Guest posting by Andrew Ta
There are countless issues in healthcare. They range from the external, like patient engagement, to the internal, e.g. electronic health records. From policy, i.e. the affordable care act and debates over universal health insurance, to personal, with concerns over self-image and internal motivation to care about one’s health and wellbeing. That last one, I believe, is top among them, and is, relative to the other issues, low hanging fruit with multiple potential solution and angles from which it can be tackled. Attempts at fixing it will undoubtedly spill over and positively affect other healthcare challenges and thus, it is my belief that such endeavors should be undertaken, in whatever form possible and as soon as possible.
The first step in approaching any problem is to look at previous solutions and research on the issue– a literature review. Already, to many, the process stalls; Coulter (2012) claims that popular belief thinks there is a lack of “published evidence on the likely effectiveness of patient engagement strategies.” However, she is able to compose a short review that walks through many such strategies, explaining the potential benefits and drawbacks of each.
Coulter establishes three goals these strategies attempt to accomplish:
- Increase patient health literacy by encouraging them to read, understand, and act on health information
- Encourage shared decision making, in which the patient works together with clinicians to select appropriate treatment and management options
- Enable quality improvement by having patients provide feedback on health care processes and outcomes
The first two, health literacy and shared decision making, work together to empower patients. It’s a necessary step, especially given that, according to Barry (2012), medical advances, while improved health outcomes, distanced patients from their physicians. This distance has created a healthcare environment where patients and their families are excluded from key decisions and discussions, and thus remain uninformed about how their problems are being managed, or how to navigate the numerous care options available to them thanks to modern medicine.
Strategies to deal with these two issues include avoidance of typical education programs since traditional didactic methods have found to be ineffective. Instead, patients must feel encouraged and motivate themselves to determine their own goals for behavior change, instead of simply relying on or complying with a professional’s agenda. Coulter notes the imperativeness of making progress towards these goals, emphasizing how inactive patients, by deferring to clinicians, continue to remain inactive in a sort of negative feedback loop. Tools by which to encourage patients that have previously shown effectiveness include consultation prompt sheets and patient information material, printed and electronic, pre-operative and pre-discharge. Implementation such material is a low cost endeavor and does not require massive policy-level changes, and that material can be fine-tuned under the aforementioned third goal.
That third goal, of patients providing feedback, is key in the critique and revision process that can help in developing workable, effective strategies. Coulter states that although gathering such feedback is required, it is not sufficient; action must be taken on it. Such a model is described in the HIV treatment process by Mugavero (2012), who also provides frameworks and an engagement continuum, examples of how continuous feedback can clarify direction and help maintain continuous improvement.
A proposed feedback loop for identifying where to improve patient care engagement (Mugavero, 2012). TLC+ refers to testing, linkage to care, plus anti-retroviral therapy.
The continuum engagement in care, as established by the Health Resources and Services Administration (Mugavero, 2012).
Mugavero also discusses various model programs and systems use to improve patient engagement, although in relation to HIV. Some factors he lights in an ideal model include culturally appropriate services, a climate of acceptance for all individuals, and strong patient-provider relationship. He looks at case management intervention, in which newly diagnosed patients are linked up with case managers who can give them more personal attention, a navigation model, which pairs up peers with similar cultural and socio-economic background to help navigate the healthcare system, and an orientation model, where trained staff would meet individually with patients shortly after initial contact to identify and troubleshoot anticipated barriers to their care. The models he covers require much larger infrastructure, but that should not be an excuse from working towards what can be accomplished and reevaluating goals and progress measures as they come up.
With the host of suggested models and solutions out there, and with the amount of framework and research, it’s time to move into the realm of implementation.
References
Barry, M. J., and S. Edgman-Levitan. “Shared Decision Making–Pinnacle of Patient-Centered Care.” N Engl J Med 366.9 (2012): 780-1. Print.
Coulter, A. “Patient Engagement–What Works?” J Ambul Care Manage 35.2 (2012): 80-9. Print.
Mugavero, M. J., W. E. Norton, and M. S. Saag. “Health Care System and Policy Factors Influencing Engagement in Hiv Medical Care: Piecing Together the Fragments of a Fractured Health Care Delivery System.” Clin Infect Dis 52 Suppl 2 (2011): S238-46. Print.