Post on 06-Mar-2016
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PATIENTS 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
Patients Centered Care
Explores patients Main reason for the visit Concerns Need for information
Seeks integrated understanding of patients world The whole person Emotional needs Life issues
Patients 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 patients 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 patients expectation Knowing why the patient has come
Understanding patients feeling Make of exclude clinical diagnosis Listen to the patients story Seek common ground mobilize the patients 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 PATIENTS 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
Patients behavior &/or mental psychological problems of the patient
Family/Environments 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
FUNGSI PSIKOLOGIS mike ibu ayah
anita barbie
jody
mike ibu ayah
anita barbie
jody
mike ibu ayah
anita barbie
jody
Keluarga Inti
Keluarga Extended
atau
Keluarga Majemuk
atau
Keluarga Orang Tua Tunggal
Keluarga Pasangan Lansia
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 patients 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 patients 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..!