Much emphasis is placed today on the importance of putting patients first as exemplified by the common use of related terms, such as patient-centered care and shared decision-making. Application of these terms represents worthy objectives. Repeated often enough, however, such language may be equivalent to the reification of a metaphor, with the implication that objectives are being fulfilled satisfactorily, while the reality of the actual situation may suggest otherwise.
Patient-centered care is a term highlighted when the Patient Protection and Affordable Care Act (PPACA), more popularly known as Obamacare, became law in March 2010. A new care model in the form of Patient-Centered Medical Homes (PCMH) and establishment of a Patient-Centered Outcomes Research Institute (PCORI) were created by that landmark piece of legislation. Regarding the former, a declared outcome by the American Academy of Pediatrics in 2002 for the 21st century was that “every child deserves a medical home.” Although for more than a decade efforts to improve the health care experiences and outcomes of high-risk pediatric populations have centered on the redesign of health care settings to deliver PCMH care, results show that more work is needed to reach fruition.
According to an article published in the October 2018 issue of the journal Medical Care, just over one-third of children with special health care needs reported experiencing PCMH concordant care and there was high variation across components. Disparities in access to PCMH care also were significant from the perspective of children’s demographic characteristics, with minority children faring worse in access to this care compared with their white counterparts.
Although they do not always agree on bracketed years, demographers find utility in generating population categories based on age, producing the following kinds of groups by birth year: Post-War Cohort (1928-1945), Baby Boomers (1946-1964), Generation X (1965-1979), Millennials (1980-1994), and Generation Z (1995- 2015). Health professionals also may benefit to some degree as a result of this taxonomy by seeking and acquiring greater knowledge about and increased sensitivity toward members of these groups from the standpoint of being able to provide more appropriate, targeted kinds of care for them.
Regardless of age bracket, shared characteristics cut across each classification, such as religiosity, adherence to prescribed treatment, and patient resilience. Also, within each group, members can be differentiated on the basis of their individual outlook, how they experience pain, reliance on family support, and desire to return to a pre-health problem stage involving employment or leisure activities.
A particularly important attribute is affective behavior consisting of verbal and non-verbal displays of emotion, mood, and other feeling states that contribute to impression formation when patients and their health care givers interact with one another. Differences stemming from age, gender, and race/ethnicity may play a decisive role in determining just how effective that interaction will prove to be.
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