Keywords: Management paradigm, rural healthcare, long term conditions

Background:

Primary care in England plays a crucial role in managing long-term care for patients with ongoing medical conditions. The Quality and Outcomes Framework (QoF) encourages healthcare practitioners to meet a minimum standard of care. However, it may not always reflect accepted best practices or a holistic approach, and it does not encompass all medical conditions. Traditionally, healthcare professionals (HCPs) are trained to cure, treat conservatively, or provide palliative care. This focus often follows a restorative paradigm in healthcare management, which may not fully align with the needs of patients suffering from chronic conditions, such as COPD.

Research questions:

To provide an alternative paradigm approach to delivering best-practice healthcare in a rural community with a high prevalence of chronic medical conditions.

Method:

To co-opt a goal-directed paradigm for enhancing quality of life to reduce processes detrimental to physical, psychological or social well-being by addressing health risks, symptoms, complications, function, education and support. It must be acknowledged that there are differences between the restorative paradigm and times when they should be used in conjunction.

Results:

According to the Dutch proverb, “An ounce of illness is felt more than a hundredweight of health.” Patients need support to ensure their safety, freedom from danger, integrity (both functional and structural), control over their physical and social environments, self-worth, mental well-being, and hope. This framework of health and disability awareness supports an approach that shifts the focus to be patient-oriented, prioritising both outcomes and processes. Appropriate outcome measures can be used as required.

Conclusions:

This alternative approach is crucial for managing primary care, especially in rural areas where most healthcare is delivered locally. It is founded on the evaluations of HCPs concerning the issues at hand and the desired outcomes, which are collaboratively determined with the patient. Additionally, this approach can be integrated with a restorative model for addressing reversible events.