When does nonadherence indicate a deviation from patient-centered care?

• Published in: The American journal of managed care 2021-05, Vol.27 (5), p.e141-e144
• Main Authors: Langford, Aisha T, Kang, Stella K, Braithwaite, R Scott
• Format: Article
• Language: English
• Subjects: Accountable care organizations; Automation; Blood pressure; Chronic illnesses; Decision making; Diabetes; Electronic health records; Health administration; Health care; Hypertension; Language; Medical screening; Patient-centered care; Preferences; Quality improvement; Surveillance
• ISSN: 1088-0224; 1936-2692
• DOI: 10.37765/ajmc.2021.88635

Patient-centered care, defined as "providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions," is advocated by clinicians and professional organizations and is part of a composite criterion for augmented reimbursement for various health care settings, including patient-centered medical homes. Despite general agreement that patient-centered care is a good idea and worthy of incentivization, patient-centered care is difficult to assess accurately, scalably, and feasibly. In this commentary, we suggest that assessment of patient-centered care may be improved by identifying circumstances that indicate its probable absence-in particular, by flagging probable discordance between a patient's preferences and their treatment care plan. One potential marker of this discordance is persistent lack of control of a comorbid condition that is easily controllable by existing therapies and where existing therapies are sufficiently diverse to be compatible with a wide range of patient preferences (eg, stage 1 hypertension, type 2 diabetes with glycated hemoglobin