Collaborative Practice and Person-Centred Care: A Case Example for Future Successes

Introduction: Collaborative care involves healthcare professionals (HCPs) working alongside patients in both planning and delivering care. Patients must be considered essential team members, as they bring valuable knowledge from managing their conditions on a daily basis. Although progress has been made toward this approach, there is still a need for more clarity on how patients can effectively take on active roles within healthcare teams. A Constructivist Grounded Theory examined the roles of patients in interprofessional primary care teams in Canada. The research identified two main roles for patients—self-care manager and co-decision maker—along with four key processes: explaining, identifying, building, and collaborating. Additionally, three conditions—flexibility, time, and readiness—were necessary for patients to successfully fulfill these roles.

Goals and Methods: While this framework has been widely recognized, its actual application in care delivery has not been consistently implemented. The aim of this presentation is to highlight a real-life case where a family was tasked with coordinating care for a chronic condition without being given the necessary tools, knowledge, or support to succeed. This case example involves a pediatric patient with nocturnal epilepsy who required a sleep study for diagnosis. After the study, the sleep specialist ordered tests and prescribed treatments but informed the caregiver that they would need to manage the coordination of care themselves, offering no further assistance.

Results: While collaborative care is known to improve patient outcomes when patients and caregivers are involved as partners, only some aspects of the framework were followed in this case.

Conclusion: This case study highlights the challenges patients and caregivers face when they are expected to manage chronic conditions without proper support from HCPs. To ensure a positive patient experience and effective self-care management, collaborative care must be implemented fully through the outlined processes and conditions.