People‑centred care improves health outcomes and patient experiences by focusing on strong patient engagement and effective care co‑ordination. This approach is particularly beneficial for managing chronic conditions, as it empowers patients to actively participate in decisions about their health and enhances patient confidence to manage their own health. However, significant challenges remain, such as insufficient care planning, limited use of digital tools, information that is difficult to understand, and poor continuity of health information across providers. The PaRIS data reveal that patients who are involved in decision-making are more confident in managing their health, but advanced self-management support is still underutilised. Additionally, older and less educated populations face greater difficulties in understanding health information and navigating digital health tools, which further hinders their care experience. To overcome these obstacles, healthcare systems must implement targeted actions to enhance care co‑ordination, improve health literacy, and use digital tools effectively, ensuring that people‑centred care is delivered seamlessly across all levels of the healthcare system.
Does Healthcare Deliver?
Abstract
What PaRIS data tell us about people‑centred care
Person-centred care, strong patient engagement strategies and better care co‑ordination improve health outcomes and patient confidence in managing chronic conditions. Higher usage of care planning for patients with chronic condition, accessible and effective communication between professionals and patients, continuity of health information throughout the healthcare system, and higher availability of easy-to‑use digital tools are all associated with more person-centred care. This is even more important for those with lower health literacy and digital literacy skills. The PaRIS data highlights important opportunities for targeted actions to ensure seamless, co‑ordinated, and patient-centred healthcare across systems.
People are more confident in managing their health when doctors involve them in decision-making and support them in taking a more active role in managing their health conditions. More than 80% of patients in the PaRIS report high levels of involvement in decision-making. This is particularly important, considering that people tended to be 10 percentage points more confident in self-management when doctors involve them in decisions about their care. Patients are also 14 percentage points more confident to manage their health when they receive strong self-management support from their primary care providers. Self-management support seems to be particularly effective in improving patient’s confidence in Norway, Portugal, Spain and Wales (United Kingdom).
Care plans are an underutilised tool with significant potential to enhance the experience of care co‑ordination when effectively communicated and implemented. According to patient-reported data, 25% of patients with chronic conditions have a care plan available, while their providers report that 45% use care plans for their patients. This shows not only that there is room to improve the use of care planning, but also that there is a breakdown in communication about between primary care practices and their patients about care planning. Average results mask differences across countries: in some countries including Australia, the Netherlands, Saudi Arabia, Portugal, Spain and Wales primary care practices report higher usage of care plans than their patients. For another group of countries, including France, Luxembourg, Romania, Greece and Czechia, patients with chronic conditions report higher usage of care plans than their corresponding primary care practices.
Patients need greater access to relevant health information to support a more person-centred experience. The most widely use of self-management support reported by primary care practices is the provision of verbal information during consultation, which is used by 89% of practices. Other forms of support, including the distribution of written health information (63% of practices) or referral to self-management classes (34%) are less often used. PaRIS data indicates that the distribution of written information (printed or digital) by doctors is associated with more person-centred care.
Giving patients enough time during consultations and ensuring clear, open communication with healthcare professionals are key to delivering more person-centred care. Doctors who take the time to engage meaningfully with patients and explain things in a clear, understandable way contribute significantly to better patient experiences. Each of these factors is linked to approximately a 15% improvement in person-centred care scores, even after accounting for patient characteristics such as the number of chronic conditions, age, sex, and education.
To reduce health inequalities, websites and digital health tools of primary care practices and health services need to be easier to understand and navigate. Older and less educated people have difficulty understanding health information and have lower confidence than younger people in using digital technology to manage their health. In Iceland, Australia, France, Wales, Canada, Czechia and Switzerland, the more educated are at least 10 percentage points more likely to be confident in using health information from the internet. Moreover, on average people with high education are 26 percentage points more likely to say that their primary care practice website is easy to use.
Continuity of care suffers from poor information exchange. While electronic health records are used in 95% of the primary care practices participating in PaRIS, only half of these practices can exchange these records electronically with other practices. In the Netherlands, Belgium and Norway, more than 80% of practices report the ability to exchange electronic health information, while in Slovenia, Romania and Greece less than one‑quarter of practices can do so. Even if the technical ability to exchange information electronically may be in place using existing systems, PaRIS results indicate the need to improve the ability of the workforce to do so.
Digital tools can be used to improve person-centred care experience in primary care, but their availability and adoption remain uneven. While more than half (54%) of patients with chronic conditions have booked primary care appointments online and 43% have ordered repeated prescriptions online, only 17% have accessed their electronic medical records and just 7% have used videoconference in primary care. This highlights the critical need to expand and improve the deployment of digital technologies in primary care to elevate overall care experiences.
This chapter aims to provide evidence and policy insights about the extent to which people‑centredness improves health outcomes and experiences that matter most to people. It also examines how key measures of people‑centredness care contribute to better outcomes and experiences, and explores the opportunities offered by digital technology to facilitate both co-production and co‑ordination (Øvretveit, 2017[1]; Lember, Brandsen and Tõnurist, 2019[2]).
Since 2017, the OECD has placed particular emphasis on building a shared understanding around the concept of people‑centredness, and how to assess it by collecting and reporting the limited existing data and identifying policies that are more effective in achieving people‑centred healthcare systems (OECD, 2021[3]). The OECD Framework on People‑Centred Healthcare systems (2021) identified the following five dimensions that can guide the assessment of people‑centredness (OECD, 2021[4]):
Voice – the formal inclusion of people in health policy decision-making bodies or processes;
Choice – the ability for people to choose their healthcare providers and access services without barriers;
Co-production – people actively managing their health by receiving accessible information, being consulted, and using digital tools to engage with the health system;
Integration – the co‑ordination of care to provide seamless and integrated care experiences, with the support of digital technologies and electronic clinical records; and
Respectfulness – ensuring people receive personal attention, are treated fairly, and are shown respect by healthcare professionals.
This chapter particular focuses on co-production of health and co‑ordination of care. It does so by examining more closely three of the PaRIS10 indicators discussed earlier in Chapter 2: confidence in self-management, as a measurement of co-production of health by the patient; experienced co‑ordination, as a measurement of integration of care from the patient’s perspective; and person-centred care, as an overall measurement of the patient’s experience of people‑centredness of healthcare services.
4.1.1. Confidence in self-management
Self-management can be defined as a process through which people with chronic disease actively cope with their condition in the context of their day to day lives (O’Connell, Mc Carthy and Savage, 2018[5]). In PaRIS, self-management is defined as the active participation by a patient in his or her own healthcare decisions and interventions. With the education and guidance of professional caregivers, the patient promotes his or her optimal health or recovery.
The closely associated concept of self-management support is a set of techniques and tools that help patients take an active role in the management of their conditions, such as provision of brochures and literature, health patient portals, reference and instruction about self-monitoring including the use of devices, referral to health education classes, among others. Studies have shown that patients receiving self-management support are more likely to have improved clinical outcomes or reduced care utilisation without compromising outcomes (Chrvala, Sherr and Lipman, 2016[6]; Panagioti et al., 2014[7]).
4.1.2. Experienced co‑ordination of care
Experienced co‑ordination of care can be understood as the patient’s perspective of integrated care, which is achieved when people experience a seamless and continuous journey through different healthcare providers and settings. Whether a patient is visiting their primary care professional, another specialist, or a hospital, their care should be well co‑ordinated and consistent.
When care is fragmented, it often means that these different parts of the healthcare system do not communicate well with each other. For example, patients might receive conflicting advice from different doctors, or their medical records may not be shared properly between primary care and the hospital. This lack of co‑ordination can lead to confusion for the patient, missed or duplicated tests, and even medication errors. Such fragmentation is not only inefficient, but it also makes it harder for patients – especially those with chronic conditions or complex health needs – to get the care and services they need to manage their health effectively (Behr and Theune, 2017[8]). In contrast, when care is well-co‑ordinated, it ensures that all healthcare providers involved are on the same page, which can improve a patient’s overall well-being, quality of life, and ability to manage their own care (Shaw, Rosen and Rumbold, 2011[9]).
4.1.3. Person-centred care
Person-centred care can be understood as an overall measurement of the experience of people‑centredness of a given health system, from the perspective of the patient. It is a description of the broad model of individual care experienced by a person, as provided by a healthcare professional. In this sense, person-centred care is an approach that focuses on managing the health of people, ensuring their preferences and needs are central to their care, empowering them to participate in decisions, and providing well-co‑ordinated support to help them manage their health and well-being.
The concept of person-centred care can be better understood by contrasting it with disease‑centred models of care which focus on specific clinical outcomes (Mercadal-Orfila et al., 2024[10]). In a disease‑centred model, people with chronic conditions are at risk of receiving inappropriate treatments and the lack of co‑ordination leads to unnecessary duplication, conflicting treatments, and recommendations. By contrast, person-centred care seeks to deliver co‑ordinated care across settings and focuses on the whole person instead of the disease.
Many claims on people‑centredness of healthcare systems are based on notions of respect to people’s needs and preferences. While this is an important goal by itself, the PaRIS data shows that people who rate their care as more person-centred also have better physical and mental health, and better well-being (Figure 4.1). In all countries, people with chronic conditions who are in the top quartile of person-centredness of care (which corresponds to a person-centred care score of 20 or more, see Box 4.6) feel healthier and report better well-being than the people in the bottom quartile of person-centred care (score of 13 or less).
These results consistently show that people with chronic conditions who experience more person-centred care report better health, even after accounting for differences in age and sex distributions across countries. However, the analysis does not control for individual level-factors, such as the number of chronic conditions or educational level. To address this, Box 4.1 takes the analysis one step further. The results confirm that, even when these factors considered, people with chronic conditions report better health outcomes when they receive more person-centred care.
Note: The figure compares health outcomes of people with low-medium person-centredness care (score below 13 points out of 24) and the group with high person-centredness care (score above or equal to 20 points out of 24). Physical health: PROMIS® Scale v1.2 – Global Health component for physical health is a T-score metric with a range of 16‑68, and a good-fair cutoff of 42, higher values represent better physical health. Mental health: PROMIS® Scale v1.2 – Global Health component for mental health is a T-score metric with a range of 21‑68, and a good-fair cutoff of 40, higher values represent better mental health. WHO‑5 well-being index. Response to five questions measuring well-being. raw scale 0‑25 converted to 0‑100 scale, higher scores represent higher well-being. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people aged 65 years or older. Differences between groups are statistically significant (p<0.05) except for Canada in the PROMIS Physical Health score and PROMIS Mental Health score.
Source: OECD PaRIS 2024 Database.
The PROMIS® Scale v1.2 – Global Health component for physical health is a measure to assess a person’s ability to carry out every day physical activities, degree of pain and fatigue. Scores below 42 are an indication of poor health. Patient-level data was analysed according to the equation below, to estimate the association between person-centredness score and physical health controlling for sex, age, number of chronic conditions, and education level of the patient, while also controlling for unobserved variation across countries and providers with a multilevel model with random intercepts. In the equation, Yijk is the physical health score for patient i, who received care from provider j, within country k.
Equation 1
Results indicate that, on average, each additional chronic disease is associated with a decrease of 2.7 points in the physical health score, while each additional point in the person-centred care score is associated with an increase of 0.4 points in the physical health score, while controlling for gender, age, education status, and unobserved characteristics of countries and providers.
To make these results easier to understand, Table 4.1 presents the predicted physical health score of stylised patients with certain characteristics – age, gender, education status, and the level of person-centredness experienced by them. Three levels of the person-centredness scale, which ranges from 0 to 24 points, were chosen to represent low (8 points), medium (13 points) and high scores of person-centred care (20 points). Results show, for example, that a woman between 54 and 65 years old who has low education, lives with three chronic conditions, and experiences low person-centred care is expected to have a physical health score of 37 (below the threshold of 42 for being in good health). If she were to experience high person-centred care, her physical health scores would have been 42.
Predicted PROMIS® Scale v1.2 – Global Health component for physical health scores for stylised patients according to the level of person-centredness
Note: Results are estimated from the analysis of patient-level data from all 19 countries.
While OECD countries have made important progress in the key dimensions of people‑centred care (OECD, 2021[3]), PaRIS results show that two out of five people (58.9%) living with chronic conditions feel confident in managing their health, and about only half (8.2 out of 15) of the ideal level of care co‑ordination is being achieved.
Table 4.2 presents more details about the dimensions of co-production of health and co‑ordination of care. The table includes one overall indicator for assessing the extent to which patients experience each of these dimensions (co-production and co‑ordination), one indicator reflecting the level of support they receive from the practices where they are treated for each dimension, and one indicator that relates to the role that digital technology can play to support each dimension.
1. Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions.
2. United States sample only includes people aged 65 years or older and does not include data collected from practices.
3. Calculated by matching patient data with primary care practice data: number of patients in practices reported as well-prepared to co‑ordinate care (practice questionnaire) divided by the total number of patients per country (patient questionnaire). Results are age and sex-standardised across countries.
4. Calculated based on the potential for data exchange at a national level, rather than being limited to the patient’s usual care setting. In Spain, 100% of medical records are electronic, and information is exchanged digitally.
Source: OECD PaRIS 2024 Database.
On average, just over three out of five (58.9%) people living with chronic conditions report being confident in managing their own health and a similar proportion (63.2%) say they receive enough support to self-manage. About one out of five people (19.3%) report being confident in online health information. The average score of co‑ordination of care reported by people with chronic conditions was just above half of the total possible score (8.2 out of 15), which would reflect and ideal experience of co‑ordination of care from the perspective of patients. Just above half of the people with chronic conditions seek primary care in practices that report being well-prepared to co‑ordinate care (55.6%) and being able to exchange medical records electronically (57.1%).
Ultimately, for co-production of health to take place, patients must have the confidence that they can manage their own health and well-being (Krist et al., 2017[11]). This is even more important in a context where health needs have become more complex, driven by population ageing and rising incidence of chronic conditions across the OECD (Cristea et al., 2020[12]), while a pipeline of new therapeutic options make navigating the care landscape ever more difficult (Johnson, 2011[13]). From the perspective of patients, co-production requires that people receive sufficient information from their healthcare professionals and other trusted sources, including dedicated patient portals, that they have opportunities to ask questions and make decisions during the care process and that they are sufficiently health literate to understand options (Realpe and Wallace, 2010[14]). The role of shared decision-making has been further highlighted as a pinnacle of patient-centred care (Barry and Edgman-Levitan, 2012[15]).
4.4.1. People feel more confident about managing their health when they receive support from their healthcare professionals
On average, patients treated in practices that offer self-management support are 14 percentage points more likely to report being confident that they can manage their own health (Figure 4.2). This is an example of co-production, showing the benefits of a proactive, collaborative partnership between healthcare providers and patients in managing health outcomes.
Self-management support includes tools and techniques that help patients take an active role in the management of their condition, such as the distribution of information, referral to self-management classes, or explicit setting of health goals and action planning. Through self-management support healthcare providers can expect to equip patients with the necessary tools, knowledge, and confidence to manage their chronic conditions effectively. By offering education, skill development, and emotional support, providers empower patients to take an active role in their health, making informed decisions and performing daily tasks that contribute to better health outcomes. Essentially, self-management support can serve as the foundation that enables the co-production of health, ensuring that patients are capable and confident in their role as partners in their care.
Percentage of patients who are confident they can manage their health and self-management support tools
Note: P3CEQ Questionnaire. Response to question: “How confident are you that you can manage your own health and well-being?”, “confident or very confident” versus “somewhat confident or not confident at all”. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people aged 65 years or older. Differences between groups are statistically significant (p<0.05) for Australia, Canada, Czechia, Greece, Iceland, Luxembourg, Norway, Portugal, Spain, Switzerland, the United States and Wales.
Source: OECD PaRIS 2024 Database.
Based on information reported by primary care practices, the most common use of self-support are the provision of verbal information during or after the consultation (89% of practices report using this type of support) and the distribution of information, including pamphlets, booklets, or internet/web-based information (67% of patients) (see Figure 4.3). Other forms of self-support are less common, reaching only between a quarter and two‑fifths patients. These include tools and techniques such as referrals to self-management classes (39%), explicit goal setting and action planning (34%), or care by practice members who are trained in patient empowerment (24%).
Percentage of patients with chronic conditions in practices offering each type of self-management support
Note: Data from a total of 78 470 patients with chronic conditions linked to primary care practices in all PaRIS countries except for the United States, where the provider questionnaire was not applied.
Source: OECD PaRIS 2024 Database.
4.4.2. People with chronic conditions are more likely to be confident in self-managing when healthcare professionals involve them in their care
Across 18 countries, people who report that healthcare professionals involve them in decision-making are 10 percentage points more likely to feel confident in managing their own health (Figure 4.4). The only exception to this pattern was Canada, where people who reported being involved in decisions about their care were less likely to be confident in self-managing. This may be explained by the fact that Canada was the only country where the majority of respondents reported not being involved in decisions about their care: only 12% of Canadian respondents with chronic conditions reported being involved in decisions about their care versus 71% of PaRIS respondents.
Percentage of patients who are confident they can manage their health according to perception of being involved in decisions about their care
Note: P3CEQ Questionnaire. Response to question: “How confident are you that you can manage your own health and well-being?”, “confident or very confident” versus “somewhat confident or not confident at all”. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people aged 65 years or older. Differences between groups are statistically significant (p<0.05) for all countries except for Italy.
Source: OECD PaRIS 2024 Database.
PaRIS results highlight that involving patients in medical decision-making is still not a standard in all countries, although it is above 75% for almost all countries (see Figure 4.5). Leading countries like Australia, Romania and the Netherlands report over 90% patient involvement, reflecting a strong commitment to patient-centred care. While the challenges of scaling up shared decision making in clinical practice are not to be underestimated (Fisher et al., 2018[16]), PaRIS findings suggest a need for targeted efforts, particularly in the countries where fewer people involved in medical decisions, to enhance patient engagement and align healthcare decisions with patients’ preferences and values.
“In a situation where we didn’t know how to face a viral infection, we jointly studied the different treatment options, considering the pros and cons of each alternative in the short, medium, and long term, as well as the adverse effects each option could produce, with the aim of making the best decision that would have the least impact on my quality of life and daily expectations. Thanks to shared decision-making, we made the right choice and anticipated treating the side effects as they appeared.”
Manuel, 50 years old, male, married, living with a chronic kidney disease (transplanted twice), osteoporosis, hypertension, survivor of Non-Hodgkin lymphoma and other urological and skin cancers
Percentage of patients with chronic conditions involved in medical decision-making across countries
Note: *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people aged 65 years or older.
Source: OECD PaRIS 2024 Database.
“My GP tends to let me be the judge of how I manage my lung conditions. I have a script for antibiotics and steroids in case I feel that I am having a flare‑up of my condition. We discussed it fully as we both agreed that if I do have a chest infection, it is better to start antibiotics and steroids immediately. If I am not improving or I get worse, then I should make an appointment to see her or call an ambulance if my breathing is affected badly.”
llyn, a patient living with chronic lung conditions, rheumatoid arthritis, osteoarthritis and post-sepsis syndrome
4.4.3. Written health information needs to be made more accessible, especially for older and less educated patients
The PaRIS results show how disparities in health literacy drive broader health inequalities across age and education. In nearly every country in PaRIS, the older and less educated people are more likely to find most health issues too complex to understand and report difficulties in understanding much of the health information they encounter. These aspects were combined to create a health literacy index (see Box 4.2).
A set of 10 questions from Porter Novelli’s HealthStyles survey included in the PaRIS patient questionnaire has been used to develop profiles of usage of health information by patients (Maibach et al., 2006[17]). One of these profiles refers to health literacy, using patients’ agreement to these two items: “Most health issues are too complex for me to understand” and “I have difficulty understanding a lot of the health information I read”. Both items were measured on a 5‑point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree), with higher scores indicating greater agreement with the statement.
Cronbach’s alpha (α = 0.7 445) was used to evaluate the internal consistency of these two items, confirming their reliability as a single construct and aligning with commonly reported thresholds in the literature (Tavakol and Dennick, 2011[18]). The scale was calculated only for respondents who provided answers to both items. To ensure that higher scores on the final scale correspond to better health literacy, the responses were inverted, such that higher values indicate better understanding of health information and health-related concepts. This transformed variable provides a summary measure of health literacy, ranging from 1 (lowest health literacy level) to 5 (highest health literacy level).
Figure 4.6 presents disparities in the 5‑item health literacy scale, showing the differences in the index for people with high education compared with those with low education (left panel) and the differences for people in the older group (over 75) compared with those in the younger group (45 to 54 years old). Countries such as Norway, Belgium and Switzerland show larger gaps for both age and education levels. Romania exhibits the widest gap in health literacy based on education, while Czechia shows the largest disparity based on age.
Health literacy is essential for patients to access, process and apply information relevant to their health and make decisions or adapt behaviours accordingly ((HLS-EU) Consortium Health Literacy Project European, 2012[19]). People with lower health literacy often struggle to understand medical instructions, leading to poorer medication adherence, which can exacerbate their conditions and hinder effective treatment (OECD, 2019[20]). Enhancing access to clear and comprehensible health information can help reduce inequities and improve overall health outcomes. Targeted strategies are needed to improve accessibility, particularly for these vulnerable groups. For example, the Clear & Simple guidelines developed by the United States National Institutes of Health recommends specific steps to developing health information for audiences with limited health literacy skills (National Institutes of Health, 2021[21]).
Comparison of an average of a 5‑point health literacy index across education and age groups
Note: *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people aged 65 years or older. Results are age and sex-standardised across countries. Gaps between education groups are statistically significant (p<0.05) for all countries. Gaps between age groups are statistically significant (p<0.05) for Belgium, Canada, Czechia, Greece, Italy, Luxembourg, the Netherlands, Norway, Slovenia and Switzerland.
Source: OECD PaRIS 2024 Database.
4.4.4. Older and less educated patients have troubles using digital health information
Compounding the trends observed in overall health literacy, older people and those with lower education are also less often confident in using health information online. This represents a dual challenge for communicating health information for older and less educated people.
Figure 4.7 shows the difference in the percentage of people who indicated that they are confident in using information from the internet to make health decisions across education groups (left panel) and age groups (right panel). The comparison of digital health literacy by level of education shows a difference of more than 15 percentage points in France, Iceland, Australia and the United States, in disfavour of those who are less educated. The opposite trend was observed in Spain, Saudi Arabia and Slovenia, while differences were very small in Romania, Portugal, and Belgium. The age gap in confidence in using health information comparing those 75 years old and over versus those aged 45 to 54 is more than 15 percentage points in Wales, France, Iceland, Canada and the United States, in disfavour of the older group. Spain is the only exception, where older people are more confident in using health information from the internet than the younger group.
Comparison of percentage of people with confidence in using health information from the internet across education and age
Note: eHeals: Percentage of patients confident in using health information from internet. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people aged 65 years or older. Results are age and sex-standardised across countries. Gaps between education groups are statistically significant (p<0.05) for all Australia, Canada, Czechia, France, Iceland, Italy, Norway, Saudi Arabia, Switzerland, United States and Wales. Gaps between age groups are statistically significant (p<0.05) for Australia, Belgium, Canada, France, Iceland, Netherlands, Norway, Portugal, Switzerland and Wales.
Source: OECD PaRIS 2024 Database.
Digital health literacy, particularly confidence in accessing and selecting high quality information sources is essential, in addition to understanding and applying the information obtained from digital sources. Moreover, digital health literacy is increasingly important as healthcare systems become more digitalised, requiring patients to engage with eHealth services such as telemedicine, mobile health apps, and online health information resources (Gybel Jensen, Gybel Jensen and Loft, 2024[22]; Fitzpatrick, 2023[23]). For example, patients’ confidence in managing their own health can potentially be enhanced by their access to their own health records and test results. High-quality health information and digital technology can be an enabler in these tasks (Neves et al., 2020[24]). Online sources also have a large potential to contribute to patient empowerment and increase confidence in self-management, however, there are also risks associated with health misinformation and disinformation (Farnood, Johnston and Mair, 2020[25]; Arora, Madison and Simpson, 2020[26]).
4.4.5. Making digital tools in primary care easier to use can help reducing health disparities
Although improving digital health literacy requires action of several levels, concrete interventions can help address disparities across age and education levels. For example, the websites of primary care practices and health services in general can be made easier to use to retrieve relevant information regarding patients’ care and care pathway. According to PaRIS data shown in Figure 4.8, in all countries people with low level of education are less likely to say that their primary care practice website is easy to use. On average the difference between the groups with high and low education exceeds 30 percentage points.
Percentage of people agreeing that their primary care practice website is easy to use by level of education
Notes: *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people aged 65 years or older. Differences between middle and low education groups are statistically significant (p<0.05) for Belgium, Czechia, France, Greece, Iceland, Italy, Luxembourg, Norway, Portugal, Romania, Saudi Arabia, Spain and the United States; between high and middle education groups for France, Greece, Italy, Norway, Spain and the United States; and between the high and low education groups for Belgium, Czechia, France, Greece, Iceland, Italy, Luxembourg, Norway, Portugal, Romania, Saudi Arabia, Spain and the United States.
Source: OECD PaRIS 2024 Database.
“I never had a video consultation, because I am not tech friendly and I don’t have the equipment to support such a method; furthermore, I have never heard of such a practice within the network of doctors I am familiar with”
Lucy, 55 years old, divorced woman with osteoporosis, Hashimoto/thyroid, hypertension
A people‑centred healthcare system requires that patients experience a seamless and continuous journey through different healthcare providers and settings. Co‑ordination of care is essential for those living with chronic conditions because they might require complex, long-term management involving multiple healthcare providers, services, and treatments. Low co‑ordination of care is likely to lead to duplicated tests, conflicting treatments, medication errors, and overall poorer health outcomes. Effective care co‑ordination helps ensure that all aspects of a patient’s care are aligned, improving management of chronic conditions, preventing complications, and promoting better quality of life (Gartner et al., 2022[27]).
In PaRIS, a patient’s experience of co‑ordinated care ideally refers to care that is overseen by a single professional who serves as the main contact for the patient, is organised in a way that works for the patient, uses care planning, and provides information and support for the patients to self-manage their health (see Box 4.3).
The summary indicator chosen to measure co‑ordination of care in the PaRIS, the Person-Centred Co‑ordinated Care Experience Questionnaire, is a scale composed by the sum of five components, each of them varying from 0 to 3 and adding up to 15. The description of the components is presented in Table 4.3.
Source: Lloyd, H. et al. (2019[28]), “Validation of the person-centred co‑ordinated care experience questionnaire (P3CEQ)”, https://doi.org/10.1093/intqhc/mzy212.
4.5.1. Insufficient use of care planning hurts the experience of co‑ordination of care
PaRIS data shows that out of the five components of co‑ordination of care, insufficient use of care planning is clearly the one that contributes the most to lowering patient’s overall experience of co‑ordination of care, as indicated in Figure 4.9 below. Moreover, on average countries are achieving just above half (55%) of the maximum level of co‑ordinated care (8.2 out of 15 points), and the best performer achieves 69% of highest possible score (10.3 out of 15 points).
Note: P3CEQ Questionnaire. Response to five questions measuring care co‑ordination. Scale ranges from 0 to 15, higher scores represent better care co‑ordination. Description of the components of the experienced co‑ordination scale (EC) in table 4.2. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people aged 65 years or older. Results are age and sex-standardised across countries.
Source: OECD PaRIS 2024 Database.
The area in which most countries achieve the highest score is “care joined up”, with scores ranging from 1.6 to 2.6 out of a maximum of 3 points. The area where most countries rate the lowest score is overall care planning, which ranges from 0.1 to 1.7 out of a total of 3 points. These results point to insufficient use of care planning for patients with chronic conditions. It further highlights that some of the largest opportunities to improve co‑ordination scores are in increasing the use of care planning.
4.5.2. Communication between patients and providers about the use of care plans needs to improve
Some of the challenges of developing and implementing care plans are made evident by crossing information reported by the patients and information reported by their healthcare professionals. On average for OECD PaRIS patients with chronic conditions, 24% report that they have a care plan available to them, while 45% of their corresponding primary care practices report that they use care plans for their chronic patients (Table 4.4). However, this average result masks a more nuanced distribution across countries. For a group of countries, including Australia, the Netherlands, Saudi Arabia, Portugal, Spain and Wales primary care practices report higher usage of care plans than their patients. For another group of countries, including France, Luxembourg, Romania, Greece and Czechia, patients with chronic conditions report higher usage of care plan their corresponding primary care practices.
Percentage of patients and primary care practices reporting use of care plans
Note: Matched practices and patient results for all countries are shown for patients with valid practice data only, except for the United States which did not collect practice data. Unstandardised data. OECD PaRIS average does not include the United States. Practice‑reported results corresponding to each patient include those that reported using care plans for patients with any chronic conditions, or those who reported using care plans for patients with specific chronic conditions or specific complex care needs, when their patients reported at least one of the following conditions (chosen due to their complexity or higher need for co‑ordination of care): cardiovascular or heart condition, diabetes (type 1 or 2), Alzheimer’s disease or other cause of dementia, chronic kidney disease, chronic liver disease, or cancer.
1. Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions.
2. United States sample only includes people aged 65 years or older.
Source: OECD PaRIS 2024 Database.
The two columns on the right of Table 4.4 are graphically shown in Figure 4.10. For countries above the 45 degrees line, use of care plans reported by patients is higher than that reported by practices, while for countries below the line, use of care plans reported by practices is higher than that reported by patients.
Share of practices who report using care plans for patients with chronic conditions and corresponding patients who report having a with chronic conditions who report having a care plan available to them (unstandardised data)
Note: *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people aged 65 years or older. Matched practices and patient results for all countries are shown for patients with valid practice data only, except for the United States which did not collect practice data. OECD PaRIS average does not include the United States.
Source: OECD PaRIS 2024 Database.
Communication challenges go beyond the interaction between patients and their primary care professionals, especially for patients with complex needs who must engage with multiple healthcare providers. Among practices that report developing care plans for their patients, only two‑fifths indicate that they share these care plans with healthcare professionals working outside their practice (Figure 4.11).
Percentage of primary care practices who share care plans with professionals outside their practice, out of those who report using care plans (out of a total of 911 practices that use some form of care plan)
Note: *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. The United States is not represented because it did not administer the provider questionnaire.
Source: OECD PaRIS 2024 Database.
4.5.3. Almost all primary care practices in PaRIS use electronic health records, but just half can share them with other practices
According to PaRIS data, almost all (95%) patients have sought care in practices that report the use of electronic medical records. This number is slightly higher than the average reported in Health at Glance 2023 (93%), which used 2021 data (OECD, 2023[29]). PaRIS data further shows that in 14 out of the 19 countries 95% or more of the patients are managed in practices using electronic medical records. However, as Figure 4.12 shows, only three countries (Belgium, the Netherlands and Norway) have more than 90% of primary care practices that are able to exchange medical records electronically with other practices.
Percentage of practices that can exchange information with other practices, and percentage using electronic records
Note: *Data for Italy refer to practices serving patients enrolled in outpatient settings for specialist visits in selected regions. The United States is not represented because it did not administer the primary care practice questionnaire. ***In Wales, a very small number of practices indicated that they do not have electronic medical records even though by national policy the national record is available for all practices to view.
Source: OECD PaRIS 2024 Database.
“Since the healthcare system [in my country] is not fully digitalized, each visit to a healthcare professional requires me to share my paper health records with at least three specialists –my GP, my HIV physician, and my cardiologist. I take on this responsibility to prevent duplicate blood tests and other exams. However, with multiple appointments each year, this process takes up a lot of unnecessary time.”
Robert, 54 years old, male, living with HIV and chronic heart disease
The inability to exchange information suggests a challenge in what has been described in the literature as “continuity of information”, or the systematic flow of relevant patient information across different healthcare providers and services over time (Berta et al., 2009[30]; Gardner et al., 2014[31]). Only 28% of primary care practices report receiving medical records from previous practice without directly requesting them; 56% reported receiving them if requested from the previous practice and 41% reported if patient brings them (Chapter 3). The limited ability to exchange electronic information as shown in Figure 4.12 can reflect technological limitations (e.g. there are no systems in place for data sharing), regulatory limitations (e.g. regulations in place prevent data sharing), or lack of awareness of primary care practices about the data sharing capabilities. For example, Wales reports having a national care record for each patient that both primary and secondary care professionals can access and update (see Box 4.4). However, while secondary care professionals can see all information, primary care professionals cannot automatically access information entered by secondary care (Welsh Government, 2023[32]). In Spain, electronic health records are present in all practices. Moreover, there are national interoperability systems in place that technically allow for data sharing across regions of its decentralised healthcare system. Box 4.5 provides further details on Spain’s approach to integrating patient clinical information.
Efforts to improve healthcare in Wales focus on creating integrated digital systems that enhance access to patient information and support co‑ordinated care across services.
The Welsh Clinical Portal (WCP) integrates patient information from various systems across Wales, enabling hospital staff to access personalised workspaces, order tests, and view results. Many hospitals now use features such as medicine transcribing, e‑Discharge, and access to the Welsh General Practice Record.
GP practice systems, provided by two suppliers in Wales, allow GPs to view local patient records alongside hospital test results and discharge notes. The Welsh GP Record (WGPR), a summary of key information from GP records, is accessible via the WCP with patient consent, and every access is logged for security.
The Welsh Community Care Information System (WCCIS) supports information sharing between health and social services, enabling co‑ordinated care through shared electronic records. While improving integration, work continues on defining access levels for social care workers and ensuring robust data governance.
My Health Online allows patients to book appointments and order prescriptions online. Future upgrades will provide patients with direct access to parts of their GP records, promoting more active engagement in their care.
Source: The Wales Audit Office (2018[33]), Informatics systems in NHS Wales, Auditor General for Wales.
The Spanish healthcare system is decentralised in 17 autonomous regions. The Regional Health Services form part of the National Health System (SNS), and all of them have electronic health record (EHR) systems, which are widely used by healthcare professionals. Within each region, primary care centres exchange information either through a single patient record or via viewing platforms that allow access to various reports generated in different systems.
In primary care, the electronic health record is the standard working tool for professionals and has a longitudinal nature, documenting the patient’s health history. The SNS has a common clinical information interoperability service (SNS Digital Health Record – HCDSNS), co‑ordinated by the Ministry of Health, which integrates:
A unique patient identification system: the SNS Protected Population common database.
Access for healthcare professionals to the patient’s HCDSNS, generated in any healthcare centre, from any point within the system.
Online access for citizens to their interoperable HCDSNS.
The interoperable electronic prescription system, which allows dispensing from any pharmacy in Spain, regardless of where it was prescribed within the SNS.
Spain also has interoperability services for Health Records and Electronic Prescriptions with other European countries through MyHealth@EU.
Source: Spanish Ministry of Health https://www.sanidad.gob.es/areas/saludDigital/home.htm
4.5.4. Regular medication reviews can help improve care co‑ordination
Patients who report that their primary care professional has reviewed their medication are more likely to report higher co‑ordination of care scores (Figure 4.13). This is even more prominent among those with two or more chronic conditions (Chapter 3). Improving co‑ordination of care may sometimes require complex interventions such as improving the interoperability of health information systems, mechanisms for healthcare payment systems and regulations related to the scope of practice of different health professionals (Khatri et al., 2023[34]).
Yet, PaRIS data show that on average, about 70% of people living with multiple chronic conditions had their medication reviewed by a healthcare professional in the last six months (Chapter 3). While about 90% of people with three of more chronic conditions have medication reviews in Czechia, Switzerland and Australia, the share is lower than 50% in Iceland and Slovenia.
Reviewing all the medications their patients are taking can provide healthcare professionals with an opportunity to inquire about the care provided by other professionals involved in the patient’s treatment. Systematic medication reviews can be complex and time‑consuming, involving the patient and multiple healthcare professionals, and often requiring follow-up visits to fully optimise medications. Digital tools, such as support systems can assist in quickly identifying and prioritising key issues, reducing the time spent navigating extensive electronic health records while ensuring a clear understanding of the patient’s treatment (Abuzour et al., 2024[35]).
Experienced care co‑ordination and healthcare professional reviewing medication
Note: P3CEQ Questionnaire. Response to five questions measuring care co‑ordination. Scale ranges from 0 to 15, higher scores represent better care co‑ordination. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people aged 65 years or older. Differences between groups are statistically significant (p<0.05) for all countries.
Source: OECD PaRIS 2024 Database.
If person-centred care is understood as an overall measure of how people experience the people‑centredness of a healthcare system, it must reflect the specific model of care a person receives from their healthcare professional.
In PaRIS, a patient’s experience of the person-centred care ideally refers to care that prioritises the individual’s unique needs, values, and preferences; ensures meaningful involvement in decision-making, recognises as whole individuals, rather than focusing solely on their conditions; minimises the need to repeat information; is organised in a way that works for patients, and offers support and information needed to help the patients to self-manage their health (see Box 4.6).
Person-centred care was measured with the P3CEQ scale, existing of eight items that are equally weighted from 0 to 3 (the higher the score, the higher the person-centredness). The scale ranges from 0 to 24. The description of the components is presented in Table 4.5.
Source: Lloyd, H. et al. (2019[28]), “Validation of the person-centred co‑ordinated care experience questionnaire (P3CEQ)”, https://doi.org/10.1093/intqhc/mzy212.
“When it comes to my health and decisions related to it, I would like to have a much more active, proactive, and informed role, where I can effectively decide on my treatment and options, with all available information and the current state of things on the table. I have not had this experience, and I have educated myself in health matters independently and through peer support, greatly missing a much more active role within the healthcare system”
Lucía, 42 years old, female, living with multiple chronic conditions
4.6.1. Person-centred care is most often hindered by poorly organised care that fails to meet patients’ needs and a lack of sufficient information to support self-management
Among the eight components of the person-centred care scale, insufficient provision of useful information for self-management and low confidence in self-management are the two components that contribute the most to lowering patients’ overall experience of person-centred care, as indicated in Figure 4.14 below. However, the distribution of scores across indicators was more balanced for the person-centred care score as opposed to the experienced co‑ordination of care, where the availability of care planning indicator stands out as having the lowest scores.
Note: P3CEQ Questionnaire. Response to eight questions measuring if care is person-centred. Scale ranges from 0 to 24, higher scores represent better person-centred care. Description of the components of the person-centred care scale in Table 4.5. *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people aged 65 years or older. Results are age and sex-standardised across countries.
Source: OECD PaRIS 2024 Database.
The areas in which most countries achieve the highest score are “involved in decisions” and “considered whole person”, with scores ranging from 2.1 to 2.7 (except for Canada, which scored 0.5 in both items) out of a maximum of 3 points. Most countries scored the lowest for “need to repeat information”, with scores ranging from 1.2 to 2.1; “information to self-manage”, with scores ranging from 1.1 to 2.1, and for “confidence to self-manage”, with scores ranging from 1.2 to 2.2. The average person-centred care score across OECD countries in the PaRIS survey is two‑thirds of the maximum possible score (16.1 out of 24), suggesting room for improvement towards person-centred care. Canada deviates from most countries by having relatively high scores for care being organised in a way that works for patients (1.8 out of 3.0), while having low scores for interpersonal doctor-patient experience, such as health professionals discussing what is important for patients, involving them in decisions, and patients considering that they are treated as a whole person.
“I think that the most characteristic example is when I went to the doctor for one of my chronic diseases. He never asked me if I was able to make an injection to myself on my own. When I discovered that I had to do this all by myself, I found it really difficult. So, I wish we had talked about this in advance.”
Zoe, 67 years old, divorced woman, living with severe osteoporosis, asthma and Paget disease
4.6.2. Sufficient consultation time, effective and accessible doctor-patient communication, and use of digital tools and are all associated with more person-centred care
Figure 4.15 presents the results from an analysis of characteristics of primary care that support person centred-care, that accounts for patient characteristics – gender, education, multimorbidity.
The results indicate that when healthcare professionals provide easy to understand information and spend enough time with patients, it has a positive impact on person-centred care scores. The provision of written information shows a smaller, but still statistically significant effect. The size of this effect comparable to the difference in person-centred care scores between people with middle and high levels of education, or between middle and low levels of education. The results also show that offering video consultations or other remote options is associated with higher person-centred scores compared to providing only telephone consultations. These results reflect the overall PaRIS population except the United States, which does not have provider-level data), but results may differ by country. This analysis builds on the findings in Chapter 3, which showed a 21% improvement in experienced care quality among people with multiple chronic conditions when more time was allocated for regular or follow-up consultations. Despite this, less than half of primary care practices (38%) report scheduling consultations that last 15 minutes or more.
Estimated effects and 95% confidence intervals of practices’ and patients’ characteristics on person-centred care
Note: Analysis includes 52 729 patients in 18 countries, only those with at least one chronic condition was included. The United States was not included for not having information at the practice level for provision. Statistical significance: *** P ≤ 0.001;:** P ≤ 0.01;:* P ≤ 0.05. Video consultations and remote options compared to having telephone only. Female compared to Male; Age groups compared to people from 45 to 54 years old; Education high and middle compared to people with low education. Random intercept models with patient, practice and country level.
Source: Author’s estimations with data form the OECD PaRIS 2024 Database.
“When I had some complications with my thyroid/hasimoto problem, my doctor explained to me my condition using simple words. He explained the available treatment options, in order to decide together which one would be more appropriate and more efficient for me. I found it really helpful, since I managed to adjust easier.“
Lucy, 55 years old, divorced woman with osteoporosis, Hashimoto/thyroid, hypertension
Subsequent statistical analysis similar to the one just presented in Figure 4.15 was conducted for all forms of self-management support reported by practices shown earlier in Figure 4.3, which includes: provision of verbal information during or after the consultation; distribution of information such as pamphlets, booklets, internet/web based information; referral to self-management classes or educators; explicit goal setting and action planning with members of practice team; and support provided by member so the practice team trained in patient empowerment and problem-solving methodologies. Results were statistically significant only for distribution of information such as pamphlets, booklets, internet/web-based information, which was positively associated with person-centred care.
This finding underscores the importance of ensuring that primary care practice websites are easy to understand and accessible, alongside promoting adequate health literacy. Written information appears to play a key role in supporting patients, particularly for this population, where consultations may often be lengthy and cover multiple health issues. This can leave patients struggling to absorb and effectively use all the information provided during the consultation to make informed decisions about their care. Providing written information, in combination with other self-management support options, can enhance patients’ ability to manage their own health and maximise the effectiveness of primary care.
The results shown in Figure 4.16 confirm that effective and accessible communication could improve experience of person-centred care. Fewer than half of all PaRIS practices regularly provide written instructions, either electronically or on paper, about how patients can manage their own care at home. such instructions may concern what to do to control symptoms, prevent flare‑ups, or monitor conditions at home.
Percentage of practices who always or often provide written instructions to chronic patients
Note: *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. The United States is not represented because it did not administer the provider questionnaire.
Source: OECD PaRIS 2024 Database.
4.6.3. Video consultations are rarely used in primary care, and in most countries patients report much lower availability than practices do
The availability of videoconference services in primary care practices is not only low, but there also appears to be a communication gap between practices and their patients regarding the availability of these services. According to practices, 28.3% of patients with chronic conditions are with practices that offer videoconference services. However, only 10.8% of these patients are aware that their primary care practice offers such services (see Table 4.6). In several countries, such as Romania, Wales, France and the Netherlands, practices report substantially higher numbers than patients. In some countries, such as Spain, Luxembourg, Greece and Slovenia, practices and patients provide quite similar numbers. Only in Spain patients reported higher numbers than their practices.
Offer of videoconference services as reported by primary care practices and their patients (unstandardised data)
Note: *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people aged 65 years or older. Matched practices and patient results for all countries are shown for patients with valid practice data only, except for the United States which did not collect practice data.
Source: OECD PaRIS 2024 Database.
Given the low availability of video consultations in primary care, it is unsurprising that their usage reported by patients is even lower. Approximately 7% of patients with chronic conditions reports having used video consultation in primary care, as shown in Figure 4.17.
Note: *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. **United States sample only includes people aged 65 years or older. Standardised results are adjusted for age and sex across countries.
Source: OECD PaRIS 2024 Database.
Despite the rise of video consultations following the COVID‑19 pandemic, aggregated data about video consultations show that this concerned on average 18% of all consultations around 2021 as reported in Health at a Glance 2023 (OECD, 2023[29]). While the PaRIS data refer to a different population, this may be an indication that usage of video consultation in primary care may be lower than in other areas of care.
In my experience, video consultations have been incredibly helpful for receiving more timely care. Accessing healthcare from home eliminated travel time and waiting in crowded clinics, allowing me to schedule appointments more easily around my daily responsibilities. This accessibility enabled me to connect quickly with my primary care professional for follow-up questions or urgent concerns.
Betsy, 68 years old, female, living with multiple chronic conditions, including obesity, dedicated caregiver for her husband, who is battling cancer, and for her daughter, who has Type 1 diabetes and chronic kidney disease
4.6.4. In several countries, patients have booked primary care appointments or ordered repeat prescriptions online, but access to electronic medical records remains limited
PaRIS data indicate a need to improve the digitalisation of the primary care experience (see Figure 4.18). On average, 54% of patients with chronic conditions have booked primary care appointments online and 43% have ordered repeat prescriptions with their primary care practice online. However, only 17% have accessed their primary care medical records online.
Note: *Data for Italy refer to patients enrolled in outpatient settings for specialist visits in selected regions. The United States is not represented because it did not administer the provider questionnaire. **United States sample only includes people aged 65 years or older.
Source: OECD PaRIS 2024 Database.
Progress for the different types of digital services in primary care – booking appointments online, ordering repeated prescriptions online, accessing electronic medical records online, and using video consultations – varies substantially across countries. Notably, the countries reporting the highest usage in some areas are not the same in others. This suggests that all countries have room for improvement in the digitalisation of the primary care experience. Considering the role of these tools in promoting more people‑centred care, accelerating the digitalisation of primary care should be a policy priority.
This chapter highlights the critical role of people‑centred care in improving health outcomes, patient confidence, and the overall efficiency of healthcare systems. The analysis of PaRIS data demonstrates that when care is designed around the health needs, preferences, and capacities of the people, it leads to better physical and mental health and enhanced well-being, particularly for patients with chronic conditions. However, important gaps persist in the adoption of key practices, such as care planning, self-management support, effective and accessible communication, and the deployment of digital tools in primary care. The PaRIS findings underscore the urgent need for targeted health policies that address structural barriers, promote equitable access to resources, and enhance health literacy and digital health literacy, especially among older and less educated populations.
There are significant opportunities to enhance primary care by expanding the use of care plans, improving care co‑ordination, promoting digital literacy, and offering more accessible digital tools. Strengthening these areas can lead to more seamless integration of healthcare services and empower patients to play a more active role in their care process. Additionally, improving the interoperability of electronic health records can help unlocking the full potential of digital systems, making healthcare more efficient and connected. Improving co‑ordination of care requires more robust mechanisms for communication across providers, alongside investments in training for healthcare professionals to deliver person-centred care effectively. Policy makers must also prioritise digital inclusion to ensure that all patients, regardless of age or education level, can benefit from advancements in health technologies.
Improve access to health information and empower patients through shared decision-making
Accessible health information is essential for a more person-centred experience. PaRIS findings show a reliance on basic forms of self-management support, such as verbal instructions, while interventions like providing written instructions or referrals to self-management classes are underutilised. Countries should prioritise the provision of written health materials – both digital and printed – tailored to diverse literacy levels and cultural contexts. In addition, they should expand funding and training for healthcare providers to deliver comprehensive self-management programmes, including the provision of curated and high-quality health information.
Patient involvement in decision-making leads to better health outcomes and greater confidence in managing chronic conditions. Policy makers should mandate training for primary care providers on shared decision-making techniques, focusing on engaging patients in their own care. Financial incentives can encourage practices to prioritise patient-centred approaches, ensuring that care plans reflect patient preferences and promote active participation in health management. Integrating such practices into primary care models will empower patients, particularly those with chronic conditions, to manage their health more effectively.
Strengthen the use and communication of care plans and enhance interoperability of electronic health records to improve continuity of care
PaRIS data show low utilisation and inconsistent communication regarding care plans, with significant gaps between patient and provider reports. Healthcare systems should mandate the development and use of personalised care plans for patients with chronic conditions, and policies should promote clear communication about care plans to ensure that patients understand and value their purpose. Countries should develop national guidelines for care planning, ensuring that all primary care practices implement and communicate plans clearly to patients. Regular surveys of patients and providers can help identify gaps in care planning and facilitate targeted improvements to bridge the communication divide.
Continuity of care and care co‑ordination relies on seamless information exchange between healthcare professionals. Despite the high usage of electronic health records, PaRIS data highlight limited interoperability across practices, restricting the seamless exchange of information. Policy makers should prioritise the development of national standards and frameworks for interoperable electronic health record systems (OECD, 2024[36]) to streamline patient care, reduce duplication, and improve care co‑ordination.
Invest in digital health literacy and expand patients’ access to digital tools in primary care
The disparities in digital health literacy, especially among older and less educated populations, hinder equitable access to healthcare services. Investments in user-friendly technologies, such as online booking systems and electronic medical record portals, are essential. Policy makers must also address digital exclusion by offering training programmes for older individuals and less educated groups, equipping them with the skills to navigate digital health tools confidently.
PaRIS data highlights the need to accelerate the digitalisation of primary care to achieve more people‑centred healthcare systems. Progress is uneven at best in the deployment of tools such as videoconferencing, booking appointments online, ordering repeat prescriptions online, and allowing patients access to their electronic medical records.
To advance people‑centred care, healthcare systems must adopt a multi-pronged approach that includes enhancing care co‑ordination, strengthening patient-provider communication, and leveraging digital tools to empower patients. Policies should prioritise co-developing care models in collaboration with patients, integrating their feedback to enhance the co-production of health, and ensuring equitable access to resources, particularly for vulnerable groups. Furthermore, systematic evaluations of patient experiences, aligned with robust data collection initiatives like PaRIS, can guide the design of policies that not only improve care delivery but also foster trust and engagement in healthcare systems. These efforts will be essential to achieving a more inclusive, resilient, responsive, and sustainable approach to healthcare.
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