Bridget L. Ryan

Purposes: We explored the experience of older adults living with multimorbidity during the COVID-19 pandemic. Methods: Using a phenomenological approach, we conducted semi-structured interviews with 17 participants aged 50 years and older living with multimorbidity. Data collection and analysis were iterative using a thematic approach. We explored participants’ overall pandemic experience as well as querying specifically about pandemic experiences of social isolation, coping and resilience. Results: We describe our findings according to four main themes: (1) Lives disrupted; (2) Diverse social isolation experiences; (3) Coping through seeking solitary and group activities; and (4) Individual ways of enacting resilience and the role of health care to build resilience. Conclusion: We found the experiences of older adults living with multimorbidity during the COVID-19 pandemic were characterized by disruption. When queried social isolation was shared as a prominent concern. We identified the creativity with which participants coped with social isolation and the resilience they marshaled. This study will be used to inform interventions to mitigate social isolation and its effects in a post-pandemic world.

Background: Virtual care accelerated to the forefront of family physician (FP) care following the COVID-19 pandemic and continues to play a significant role in patient care. The choice between virtual and in-person primary care must be sensitive to patients’ contexts particularly for those with multi-morbidity. Objectives: This study explored how to make the choice between virtual and in-person FP care for persons living with multi-morbidity that is acceptable to patients and FPs. Methods: We conducted a constructivist grounded theory study to understand the processes patients and FPs employ when deciding on the mode of primary care delivery. We used individual interviews to understand the perspectives and expectations of patients with multi-morbidity (2+ chronic conditions) and FPs. Results: There were two main themes revealed in data analysis: Considerations in choosing mode of delivery (including reason for visit, impact on access, technological logistics, and reimbursement for virtual care) and Process for choosing mode of delivery (including endorsing the patient choice when possible and scheduling visits). Conclusion: This paper integrated the experience of both patients and FPs to understand how to make the choice between virtual and in-person care. This understanding can support the future of FP care where diverse modes of delivery are employed, but currently technological barriers remain. Clinical scheduling systems that depend on telephone interactions between clinic staff and patients do not always support the process patients and FPs indicated they prefer; that is, one that respects patient preference and FP clinical expertise.

The Revised Patient Perception of Patient-Centeredness (PPPC-R) scale was originally formulated in English to examine patient-centeredness. To translate and validate the PPPC-R questionnaire into Arabic. Translating the PPPC-R into Arabic involved forward and back translations by bilingual experts. Content validity was checked through the Item and Scale Content Validity Indices. The instrument underwent pilot testing and was then completed by 179 patients in the emergency department to examine construct validity using both confirmatory and exploratory factor analyses. Reliability was tested using Cronbach’s alpha to ensure internal consistency. The Item Content Validity Index ranged between 0.66 and 1, and the Scale Content Validity Index was 0.96. Initial confirmatory factor analysis of the Arabic-PPPC-R revealed an inadequate fit, prompting an exploratory factor analysis with Promax rotation, which identified three factors that explained 66.3% of the variance. The refined model, tested again using confirmatory factor analysis, demonstrated an acceptable fit with improved statistical measures, including CFI and TLI values above 0.90 and RMSEA of 0.07. Reliability testing revealed high internal consistency with a Cronbach’s alpha of 0.949 for the full scale and between 0.889 and 0.906 for the individual subscales. The study findings showed that the Arabic version of the PPPC-R has good structural characteristics and is a reliable and valid instrument for measuring patient-centeredness.

This chapter explores the integration of digital health technologies within patient-centred care in primary healthcare. It highlights the principles of patient-centredness, emphasising the holistic understanding of patients’ medical and personal contexts and the importance of longitudinal relationships built on trust. The text describes holistic and prescriptive technologies, arguing that digital tools can enhance healthcare delivery, but their implementation must align with the values of patient-centred care. The chapter delves into various digital innovations, such as patient portals, mobile health applications, and wearable devices, outlining their potential to empower patients through improved access to health information, personalised care, and self-management strategies. The role of electronic medical records and their dual impact on clinical efficiency and patient interaction is examined, alongside the transformative potential of AI and predictive analytics in personalised prevention and early detection. However, the narrative also acknowledges challenges, such as disparities in digital access, technical issues, and the limitations of virtual care in addressing complex patient needs. A detailed case study illustrates these limitations, underscoring the need to blend technology with humanistic care to achieve comprehensive, patient-centred outcomes. The chapter concludes by advocating for a synergistic approach where digital health complements the patient-centred clinical method, fostering holistic and equitable healthcare delivery.

Introduction: Following the COVID-19 pandemic, the role of virtual family medicine care is evolving. It can be tempting to consider only the technological aspects of virtual care; we argue we must attend to compassion’s essential role in virtual family medicine care. This research aimed to understand the components contributing to compassionate family medicine virtual care and how these were demonstrated. Methods: We conducted a qualitative Constructivist Grounded Theory study with 2 components; individual interviews with patients and family physicians (FP), and Collaborative Discussions, informed by the interviews, that brought patients and FPs together. Data collection and analysis were iterative using a constant comparative analysis. Results: We recruited nineteen patient and fourteen FP participants for the first component and 6 patient and 4 FP participants for the second. We identified 4 themes: Conveying virtual compassion through actions; External factors affecting virtual compassion; Virtual visits extending compassionate care; and Role of the patient-FP relationship. These themes can be characterized as a stance that FPs assume in their practice of virtual care. Discussion: We highlight 4 themes important to the delivery of compassionate virtual care. We provide specific actions FPs may consider in delivering virtual care. Offering virtual visits was viewed as a compassionate bridge between in-person visits. Conclusion: Our findings support that it is possible to convey compassion in virtual visits including telephone interactions. As virtual care evolves, our findings can support patients and family physicians to safeguard compassion so that it remains a hallmark of care for all modes of delivery.

Family physicians (FPs) play an important but underappreciated role in the pathways to care for people with early psychosis. We conducted a mixed-methods study to describe the knowledge, attitudes, preferences, and needs of FPs towards the recognition and management of early psychosis. We sent a cross-sectional postal survey to a random sample of FPs in Ontario, Canada, and conducted in-depth qualitative interviews with twenty. FPs were generally aware of important early psychosis symptoms, however, there were some knowledge gaps. Among surveyed FPs, 25% were unsure of the availability of early psychosis intervention services in their region, and most (80%) would prefer to co-manage with specialists. In the qualitative interviews, FPs expressed varied comfort levels in recognizing psychosis, and that timely access to psychiatry was a main concern. Our findings suggest that FPs require better support in recognizing and managing early psychosis and facilitating connections with specialized care.

The main goal of this chapter is to present the new 18-item questionnaire on Patient Perception of Patient-Centeredness (PPPC) in both English and French. The chapter begins with a brief review of similar measures used by other authors over the past 15 years. The chapter then provides a short history of the PPPC since 1990 including its 9-item version for continuous quality improvement and education. The remainder of the chapter focuses on the development and testing of the 18-item English and French versions of the revised PPPC (PPPC-R). The English version was tested with 381 patients in Ontario, Canada, using confirmatory and then exploratory factor analysis. The French version was evaluated through exploratory factor analysis on a sample of 301 patients in Quebec, Canada. Inter-item reliability was high for both samples. The English and French versions are presented to the reader. The PPPC and PPPC-R have been used widely across different countries and in a variety of patient populations.

Chapter 8 presents a parallel process of a team-centered approach based on the four components of patient-centered care. The four components are described in text supported by the literature on team-based care and are displayed in succinct tables. Component 1 is exploring both the team member’s discipline and the members’ personal experiences of their discipline. Component 2 is understanding the whole person, their history, and context. The first two components focus on the individual team members, asking them to reflect on and share their own discipline, life history, and personal context. Components 3 and 4 consider the team itself and its attributes. Component 3 considers the shared language, culture, and philosophy of the team. Component 4 describes the dimensions of ongoing team relationships. The chapter closes with a case illustrating a patient, Francine, whose team was the container for her story.