Principles of Care

Patient-Centred Care 

The principles of patient-centred care and shared decision making are now understood to be essential for effective treatment for alcohol problems. This entails providing care that is respectful of, and responsive to, individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions. The clinical ‘encounter’ is often the most opportune time for patients to become engaged in their own healthcare and presents an opportunity to develop a collaborative relationship on which to base shared-decision making. The term patient-centred care is used to emphasise the importance of improving understanding of the experience of illness and addressing the patient’s need. This endeavour is increasingly more challenging when health delivery systems are complex and fragmented. This approach uses the expertise of the clinician in appropriately explaining to the patient the features of the illness, the impact the condition may have, and the benefits and risks associated with various treatment approaches. Providing a supportive environment within which the patient can explore their values and preferences to treatment options (or indeed the option of no treatment) places value on the therapeutic relationship between clinician and patient. The treatment plan, goals including time frame are all individualised according the patient needs, to the extent possible. When impaired decision-making is a feature of the presentation, consultation with the patient’s family, caregivers, or other support people can be an effective substitution.  

Integrated Care 

Alcohol problems characteristically are associated with more than one health or social concern creating a need for diverse supports. It may be difficult or costly to co-ordinate these leading to incomplete treatment and poor clinical outcomes. Integrated care is an approach that aims to deliver seamless care within the health system across settings and providers. It places patients at the centre of care by providing wrap-around services for patients with complex needs. Successful integration of care is responsive to the needs of patients and provides patients more choice and greater opportunities to engage with the health system. Integrated care is best seen as a continuum rather than an absolute. Related services may be co-located according to patterns of need providing access to the requisite specialist skills in a single treatment centre. The modern primary health care centre is a key example. An individual clinician may be trained in multiple domains so as to provide more complete patient care, for example treating common medical issues in a patient with alcohol use disorder. This can lead to efficient and cost-effective patient care. It is critical to ensure that professionals define and maintain professional boundaries concerning their training and skills so that quality of care is maintained.  

Screening, assessment and treatment planning is discussed in detail in Chapter 4 and is the first step in determining appropriate care. The most common approaches to the coordination and delivery of care for people with alcohol problems include the stepped-care approach, case management, residential rehabilitation, and involuntary treatment. The following chapter does not discuss the content of interventions employed within these care systems but focusses on the types of coordination and delivery of care that are available. Further information about psychosocial interventions, and pharmacotherapy approaches can be found in Chapter 9 and Chapter 10.