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, socialeconomy 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
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jody

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anita

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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

Hasil Intervensi

Content
Coping score akhir
Kesimpulan akhir
pembinaan
Faktor pendukungpenghambat
Rencana penatalaksanaan
selanjutnya (bila
diperlukan)

Follow up
Diagnosis holistik pasca
pembinaan

FOLLOW UP VISIT
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-
-
-
-
-
-
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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..!