Rx For The ‘Blockbuster Drug’ Of Patient Engagement
2013; Project HOPE; Volume: 32; Issue: 2 Linguagem: Inglês
10.1377/hlthaff.2013.0037
ISSN2694-233X
Autores Tópico(s)Healthcare Systems and Technology
ResumoFrom the Editor-In-Chief Health AffairsVol. 32, No. 2: New Era Of Patient Engagement Rx For The ‘Blockbuster Drug’ Of Patient EngagementSusan DentzerPUBLISHED:February 2013Free Accesshttps://doi.org/10.1377/hlthaff.2013.0037AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSPatient engagementOutcomes researchShared decision makingEven in an age of hype, calling something “the blockbuster drug of the century” grabs our attention. In this case, the “drug” is actually a concept—patient activation and engagement—that should have formed the heart of health care all along. The topic of this thematic issue of Health Affairs , patient engagement is variously defined; the Institute for Healthcare Improvement describes it as “actions that people take for their health and to benefit from care.” Engagement’s close cousin is patient activation—“understanding one’s own role in the care process and having the knowledge, skills, and confidence to take on that role,” as Judith Hibbard and coauthors explain. More holistic definitions broaden these concepts further, describing patients and families working with providers all across health care, in such areas as patient-centered outcomes research. Two articles in this issue, including Entry Point, examine engagement in the “ultimate conversation” about the end of life.Achieving The PotentialWherever engagement takes place, the emerging evidence is that patients who are actively involved in their health and health care achieve better health outcomes, and have lower health costs, than those who aren’t. Thus, patient engagement and activation are increasingly understood to be distinguishable factors in achieving the Triple Aim (hence, the “blockbuster drug” designation by Leonard Kish, a health information technology consultant). The challenge is encouraging patients and providers alike to embrace engagement and achieve its full potential to improve health and care.A number of articles place the onus on care providers to “meet patients where they are” and build on their often limited initial capacity to engage. Noting that many patients struggle to understand even basic health information, US Assistant Secretary for Health Howard Koh and colleagues call for a “health literate care” approach that would combine strategies to improve health literacy with the famed Chronic Care Model.The model would take as a given that every patient is at risk of “not understanding their health conditions or how to deal with them,” and that the complexity of the health care system “challenges virtually everyone,” the authors write.Shared Decision MakingOther articles describe challenges and opportunities in shared decision making—or, as detailed by Jaime King and Benjamin Moulton, the process of presenting treatment options to patients, providing a full picture of benefits and risks, encouraging deliberation, and eliciting patients’ care preferences. Demonstrations at Seattle-based Group Health and elsewhere have already shown that fully informed patients often choose less invasive and lower-cost treatment than their doctors recommend—and that variation in practice patterns among different physicians also narrows as a result.But while many physicians have bought into shared decision making, others haven’t. Grace Lin and coauthors describe a largely unsuccessful attempt to spread the use of decision aids—typically, brochures or videos that spell out pros and cons of various treatment options and can lay the groundwork for discussions between patients and physicians. In their case study of five primary care practices in California, the effort ran into a number of obstacles—including some physicians’ reluctance to give up their traditional decision-making roles, their lack of training in communication, and their complaint that they simply lacked the time.Obstacles And BarriersIf clinicians’ attitudes sometimes stand in the way of patient engagement, so, too, can patients’ tendencies. Roseanna Sommers and coauthors explore the willingness of focus groups of patients to engage in discussions with clinicians about the costs of nearly comparable care options. Focus-group members’ reactions ranged from delusion to denial. Patients revealed a widespread belief that more expensive care is always better, and even a sense that getting costly care was “payback” for being gouged by health insurers. Most of all, they abhorred the thought that doctors should ever talk about costs. Shifting public attitudes to having reasonable discussions about health costs clearly has a considerable way to go.We are grateful to the organizations whose support made this issue possible: the Robert Wood Johnson Foundation, the Gordon and Betty Moore Foundation, the Patient-Centered Outcomes Research Institute, and the California HealthCare Foundation. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics Citations: Crossref 106 History Published online 1 February 2013 Information Project HOPE—The People-to-People Health Foundation, Inc. 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