Engaging Patients in Their Care

Dr. Farzad Mostashari, former National Coordinator for Health Information Technology in the U.S., calls patient engagement “the blockbuster drug of the century.

Dr. Joshua Tepper, President and CEO for Health Quality Ontario and Hugh MacLeod, a former Assistant Deputy Minister for Health in Ontario, state in a recent essay1  for Longwoods.com, “it feels that we have reached a ‘tipping point’ in believing that we need to engage patients in their care and in the design of the system.”

As other industries have already discovered, actively engaging the individuals to whom services are delivered not only reduces costs but can also drive better outcomes. The potential for similarly engaging patients as active participants in their care is  significant.

Dr. Judith Hibbard, a Senior Researcher with the Health Policy Research Group at the University of Oregon, has conducted extensive research regarding the various factors influencing patient engagement. To quantify levels of patient engagement, Dr. Hibbard developed the Patient Activation Measure (PAM), a validated survey that assesses the degree to which someone sees themselves as a manger of their health and care.

In one study2, Dr. Hibbard and co-authors found that there was a relationship between patients’ activation scores and the costs to provide health care services. Those patients with the least skills and confidence to actively engage in their own healthcare (those with the lowest activation scores) incurred costs that averaged 8% to 21% higher than those patients with the highest activation scores.

Another example of the benefits of patient engagement is the OpenNotes initiative. Based on evidence from a 12-month study involving more than 100 primary care physicians, OpenNotes is working to give patients access to the visit notes in their health  records.

The OpenNotes study3  found that both patients and healthcare providers derived benefits from the open access to visit notes. Just about everyone who participated wanted to continue beyond the study period. Nearly 90% of the patients indicated that they believed having access to visit notes would affect their decisions when seeking care in the future. The vast majority of patients reported “an increased sense of control, greater understanding of their medical issues, improved recall of their plans for care, and better preparation for future visits.”

One hypothesis the Open Notes study explored was that providing access to visit notes would have “few adverse effects on the doctors’ frenetic work lives.” Only a small percentage of the primary care physicians who participated in the study reported any increase in visit time. Equally important, none of the physicians opted to discontinue sharing visit notes at the end of the study.

While there is considerable interest in patient engagement, a study4  published in the Journal of Participatory Medicine notes that “the term ‘patient engagement’ is at risk of becoming nothing more than a ‘hot buzz phrase’ as it lacks a shared definition.” This same study also notes that patient engagement is “often used as an umbrella term to cover a multiplicity of interactions that patients have with their health care systems.”

What I found most intriguing about the study was its observation that the definition of patient engagement varies depending on the period in which it was developed. According to the study, there are two distinct periods, each with a different focus:

  • 2002 to 2006:  “a major interest was devoted to defining the relational nature of patient engagement as a key component of patient centred medical paradigm.”
  • 2008 to present: “probably due to the onset of the global financial and economic crisis, patient engagement was conceived as a means expected to allow health care systems to prevent unnecessary costs and optimize and rationalize health services’ delivery.”

This latter focus on costs and outcomes is one of several factors driving interest in patient engagement. Patient engagement is viewed by many as a key strategy in achieving the “Triple Aim” approach to healthcare improvement initiatives.

Developed by the Institute  for Health Improvement and adopted by organizations such as the Hamilton Niagara Haldimand Brant LHIN  in Ontario and the Saskatchewan Ministry of Health, the “Triple Aim” approach defines three goals that, when pursued in balance, can lead to improved healthcare outcomes:

  • Improve the health of a defined population.
  • Enhance the patient care experience
  • Reduce, or at least control, the per capita cost of care.

Another major factor driving interest in patient engagement, particularly in the U.S., is the regulations related to the meaningful use of electronic health record technology. These regulations include requirements for healthcare providers to engage patients and their families.

In addition to the regulatory and cost pressures driving patient engagement, patient demand is becoming an increasingly important factor. Numerous surveys clearly show that patients are keenly interested in using technology to interact with their healthcare providers.

Patient engagement,  while compelling, is fraught with obstacles and   barriers. An effective patient engagement strategy involves so much more than deploying a patient portal. It is, perhaps, one of the most demanding healthcare change management challenges. Yet, the benefits are so compelling and the impact on patients so profound that implementing a patient engagement strategy is well worth the effort.

What are your thoughts on the patient engagement? Do you think patient engagement can be transformative?

Please share your thoughts with me at michael.martineau@avenant.ca or on my blog  at ehealthmusings.ca.

http://www.longwoods.com/content/24054

http://healthpopuli.com/2013/02/05/the-more-engaged-a-patient-is-the-lower-their-costs/

http://annals.org/article.aspx?articleid=1363511

http://www.jopm.org/evidence/reviews/2014/06/11/the-challenges-of- conceptualizing-patient-engagement-in-health-care- a-lexicographic-literature-review/

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