Speaker - Stefan Palkovits

Quality of care refers to how much a health service could enhance the likelihood of achieving desired outcomes. The World Health Organization defines quality of care as the extent to which a health service aims to improve the probability of reaching these outcomes. This concept was divided into six quality healthcare pillars: effective, evidence-based, safe, timely, equitable, integrated, efficient, and person-centered care. Effective treatment involved the application of evidence-based interventions, ensuring patient benefit while maintaining safety. Safe treatment was critical in all medical practices, and timely care was necessary, provided impartially regardless of a patient's gender, ethnicity, or socioeconomic background. Integrated care ensured that treatment was delivered within the healthcare system with minimal wait time for optimal outcomes. Efficient care refers to effectively utilizing available resources to maximize their impact. A high standard of care was achieved when patient preferences and values were considered. The new framework for person-centered care emphasized incorporating these preferences and values.

The traditional healthcare model, comprising doctors, nurses, technicians, and other healthcare professionals focusing on treating specific diseases, remains prevalent in modern clinical practice. This model emphasizes the roles of care providers and regulators, maintaining a disease-centered approach. However, there is a growing need to shift towards a patient-centered approach, where the patient is at the core of care planning and outcome evaluation. This approach fosters greater patient autonomy and involves them in decision-making processes. As Susanne's study demonstrated, patient-reported outcome measures highlighted a disparity between clinical and patient-reported outcomes. While some patients exhibited favorable clinical results, such as improved visual acuity and controlled intraocular pressure, others with similar clinical success reported dissatisfaction and more challenging outcomes.

Patient-centered care has varying definitions and approaches across different institutions and societies. However, the "four C's"—culture, coordination, communication, and collaboration—capture the essential aspects of this approach. Culture emphasizes respect for patient and family preferences, including risk-benefit assessments, cultural traditions, and socioeconomic circumstances. This cultural sensitivity ensures that care aligns with each patient's unique needs. Collaboration refers to the teamwork among healthcare professionals, patients, their families, and colleagues within and across clinical settings. Effective collaboration ensures that patient care is holistic and addresses medical needs and social and emotional aspects. Coordination of care is crucial to guarantee smooth transitions, safe transportation, and accessible, feasible treatment plans. It involves organizing all aspects of care to ensure seamless delivery, reducing the risk of errors and inefficiencies. Communication is a cornerstone of patient-centered care. Healthcare providers must share information promptly and transparently. Techniques for effective communication include active listening, maintaining eye contact, and asking open-ended questions. However, screen time during consultations often detracts from patient interaction. To address this, healthcare providers should prioritize face-to-face conversations, fostering a deeper understanding of patient concerns. Collaboration, which involves working with patients and their families, is critical to ensuring shared decision-making. Patients are partners in their care and expect healthcare professionals to treat them with dignity, respect, and compassion. For example, in a glaucoma clinic, a patient with elevated intraocular pressure may initially opt for surgery but, after discussing all treatment options with the physician, may express a preference against it, saying, "Doctor, I don't want surgery at all." Respecting patient decisions is fundamental. Involving family members during consultations can also enhance decision-making, ensuring the patient's preferences are understood and met. This collaborative approach strengthens the relationship between healthcare providers and patients, ensuring that care is effective and aligned with the patient's values.

The benefits of patient-centered care in medicine include patient empowerment, shared decision-making, and increased patient and family satisfaction. However, several barriers can impede the implementation of this approach, such as time constraints, staff shortages, language differences, and educational gaps. Effective communication is essential to overcome these challenges, ensuring patients fully understand the information. Additionally, cultural differences may contribute to a more task-oriented approach in medical practice, sometimes overshadowing patient-centered goals. The literature on patient-centered care within ophthalmology notes that many consultations remain clinician-centered, particularly when addressing intraocular pressures (IOPs). These approaches are appropriate for straightforward conditions like corneal foreign bodies, where treatment plans are simple and easily communicated. However, chronic diseases such as glaucoma, macular degeneration, and dry eye syndrome pose greater challenges. Adopting a patient-centered approach can improve outcomes by involving patients in their care and tailoring treatments to their needs. In complex scenarios, such as refractive surgery correction for presbyopia or other refractive procedures, involving patients in decision-making becomes even more critical.

Glaucoma is a chronic condition that requires a long-term commitment to IOP reduction to minimize the risk of visual impairment. A key issue in glaucoma management is the lack of symptoms in the early stages, which leads to a low perceived severity among patients, which often reduces motivation to adhere to treatment or attend follow-up appointments. Additionally, low levels of patient knowledge exacerbate the problem. Studies have shown that 13% of patients are unaware of the purpose of their eye drops, which are designed to lower IOP and prevent blindness. Moreover, one in four patients cannot recall the name of the drops they use daily. To improve long-term adherence to glaucoma therapy, patient-centered strategies are crucial. These include intensive education about glaucoma, patient-centered communication techniques, and shared medical appointments. Such approaches have increased patient knowledge, satisfaction, and understanding of the disease. Specifically, patient-centered communication techniques have proven effective in improving the detection rate of non-adherence to therapy from 25% to nearly 80%. In the context of refractive cataract surgery, employing different methods for obtaining informed consent, such as videos or interactive tools, can help reduce patient anxiety and enhance satisfaction. Managing patient expectations and prioritizing their satisfaction over the mere delivery of services is essential. A recent study assessing the effectiveness of shared decision-making (SDM) in lens selection for cataract surgery found that higher patient education and preparation levels were associated with better outcomes. The study used a nine-item questionnaire (SDM Q-9), which revealed a positive correlation between patient preparation and higher SDM Q-9 scores, indicating a more successful decision-making process. 

The traditional and patient-centered approaches each offer advantages for patients and healthcare providers, but the patient-centered approach requires additional time and a deeper respect for patient preferences, which is particularly important for managing chronic conditions such as glaucoma, cataracts, age-related macular degeneration, and dry eye syndrome. Shared decision-making is critical in ensuring long-term treatment adherence and successful follow-up in these cases. The study underscored the importance of incorporating patient-reported outcome measures in clinical studies, emphasizing the need to place patients at the center of care. 

42nd Congress of the European Society of Cataract and Refractive Surgeons, 6 – 10 September 2024, Fira de Barcelona, Spain.