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Table 4 Issues related to health service encounters raised by chronically ill patients, and suggestions of patients, carers and health care professionals for overcoming them

From: A patient-centred approach to health service delivery: improving health outcomes for people with chronic illness

Challenges raised by participants Patients’ and carers’ suggestions HCP suggestions and solutions
•Communication and delivery of information  
Inadequate explanation of illness, prescribed medication and side effects HCPs provide patients with a written care plan in plain language Improvement of health literacy
Confusing and conflicting information provided Professional organisations endorse guidelines Better communication between different professional groups
Practical examples of appropriate diets and concepts not provided (e.g., Glycemic Index) NS NS
Lectures given by HCPs seem pointless More interactive learning experiences such as support groups Improved communication between patients and HCPs
No explanation given about the side effects of medication NS Enhanced information technology infrastructure
No help provided in accessing internet NS Enhanced information technology infrastructure
CALD participants want information in their own language GPs increase their awareness of cultural issues and exercise care in providing information to CALD patients Improved communication between professionals and CALD groups
HCP seen as inflexible and unaccommodating NS Need to improve accountability between service providers
Outdated information about disease management NS Enhanced information technology infrastructure
Insufficient information about community resources provided Provide access to relevant data bases Better co-ordination of care
Poor communication by interns Improved supervision by specialists before diagnosing conditions with a poor prognosis such as cancer Need to improve accountability between service providers
•Organisation of service delivery and waiting time to see HCP’s  
Arranging appointments in urgent situations On call doctors to give information and directions Need to reduce communication gaps
Arranging appointments when new symptoms appear Electronic booking systems Enhanced electronic infrastructure
Long waiting time to make appointments and delays in seeing HCPs Phone or SMS patients to inform them of possible delays Need to reduce communication gaps
Inflexible appointment times Greater flexibility NS
Rigid eligibility criteria which exclude some people from inpatient or outpatient care Revision of eligibility criteria of services to ensure they cover patients at different states of disease Need to improve communication between various service providers
•Facilitation of self care  
Insufficient support for self-care NS NS
Insufficient written information about what to do in different conditions Handbooks and disease specific information packages Enhanced communication
Insufficient follow up and monitoring of patient’s condition as well as new symptoms GP’s and case coordinators follow up, from hospital or private health insurance Need to improve co-ordination of care by service providers
•Single illness focus  
GPs and specialist focus only on the immediate symptoms and conditions Holistic approach to patient’s conditions with careful review of medical history Need to improve fragmentation of services
•Inclusion of patients and carers in decision making  
Lack of trust in patient’s knowledge and understanding of signs and symptoms NS Need to improve health literacy
Patients don’t feel hopeful and motivated about the future Provide up to date information and review of the latest developments in lay language Need to improve patients’ focus on management of conditions
Failure to ask patients about their tolerance of available treatments   Be sure to ask patients about any tolerance or compliance issues before prescribing medications
  1. HCP: Health Care Professional, NS: No suggestion, CALD: Culturally and Linguistically Diverse.