Experiences with Person-Centred chronic primary care for people of low socio-economic status.

Background: People with low socioeconomic status (LSES) are more likely to experience chronic diseases, have limited health literacy, and face social challenges. A person-centred integrated care (PC-IC) approach in general practice seems promising for improving health, satisfaction, and efficiency, but must be tailored to patients’ needs and capabilities. This study aimed to improve primary care for LSES patients with chronic conditions by co-developing, testing, evaluating, and implementing a tailored PC-IC approach.

 

Approach: /Methods: A cluster randomised controlled trial (CRCT) evaluated a modified PC-IC approach for patients with chronic conditions and LSES in general practice. Co-developed with individuals with LSES, the approach included tailored patient materials and adapted training for general practitioners (GPs) and practice nurses (PNs). 22 general practices in (semi-)rural areas were randomised into intervention group, the new person-centered and integrated approach (EMBOSS, n=11) or control group, usual chronic care (n=11).

 

Over twelve months, data from questionnaires, and medical records were collected to assess experiences, quality of care, health outcomes, and job satisfaction. In total, 70 healthcare professionals (HCP) and 231 patients with low socioeconomic status and a chronic condition participated. After 12 months, semi-structured interviews were conducted with 18 LSES patients and 14 GPs/PNs from the intervention group to assess feasibility, perceived suitability, and the need for optimisation of the approach and materials for future implementation.

 

Results: Experiences with the PC-IC approach were highly positive. Healthcare professionals reported greater job satisfaction, more meaningful patient interactions, and deeper insight into patients’ social contexts, even for those who were already longer in care. This enabled more tailored support, such as through social services or stress management. Patients felt more heard, valued, and involved in care decisions. The experiences form patients and HCP’s indicated that the visual communication tool strengthened trust, improved dialogue, and clarified broader needs. Patients received more personalized advice and engagement, while professionals gained a clearer understanding of patients’ abilities and limitations. Overall, the approach highlighted the importance of interdisciplinary collaboration in delivering person-centred care.

 

Preliminary analyses show that, across both follow-up periods, slightly more participants in the intervention group showed a positive primary outcome (improvement) compared to the control group. However, logistic regression analyses, adjusted for age and gender, did not indicate any significant effects of the intervention after 6 or 12 months.

 

Implications: This study provides insights into the effectiveness of a tailored PC-IC approach for LSES patients with chronic conditions. Findings may guide future healthcare strategies and inform policy decisions for vulnerable populations. Reducing health disparities requires person-centred care, co-developed with LSES patients and grounded in their context, strengths, and needs. LSES patients face complex challenges requiring integrated, cross-sector collaboration.