Abstracts

Rationale: In healthcare the term codesign refers to patients and carers working in partnership with staff to improve services (Robert et al, 2015). Such partnerships reflect a practice where both the consumer and the provider of a service/product work together, in partnership, to make something happen. These concepts are inherent in models of patient-centred/person-centred healthcare reform.  Patient-centred/person-centred care (PCC) is high on the health reform agenda.  Its delivery requires the active participation of patients and healthcare professionals (HCP) to explore and co-design meaningful care processes (Lord & Gale, 2014). While collecting data on “patient experiences” has become somewhat ubiquitous, effectively using this information to design safer more patient-centred services remains challenging.Participatory Action Research (PAR) can facilitate closer working partnerships between people who receive and deliver health care. PAR brings HCP's and patients together in groups to examine issues for attention and devise and apply solutions that will iteratively and incrementally create conditions for advancing PCC. Using epilepsy as a probe, the National Clinical Care Programme for Epilepsy in Ireland is delivering a project entitled “Epilepsy Partnership in Care (EPiC)”. The  EPiC project aims to 1) realise the promise of PCC in the management of  epilepsy 2) develop a fine-grained understanding of the provision of services and the experience(s) of living with epilepsy 3) identify and act on opportunities for improving PCC.   Methods: Ethnographic Fieldwork: engages with patients, family and carers, and HCP's to help understand the culture of epilepsy care and the nature of transactions between those involved in the provision and receipt of clinical care and services.Interviews and Focus Groups:  are exploring perspectives on what counts as PCC, to what extent there is a shared understanding of the concept and defining the barriers/facilitators to achieving it.Participatory Action Research: is bringing HCP's and patients together in groups to examine issues for attention and devise and apply solutions that will iteratively and incrementally create conditions for advancing PCC. Results: EPiC is a nationwide research project with ethnography, interviews and focus groups taking place at multiple locations across Ireland within specialist epilepsy centres, in patients’ homes and in the community (Figure 1). The exploration has elucidated the full range of actors involved in the epilepsy ecosystem, and the nature of their interactions with each other and their surroundings. Strengths and weaknesses of patient-centeredness in the epilepsy domain have emerged as are opportunities for advancing PCC through a balanced patient-provider partnership.Four such PAR teams (Community Care; Education; Adolescent Transition; Telephone Advice) have been formed (Figure 2). The teams are made up of people who receive and deliver epilepsy care. Each team is iteratively and incrementally exploring the meaning of PCC while simultaneously identifying both opportunities for and challenges to achieving sustainable PCC.  Conclusions: The EPiC project is working to realise more fully the promise of PCC in the management of epilepsy through a fine-grained understanding of the spaces between the provision of health services and the experience of living with the condition. PAR is promoting continuous improvement and implementation of sustainable patient-centred care by rebalancing the patient-HCP relationship. Such partnership can shift the healthcare professionals role from “experts that care for patients to enablers that support patients to make decisions”.  Funding: N/A