REVIEW

Patient-centered care and adherence: Definitions and

applications to improve outcomes
Janice H. Robinson, MSN, FNP (MSN Graduate), Lynn C. Callister, RN, PhD, FAAN (Associate Professor), Judith A.
Berry, DNSc, APRN, FNP (Associate Professor), & Karen A. Dearing, PhD, APRN (Associate Professor)
College of Nursing, Brigham Young University, Provo, Utah

Keywords
Patient-centered care; adherence; patient
involvement; patient perspective.
Correspondence
Janice H. Robinson, MSN, FNP, College of
Nursing, Brigham Young University, 400 SWKT,
Provo, UT 84602
Tel: 801-762-7472; Fax: 801-422-0536;
E-mail: janicehrobinson@gmail.com
Received: August 2007;
accepted: January 2008
doi:10.1111/j.1745-7599.2008.00360.x
Abstract
Purpose: The implementation of patient-centered care (PCC) has been ham-
pered by the lack of a clear definition and method of measurement. The purpose
of this review is to identify the fundamental characteristics of PCC to clarify its
definition, propose a method for measurement of PCC, and recommend effective
PCC practices.
Data sources: Review of literature related to PCC, adherence and communication
from Cinahl, PubMed Academic Search Premier, and Cochrane Library databases.
Conclusions: Research has shown that patient-centered interactions promote
adherence and lead to improved health outcomes. The fundamental character-
istics of PCC were identified as (a) patient involvement in care and (b) the
individualization of patient care. The use of a numeric rating scale to measure the
presence of these characteristics allows quantification from the patient perspec-
tive. Effective PCC practices were related to communication, shared decision
making, and patient education.
Implications for practice: PCC is a measure of the quality of health care.
Understanding the characteristics of PCC facilitates its implementation and
measurement. Promoting PCC activities will improve adherence and encourage
patient responsibility for health status.

PCC improves communication, promotes patient involve-

Introduction
Patient-centered care (PCC) is recognized as a measure of
the quality of health care. Healthcare advocacy groups as
well as government and regulatory agencies are promoting
the use of PCC as a desirable component of quality health
care. Public funds are used for 44% of all healthcare
expenditures, with private insurance accounting for
36%, and consumers for 20% (National Center for Health
Statistics, 2005). Financial interests necessitate public and
private organizations take part in determining standards of
quality of care. While PCC is not a criterion for reimburse-
ment, it influences policies associated with credentialing,
licensure, medical education, and assessment of quality of
care (Epstein et al., 2005). In 2001, the Institute of Med-
icine (IOM) included PCC as one of the six essential aims of
the healthcare system (IOM, 2001a). Studies relate that
ment in care, creates a positive relationship with the pro-
vider, and results in improved adherence to treatment plan
(Agency for Healthcare Research and Quality [AHRQ],
2005; Anderson, 2002; Beck, Daughtridge, & Sloane,
2002; Stewart et al., 2000).
In spite of the reported benefits of PCC, there are prob-
lems in implementing its use. In the latest National Health-
care Quality Report by the AHRQ (2005), PCC was
reportedly always used in only 45%62% of patient
encounters. Patient-centeredness was always or usu-
ally evident in 89% of total encounters, with 6%18% of
patients reporting they have never experienced PCC.
There is variation of almost 12% between surveyed groups
based on race, age, level of education, income, perceived
health status, and health insurance coverage. Of the
four dimensions of healthcare quality, patient safety

600 Journal of the American Academy of Nurse Practitioners 20 (2008) 600607 2008 The Author(s)
Journal compilation 2008 American Academy of Nurse Practitioners
J.H. Robinson et al.
demonstrated the greatest improvement of 10.2%, effec-
tiveness improved by 3%, while PCC and timeliness were
combined for a total rate of improvement of only 1.9%
when compared with measures from the previous year
(AHRQ, 2005, p. 4)
Some of the factors slowing implementation of PCC are
related to difficulty in changing traditional patterns of inter-
action (Ponte et al., 2003), perceptions of increased time and
cost (Bechel, Myers, & Smith, 2000), and vagueness about
what constitutes PCC (Mead & Bower, 2000). The inability
to define and measure patient-centeredness in a uniform
way seriously decreases its scientific utility. Finding ways to
overcome the barriers to PCC is important in improving the
quality of health care, increasing patient satisfaction, pro-
moting patient adherence, and advancing research.
Examining the relationship between adherence and
PCC can increase understanding of PCC and establish its
usefulness in clinical practice. Adherence is a key factor in
health promotion as well as cost-effective use of health
care. It is estimated that the cost of nonadherence is
approximately $300 billion a year (DiMatteo, 2004). In
addition to economic benefits, adherence contributes to an
improved quality of life and greater productivity (Thorpe,
2005). As clinicians, advanced practice registered nurses
(APRNs) can become caught in the daily routine and stress
of patient interactions and overlook the importance of
PCC. Understanding and utilizing PCC consistently in
clinical interactions aid the APRN in establishing a positive
patient relationship, which promotes patient satisfaction
and encourages adherence, ultimately improving patient
health status. Additionally, the focus of health care has
moved from a traditional model of paternalistic care by the
provider to one that involves more patient participation in
care. Understanding PCC allows the practitioner to facil-
itate that transition. The purposes of this review were
twofold: (a) to examine the literature to define PCC and
adherence and (b) to identify elements of PCC that are
effectively being used to improve treatment adherence.
Method
An electronic search was conducted to identify studies
from 2000 to 2006 in the following databases: CINAHL,
PubMed, Academic Search Premier (EBSCO), and
Cochrane Library. Search terms were adherence, PCC,
patient-centered communication, providerpatient rela-
tionship, healthcare communication, patient goals, and
compliance. References from all articles were reviewed for
additional relevant studies.
Inclusion criteria for this article focusing on PCC and
adherence include an adult population, aged 18 years and
older, and studies from the United States and Great Britain
published in English. Specific studies to be examined were
PCC and adherence
related to management of hypertension, hyperlipidemia,
diabetes, cardiac disease, and renal disease. Studies focus-
ing on the treatment of chronic disease were felt to be more
useful in determining the effectiveness of the intervention
on adherence because treatment of chronic illness requires
more patient involvement with the management of mul-
tiple interventions. Chronic care also provides the practi-
tioner more opportunity for interaction with the patient to
work on adherence issues. Successful adherence would be
evidence of effective, patient-centered interactions.
Articles related to psychiatric interactions, HIV/AIDS, and
end-of-life care were excluded because of increased psy-
chosocial implications. Studies pertaining to short-term
adherence were excluded because they would not reflect
persistence in the maintenance of long-term adherence.
Results
Definition of PCC
Patient-centeredness has its roots in holistic health care
and is a shift from the traditional disease-oriented model
(Epstein, 2000). Its popularity began to increase in the
1970s, coming to prominence as healthcare organizations,
institutions, and public agencies have more recently
endorsed patient-centeredness. Given the interest in
PCC, efforts to define and measure the outcomes of PCC
have become more important. The definition of PCC varies
depending upon the setting or perspective being repre-
sented. An examination of the literature revealed four
sources of definitions for PCC. These include a public
policy perspective, an economic perspective, clinical per-
spective, and patient perspective.
PCC and public policy perspective
The IOM defines PCC as a partnership among practi-
tioners, patients, and their families (when appropriate) to
ensure that decisions respect patients wants, needs, and
preferences and that patients have the education and
support they need to make decisions and participate in
their own care (IOM, 2001b, p.7). This definition is used
by the Agency for Healthcare Research and Quality
(AHRQ), which measures healthcare quality in the United
States. This position regarding patient-centeredness helps
shape the vision of health care, provides the basic concepts
for building a quality healthcare system, and is the foun-
dation of other definitions of PCC.
PCC in economic perspective
Another definition of PCC examines the patient as
consumer in the healthcare environment. A consumerist
view, or patient-centered view, recognizes the patients
ability to make informed healthcare choices that balance
601
PCC and adherence
cost, quality, convenience, and other service characteristics
(Robinson, 2005). Greater media coverage of healthcare
issues, direct-to-consumer marketing of pharmaceuticals,
and Internet access to information has influenced the role
patients now have in the relationship with their healthcare
provider. Patients are now more actively involved in a rela-
tionship of shared decision making and empowerment
(Dontje, Corser, Kreulen, & Teitelman, 2004). Patients,
using information from multiple sources, now look to the
provider to supply care based on patient wants. This results
in PCC that resembles a supply and demand model of care.
The concept of managed consumerism in health care looks
to balance these two components, supply of services by
providers with the demands of patients (the PCC compo-
nent), and is the goal of a market-oriented health policy
(Robinson).
The Economic and Social Research Institute (ESRI)
disputes the idea that consumer-driven care is PCC. The
focus of PCC is on meeting the patients needs rather than
simply providing diagnostic services and advice without
support for following recommendations (ESRI, 2006). It is
argued that patient-centeredness means putting the
patient at the center of the healthcare system not balancing
two economic interests. Patient-centeredness involves
more than meeting consumer demands and is more than
just giving the patient what is wanted or asked for. Alter-
natively, PCC recognizes the values, needs, and wants of
the patient. Patient expectations of health care include
consumer-minded factors regarding the time, cost, and
quality of care. These patient values need to be addressed
as part of PCC.
PCC defined from a clinical practice perspective
In the clinical setting, the patientprovider relationship
historically has been controlling or paternalistic in nature
(Teutsch, 2003). Traditional practice with a provider-
centered focus of delivery meant patients received care
without regard to their preferences. An early definition of
PCC referred to the providerpatient relationship as one
that integrates the patient perspective and preferences
while involving the patient in decision making and self-
care (Gerteis, Edgman-Levitan, Daley, & Delbanco, 1993).
Stewart et al. (2000) defined PCC as providing a relation-
ship that focuses on the well-being of the individual.
Additionally, the psychosocial context and the patients
experience of the illness should be integrated into the pro-
cess (Stewart et al., 2000). PCC recognizes the belief that
healing involves knowing the patient as a person while
accurately diagnosing his or her illness (Epstein, 2000).
The terms patient-focused, patient-based, and patient-
centered are used by Bechel et al. (2000) to distinguish
different aspects of implementing the patient perspective.
The three terms are used to describe tailoring treatment to
602
J.H. Robinson et al.
patient needs, setting patient goals based on patient pref-
erence, and increasing the humaneness of care. Activities
to achieve these goals include involving the patient in
treatment decisions, improving patientprovider commu-
nication, and including family members in care.
PCC from the patient perspective
Patient perspective is essential in defining patient-cen-
teredness. While a formal definition of PCC from a patient
perspective has not been developed, research has identi-
fied patient preferences for healthcare interactions. Patient
priorities for care include the following characteristics:
respect, courtesy, competence, efficiency, patient involve-
ment in decisions, time for care, availability/accessibility,
information, exploring patients needs, and communica-
tion (Jennings, Heiner, Loan, Hemman, & Swanson, 2005;
Wanzer, Booth-Butterfield, & Gruber, 2004; Wensing,
Jung, Mainz, Olesen, & Grol, 1998). A survey of patient
preferences in the primary care setting determined that
communication, partnership, and health promotion were
the most important patient needs, particularly among
patients with psychosocial issues or who were symptom-
atic (Little et al., 2001). Additionally, a study by Jennings
et al. showed that patients want to be treated respectfully,
with competence, and given information to create a more
patient-centered healthcare system.
Measurement of PCC
Measurement of PCC has generally been conducted
through the use of patient questionnaires reporting the
patients perception of PCC practices or patient satisfaction
with the interaction. This was the method used in the
National Healthcare Quality Report which asked patients to
respond to survey questions related to: (a) the provider
listens carefully, (b) the provider explains things clearly,
(c) the provider respects what the patient has to say, and
(d) the provider spends enough time with the patient
(AHRQ, 2005). The questions focused on the use of
patient-centered communication as well as examining
time as a component of PCC. Patient surveys have weak-
nesses because of variations in perceptions of terminology
and limitations in understanding responses. A patient may
respond that the provider listens carefully but that does not
identify what constitutes listening carefully.
The other method generally used to determine the pre-
sence of patient-centeredness is analysis of taped patient
provider interactions. Focusing on patientprovider commu-
nication patterns alone has not correlated with health out-
comes or the determination of the presence of PCC
independent of patient perception (Epstein, 2000; Howie,
Heaney, & Maxwell, 2004). The patients perception is the
most reliable measure of patient-centeredness regardless of
J.H. Robinson et al.
the analysis of the communication pattern. A study by
Stewart et al. (2000) found a difference in health outcomes
based on patient-reported perception of patient-centeredness
versus the use of audiotapes to identify patient-centeredness.
Diagnostic tests and referrals were one half as frequent if the
visit was perceived to be patient-centered as reported by
the patient when compared with those based on the use
of audio-taped interviews alone. Essentially, the patient is
the sole determinant of patient-centeredness. Although
observable characteristics may indicate the presence of
a patient-centered interaction, unless that is the patients
perception, it really is not patient-centered (Stewart, 2001).
Effortstomeasuretheeffectivenessofpatient-centeredness
using direct health outcomes such as lipid levels, body mass
index (BMI), hemoglobin A1c (HgbA1c) levels, and blood
pressure have provided inconclusive results (Kinmonth,
Woodcock, Griffin, Spiegal, & Campbell, 1998). Difficulties
in methods for measurement include measures that are not
appropriate, are poorly designed, and lack reliability and
consistency (Howie et al., 2004). Franks et al. (2005) also
point out the limitations of measuring effectiveness based on
patient satisfaction because of patient confounding.
Definition of adherence
Adherence and compliance have previously been used
interchangeably to refer to a patients efforts to follow
healthcare advice. The term compliance was initially de-
fined as the extent to which a persons behavior (in terms
of taking medications, following diets, or executing life-
style changes) coincides with the clinical advice (Sackett
& Haynes, 1976, p. 11). Compliance suggests that the
patient obeys or conforms to the providers instructions
without regard to the patients independence, autonomy,
and ability to take an active role in their health care (Lutfey
& Wishner, 1999). There is a connotation of control that
condemns a patients behavior as flawed for the inability
to conform to treatment. When a providers healthcare
goals are not met, the patient is labeled as noncompliant
and treatment goals lowered, to the detriment of patient
health (Lutfey & Wishner). An important aspect of adher-
ence is recognizing the patients right to choose whether or
not to follow treatment recommendations. The difference
between refusal of treatment and nonadherence is the
patients involvement in the decision-making process.
Nonadherence occurs only if the patient does not follow
treatment recommendations that are mutually agreed
upon (Resnik, 2005).
Adherence focuses more on patient involvement and
the patientprovider relationship. The term adherence is
preferred as having a broader interpretation and under-
standing of factors that affect a patients ability to follow
treatment recommendations. Because of these factors,
PCC and adherence
adherence is seen as being more patient-centered than
compliance (Vlasnik, Aliotta, & DeLor, 2005).
Measurement of adherence
Like PCC, adherence is difficult to measure because of
confusing terminology and the use of different methods of
measurement with variable degrees of reliability. Direct
measures are considered more accurate and involve ob-
servable data such as blood or urine testing. Indirect meas-
ures are less reliable and include pill counts, diaries,
pharmacy refill records, and outcome measures such as
blood pressure and weight change. Self-report, surveys,
questionnaires, interviews, and physician estimate are sub-
ject to errors of over- or underestimation (Bartels, 2004;
Vermeire, Hearnshaw, Van Royen, & Denekens, 2001).
The accurate measurement of adherence serves two
purposes. First, it is important as a means of motivating
patients to continue adherence. Second, it is also impor-
tant in determining the efficacy of prescribed treatment.
The question of the appropriateness of treatment remains
unclear if it has not been implemented correctly.
Patient-centered practices to improve adherence
Multiple variables have been examined without strong
correlation or predictive value of adherence. Findings are
inconsistent whether social class, age, sex, marital status,
education, and disease factors influence adherence (Lutfey
& Wishner, 1999; Vermeire et al., 2001). Differences in
patient values and perceptions account for some of this
variability. Practical issues of time, money, transportation,
physical or mental handicaps, difficulty managing the
healthcare system, poor communication, and unpleasant
side effects also contribute to nonadherence (Popa-Lisseanu
et al., 2005; Resnik, 2005). The factor that appears to most
strongly correlate with adherence is the patients own
beliefs influenced by personal knowledge and experience
as well as that of family and friends (Vermeire et al.).
Understanding the patient perspective allows the provider
to give treatment options congruent with patient needs and
values. A patient-centered approach is essential to promot-
ing adherence. Elements of patient-centeredness applied to
adherence include communication, shared decision mak-
ing, and support for self-management.
Communication
Communication skills are considered to be as important
as the providers technical skills in providing quality health
care (United States Department of Health and Human
Services, Office of Disease Prevention and Health Promo-
tion, 2000). A great deal of research has focused on com-
munication, particularly patient-centered communication.
Two aspects of communication that are of interest to PCC
603
PCC and adherence
are the impact of provider style on the patientprovider
relationship and the issue of time for the patient visit.
Provider styles that are based on using open-ended
questions, paying attention to patient concerns, and allow-
ing patients the time to express themselves are considered
patient-centered (Howie et al., 2004). Maintaining
patient-centered communication throughout the visit
appears to be problematic. In looking at provider styles
that were informational or controlling, researchers found
that most providers used an informational style that
became a controlling style when making decisions and
planning patient care (Lawson, 2002). Patient satisfaction
with provider style also varies with the type of visit.
Patients with simple complaints preferred a directing style,
while those with chronic illness preferred a sharing (or
patient-centered) style (Mead & Bower, 2000).
Another focus of PCC is time spent with the patient. The
patient perception of enough time with the provider is
more directly related to having patient needs addressed
than actual amount oftimeinthe visit.Mechanic, McAlpine,
and Rosenthal (2001) found that the time of a healthcare
visit has actually increased by 12 min in the past 10 years.
The perception of a shorter provider visit may be because of
compressing more information into the visit. Female physi-
cians spend almost 2 min more time with patients and are
more positive, attend to more psychosocial issues, and are
more active in listening. There was no difference in patient
satisfaction or report on health outcomes related to in-
creased time of healthcare visit (Roter & Hall, 2004). Using
enough time to understand and meet patient needs, not
a specified amount of time, is the critical determinant of
effective patientprovider communication.
Communication is essential in establishing a high-quality
patientprovider relationship. In turn, the quality of the
patientprovider relationship is a key factor in improving
adherence (Harmon, Lefante, & Krousel-Wood, 2006).
Healthcare education needs to provide greater emphasis
on the development of communication skills. The ESRI
(2006) suggests an examination of nursing curricula to
identify methods for teaching PCC communication techni-
ques. Currently, the effectiveness of nursepatient commu-
nication has not been established.
Shared decision making
Understanding the patients goal in treatment will
increase the probability of adherence. The patient may be
concerned about issues related to symptom management,
side effects, cost, quality of life, and complexity of treatment
(Vermeire et al., 2001). Providing options allows the patient
to address concerns and choose a treatment that reflects his
or her ability and propensity to adhere to treatment.
Shared decision-making enables the provider to identify
barriers to adherence and offer solutions that incorporate
604
J.H. Robinson et al.
the patient perspective (Harmon et al., 2006). Patient
involvement in care can be affected by cultural differences,
age, level of education, gender, and socioeconomic status
(Popa-Lisseanu et al., 2005; Street, Gordon, Ward, Krupat,
& Kravitz, 2005; Tennstedt, 2000). Methods to improve
patient involvement involve teaching the patient what to
do, assessing the patients ability and resources to follow
treatment, and understanding the patients attitude
toward treatment (DiMatteo, 2004).
Patient-centeredness should not exclude the promotion
of evidence-based practice by the provider. If health care is
more than just giving the patient what is wanted, then care
must integrate both evidence-based and patient-centered
approaches (Sidani, Epstein, & Miranda, 2006). Methods
to achieve the complementary use of both concepts
include identification of effective interventions, presenta-
tion of pros and cons of treatment options, and incorpo-
ration of patient preferences for treatment (Coyler &
Kamath, 1999).
Support for self-management
Patient education alone has been largely ineffective in
improving adherence. When combined with other inter-
ventions, education does enable a patient to participate
more effectively in managing care (Roter et al., 1998). The
need for education is especially important for patients
living with chronic conditions. Complexity of treatment
is a factor in poor adherence. Education combined with
timely follow-up visits, progress reports, and psychosocial
support have produced positive results (Davidson, 2005;
Mason, 2005).
Education methods involve patientprovider interac-
tion, non face-to-face communication, and disease man-
agement programs. The patientprovider interaction
should be understandable, at the level of interest of the
patient, and focus on what the patient needs to know
rather than teaching the patient what the provider knows
(Lowes, 1998). Almost one half of the adults in the
United States cannot understand and apply health infor-
mation because of low literacy levels (Nielsen-Bohlman,
Panzer, & Kindig, 2004). The use of analogies or visual
displays of information can help improve understanding.
Non face-to-face communication methods are useful
to educate, motivate, remind, reinforce, and respond
to patient concerns. These include print, Internet, and
telephone interactions (Hughes, 2003). Disease man-
agement programs provide education from a variety of
different health professionals to assist in the daily man-
agement of chronic illness. They are often offered
through medical centers or health systems. Patients par-
ticipating in these programs have improved health out-
comes, greater self-efficacy, and improved quality of life
(Sweet, 2004).
J.H. Robinson et al.
Discussion
Understanding PCC
The primary difference between PCC and the biomed-
ical, or traditional, healthcare model is the providers focus
on the patient versus the health concern or problem. In
a traditional model, the focus is on treating the condition,
resulting in the provider taking responsibility for care of
the problem, consequently taking care of the patient. In
PCC, the patient maintains responsibility for his or her
health care with help from the provider. This is a funda-
mental principle of PCC that has not been addressed in the
literature.
Definition and measurement of PCC
Attempts to define PCC have resulted in multiple terms
and descriptions often obscuring the core concepts. Table 1
provides the descriptors from definitions of PCC from the
four sources of PCC perspective addressed earlier (i.e.,
public policy, economic, clinical, and patient perspective).
The descriptors have been classified into two categories
that represent fundamental principles of PCC. As Table 1
shows, the various definitions of PCC condense into the
two concepts of (a) a patientprovider relationship that
promotes patient involvement and (b) care that individu-
alizes patient treatment. Simply defined, PCC promotes
patient involvement and individualization of care.
Because a major focus of PCC is patient perspective,
measurement of PCC should be based on patient percep-
tion of PCC. An approach similar to using a numeric rating
scale (NRS) to measure a patients pain may be useful in
measuring PCC. Pain has been defined as being a personal
and subjective experience (Katz & Melzak, 1999). PCC
could also be viewed as being a personal and subjective
experience. Using an NRS can help determine the degree of
involvement or personalization of care from the patient
perspective.
Figure 1 provides an example of using an NRS to quan-
tify the degree of PCC. The two components of PCC, patient
Table 1 Categorization of PCC descriptors from four definitions
Public policy definitions Economic definitions
Patient involvement Partnership Shared decision making
Education Empowerment
Participation in care
Participate in decisions
Individualized care Respect for patient Patient demand for cost,
wants needs, and preferences quality, convenience,
and other concerns
PCC and adherence
involvement and personalization of care, would be rated
independently on an NRS scale of 05. Combining those
two scores would then determine the level of PCC on
a scale of 010. The use of such a tool would provide
feedback, from the patient perspective, in a clinical setting
as well as enable quantitative research into the correlation
between PCC and adherence.
Definition and measurement of adherence
The definition of adherence while similar to compliance
must include the patient perspective. Adherence can be
defined as a patients efforts to follow treatment recom-
mendations that are mutually agreed upon. This acknowl-
edges the patients ability to participate in making
healthcare decisions.
Measurement of adherence must reflect the patients
efforts to adhere to treatment. Although less reliable, the
most valid measurement of adherence would be those
measures that track patient behavior, such as pill counts,
weight change, or interviews. Conversely, direct meas-
ures, while preferred for reliability, lack validity if a corre-
lation between the proposed treatment the patient adheres
to and the outcome is not established. For example,
a patient with type 2 diabetes agrees to lose 30 pounds
to achieve an HgbA1c level of 7.0. In spite of losing the
weight, the HgbA1c level is above 7.0. The patient was
100% adherent with their behavior but appears nonad-
herent based on the outcome of the direct measure of
HgbA1c level. In this example, the efficacy of a specific
weight loss to a specific HgbA1c is not established and
therefore should not be linked to a measure of adherence.
PCC and adherence
Adherence is an outcome of PCC but is often addressed
in the same manner as compliance, with provider expect-
ations that patients will follow prescribed treatment based
on the traditional delivery of health care. Communication
is critical in both facets of patient involvement and per-
sonalization of care. The provider must thoughtfully
Clinical practice definitions Patient definitions
Self-care Involvement in treatment
Patient goals Information provided
Family Involvement Partnership
Psychosocial experience Respectful treatment
Knowing patient Time for care
Tailoring treatment Communication
Humane care Patient as priority
Communication Accessible care
605
PCC and adherence J.H. Robinson et al.

1. Degree of patient involvement in care

0 1 2 3 4 5
No Mod. Involvement Shared Decision Making
Involvement Clearly understands care
Maximal support for patient

2. Degree of individualized care

0 1 2 3 4 5
Standardized care Some Care reflects personal
No personalization Personalization needs, wants and preferences

3. Combined patient involvement/individualized care scores---PCC score

0 1 2 3 4 5 6 7 8 9 10
No PCC Moderate PCC Maximal PCC
(Low potential (Moderate potential (Strong potential
for adherence) for adherence) for adherence)

Figure 1 NRS for PCC: A combination of patient involvement and individualized care ratings.

organize time with the patient to effectively meet diag-
nostic, psychosocial, and educational needs of the patient.
Provider education for the patient as well as supplemental
resources such as non face-to-face communication and
community or healthcare programs can improve a
patients involvement in adherence. Providers also sup-
port patient adherence by identifying individual patient
circumstances that are barriers to adherence and tailoring
treatment to those needs.
Conclusions
The purpose of PCC is to improve the quality of health.
Developing a concise definition of what is or is not patient-
centered can help in determining appropriate methods to
implement PCC in both clinical practice and for research
purposes. PCC involves enabling patient responsibility for
health care by promoting patient involvement and indi-
vidualization of patient care.
Providers need a method to measure the patients per-
ception of the providerpatient interaction in order to
improve the quality of that interaction. A provider may
be more patient-centered with some patients than others
or may believe their actions are patient-centered when
they are not perceived that way by the patient. The method
used to assess PCC needs to be simple and understandable
to the patient. Use of an NRS individualizes the assessment
of PCC, making it an invaluable tool in research and
clinical practice. A pilot study to determine the effective-
ness of an NRS in determining the level of PCC and its
correlation to reported adherence would establish the
utility of such a tool. Assuming a high level of PCC
corresponds to a high level of adherence, specific outcomes
that rely on adherence, such as blood pressure control,
could be investigated to determine if improved PCC con-
tributes to improved outcomes.
Research in the implementation of PCC is needed as well
to identify methods for improvement in communication,
patient education, shared decision making, and support for
patient needs. PCC is a key factor in improving the quality
of health care, increasing patient adherence, and eventu-
ally reducing healthcare costs. Efforts to improve its imple-
mentation in practice will benefit the patient, the provider,
and the healthcare system.
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