Exploring patient-centered care delivery in elderly outpatient settings: A scoping review and recommendations for implementation in countries with low and middle income

Background: Patient-centered care (PCC) has emerged as a crucial approach in the healthcare delivery for older adults due to the aging population and the unique challenges they face. Long-term management and patient involvement are particularly relevant in outpatient settings. This scoping review provides a comprehensive overview of existing evidence on PCC for older adults, mapping definitions, elements, stakeholder perspectives, barriers to implementation, and practical models of PCC adoptation. Additionally, it offers actionable recommendations for integrating PCC into healthcare systems in low- and middle-income countries (LMICs). Methods: A systematic search was conducted in PubMed, Web of Science, Scopus, and Google Scholar on 2 August 2024, with no publication year restrictions, to capture the full range of available evidence. We adhered to the JBI methodology for scoping reviews. Data synthesis involved a descriptive approach with findings contextualized to support the integration of PCC into LMIC healthcare systems. Results: From an initial pool of 1474 sources, 76 records were included for data extraction. The majority of PCC definitions shared key themes, including partnership with patients in decision-making, a holistic approach to patient care, and coordination across multiple disciplines. The review revealed that while patients and providers shared the goal of achieving high-quality, personalized care, their perspectives on PCC differed. Providers emphasized systemic efficiency, teamwork, and care coordination, whereas patients valued accessibility, emotional connection, trust, and relational aspects of care. Key barriers to implementing PCC included infrastructural challenges, financial and human resource limitations, transportation issues, and time constraints. Successful models of PCC often involved multidisciplinary teams and community-based collaborations, which were particularly effective in managing chronic diseases in elderly patients. Conclusions: This review highlights the potential of PCC in enhancing the quality of care for older adults in outpatient settings. Building on our findings, a phased approach focusing on older adults with multimorbidity is recommended for LMICs like Iran, with an emphasis on integrating both primary and specialized care. Our proposed seven-dimensional PCC model includes access to care, proactive care, patient empowerment, integration into care pathways, a whole-person approach, coordinated care, and shared decision-making, tailored for LMIC contexts to improve care for elderly patients.