title: What Gets in the Way of Person-Centred Care for People with Multimorbidity? Lessons from Ontario, Canada.
abstract: Person-centred care is becoming a key component of quality in health systems worldwide. Although the term can mean different things, it typically entails paying attention to the needs and background of health system users, involving them in decisions that affect their health, assessing their care goals and implementing a coordinated plan of care that aligns with their unique circumstances. The importance of practising a person-centred approach in care delivery dominates policy and research rhetoric worldwide, yet competing goals set by policy planners to save money, eliminate waste and sustain the healthcare system challenge the implementation of such an approach. In this commentary, we begin by exploring the concept of person-centred care and its importance among people who frequently use healthcare, such as those with multimorbidity. We then provide a brief overview of the evolution of Ontario's healthcare system and its emphasis on achieving cost savings. In doing so, we illustrate the implications for health system users, particularly people with multimorbidity, their carers and formal care providers. Finally, we reflect on examples of innovations that are striving to deliver person-centred care, despite a constrained healthcare environment. While a step in the right direction, we conclude that these "one-off" strategies are unsustainable in the absence of supporting policy levers.
authors.affiliation: Scientist in the Lunenfeld-Tanenbaum Research Institute, Sinai Health System and assistant professor, Institute of Health Policy, Management and Evaluation, University of Toronto, ON.
authors.forename: Kerry
authors.initials: K
authors.lastname: Kuluski
authors.affiliation: Postdoctoral fellow in the Institute of Health Policy, Management and Evaluation, University of Toronto, ON.
authors.forename: Allie
authors.initials: A
authors.lastname: Peckham
authors.affiliation: Professor of Health Policy in the Institute of Health Policy, Management and Evaluation, University of Toronto, ON.
authors.forename: A Paul
authors.initials: AP
authors.lastname: Williams
authors.affiliation: Professor in the Department of Family and Community Medicine and the Dalla Lana School of Public Health at the University of Toronto, assistant director of the Lunenfeld Tanenbaum Research Institute, Sinai Health System, and head of the Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, ON.
authors.forename: Ross E G
authors.initials: RE
authors.lastname: Upshur
mesh_terms: D015897:Comorbidity; D003363:Cost Control; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration; D018166:Health Care Reform; D006699:Home Care Services / Q000191:economics / Q000458:organization & administration; D006801:Humans; D009864:Ontario; D018802:Patient-Centered Care / Q000191:economics / Q000458:organization & administration*