mind and the body

HOLISTIC CONCEPT

Six interactive components of the patient centered process

1. Exploring both disease and illness experience

2. Understanding the whole person – The person : life history, personal, and

developmental issues, life style – The environment : family, occupation, social-

economy support – The culture

3. Finding common ground mutual decisions –  Problems and priorities – Goals of the treatment and management – Roles of patient and doctor

Six interactive components of the patient centered process

4. Incorporating prevention and health promotion – Health enhancement – Risk avoidance – Risk reduction – Early identification – Complication reduction

Six interactive components of the patient centered process

5. Enhancing doctor-patient relationship – Compassion – Power of healing – Self awareness

6. Being realistic – Time – Team building and team work – Using all the resources wisely

Eksplorasi data ? Informasi kesehatan tentang apa?

Spesifik terhadap keluhan (30’)

SHARING INFORMATION TO OTHERS

•  Bertemu pasien di poli puskesmas atau kdk : – Alasan kedatangan – Anamnesis RPS, RPD, RPK – Anamnesis Lingkungan, Riwayat sosial, Pekerjaan

(saat ini dan sebelumnya), Kebiasaan, dan Gaya hidup

– Pemeriksaan fisik : BB/TB, tanda vital, status generalis, status lokalis

– (Pengkajian masalah kesehatan) – Diagnosis holistik – Rencana tatalaksana : farmako – non farmako

(EBM)  Alasan dilakukan pembinaan  Tujuan pembinaan

Keluhan Berkaitan Okupasi •  Jenis pekerjaan (saat ini dan sebelum) •  Bahan/material yang digunakan (saat ini

dan sebelum) •  Tempat kerja (saat ini dan sebelum) •  Lama Kerja (saat ini dan sebelum) •  Uraian tugas pekerjaan saat ini •  Bahaya potensial (Fisik, Kimia, Biologi,

Ergonomi, Psikologi)

Keluhan Berkaitan Okupasi •  Gangguan kesehatan yang mungkin

terjadi pada tiap-tiap bahaya potensial •  Risiko kecelakaan kerja yang dapat

terjadi •  Hubungan pekerjaan dengan keluhan

yang dialami saat ini •  Pemeriksaan khusus : – Body Discomfort Map – Brief Survey – Stress Diagnosis Survey (SDS)

HOLISTIC DIAGNOSIS •  Reason for Encounter, Fear, Expectation

•  Clinical Diagnosis / WD / DD

•  Patient’s behavior &/or mental psychological problems of the patient

•  Family/Environment’s problems

•  Functional Status

Diagnosis Okupasi •  Menentukan diagnosis klinis •  Menentukan pajanan yang dialami tersebut dalam

pekerjaan •  Menentukan apakah ada hubungan antara pajanan

dengan penyakit/keluhan •  Menentukan apakah pajanan yang dialmi cukup

(dose response relationship) •  Menentukan apakah ada faktor individu yang

berperan •  Menentukan apakah ada faktor lain di luar

pekerjaan •  Menentukan PAK / bukan PAK

FUNCTIONAL STATUS

•  1 = No difficulty at all •  2 = Started to have difficulties •  3 = Several difficulties •  4 = Lots of difficulties •  5 = No activity at all

Pembinaan •  Identifikasi Kualitas Kehidupan Keluarga : – Struktur anatomi keluarga

•  Profil keluarga satu rumah •  Genogram •  Bentuk keluarga •  Siklus kehidupan keluarga

– Fungsi keluarga •  Biologi •  Psikologis family map •  Sosial •  Ekonomi dan pemenuhan kebutuhan •  Adaptasi

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Keluarga Orang Tua Tunggal

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Pembinaan •  Identifikasi Faktor lainnya : – Gaya hidup – Kebersihan pribadi / hygiene – Kualitas asah-asih-asuh – Reproduksi (KB, menarche, menopause,

GxPxOx, riwayat melahirkan > 4 kg – Pemenuhan gizi keluarga – Perilaku pencegahan – Pemanfaatan fasilitas yankes – Lingkungan rumah

Pembinaan

•  Identifikasi lingkungan pekerjaan (bila pasien atau salah satu anggota keluarga memiliki keluhan berkaitan dengan pekerjaan) – Pemeriksaan fisik lengkap sesuai status

okupasi – Identifikasi potensial hazard : biologi,

kimia, fisik, ergonomi, psikis – Identifikasi risiko kecelakaan kerja – Rekomendasi pengobatan dan pencegahan

Identifikasi Masalah

•  Masalah keluarga berdasarkan fungsi keluarga

•  Masalah kesehatan berkaitan dengan pekerjaan

Management Penatalaksanaan

Rencana Intervensi •  Content EBM •  Sasaran •  Coping score awal •  Hasil yang diharapkan •  Waktu

•  Follow up

Hasil Intervensi •  Content •  Coping score akhir •  Kesimpulan akhir

pembinaan •  Faktor pendukung-

penghambat •  Rencana penatalaksanaan

selanjutnya (bila diperlukan)

•  Diagnosis holistik pasca pembinaan

FOLLOW UP VISIT

-  Complaint ? -  Physical condition ? -  Other organ function ? -  Psychological condition ? -  Diet, exercise, compliance ? -  Self care ? -  Family and social interaction ? -  Functional in the family and community ? -  Use every minute of patient’s visit to give knowledge

prescription -  Always comparing social function before – after

intervention

SELF MONITORED AGENDA AND EMERGENCY ALERT AT HOME

-  Explain the importance of monitoring -  Timing : Monthly/Weekly, depends on the

complaint and the exist risk factor -  Healthy lifestyle, infection prevention,

detect the sign of emergency -  Gaining organ and social function, -  Diet and exercise habit -  Leisure activities

SELF MONITOR AGENDA AND EMERGENCY ALERT AT HOME

The agenda/log book is used by patient him/herself or the caregiver

Can be use also for other family member as early detection of disease

The next medical decision will be made by the doctor on the next patient’s visit

Ask patient to always bring the agenda/log book if he/she comes for control visit

ADDITIONAL INFORMATION

•  Diagnosis code (ICD 10 / ICPC 2) •  Well and readable written •  Good communication (verbal-non verbal) good rapport/relationship more data collected better management better compliance

•  Do not open any literature in front of the patient except MIMS

•  Use diagram/chart for ‘diagnosis flow”

ADDITIONAL INFORMATION

•  Neat, polite, and confidence performance •  Good cooperation with the local staff/

health provider/ cadre •  On time working hours •  Consultation time 10-15 minutes (may be

more) •  Use other room/home visit (if necessary)

to get more data collection

THANK YOU

Please use your time productively while working in primary care services..!