If patient engagement were a drug, it would be the blockbuster drug of the century and malpractice not to use it.” Leonard Kish1

The model of health care delivery has changed dramatically in recent decades.  Currently, focus is centred on increasing efficiency and care co-ordination while maintaining healthcare quality.  Over the years there have also been significant shifts in how individuals perceive their health, and their roles and responsibilities with respect to personal health.  The result is that patients today face an increasingly complex process of seeking and using health care services.  To benefit optimally from available services, patients must now participate in their care – that is, patients must be active and engaged2 – and this requires extensive skills, knowledge, energy, and motivation2,3.  An excerpt from a recent editorial on patient engagement in health care summarizes nicely the demands placed on patients3:

“Individuals are expected to decide whether and when to seek care, which plans and providers meet their needs, how to manage their health, and how to cope with sometimes conflicting advice from providers and friends and family, all amplified by advances in communications and information technology.”

Another term commonly used for patient engagement is patient activation, derived from the Hibbard et al.’s Patient Activation Measure (PAM)4.  The PAM specifies four stages of patient activation that occur in succession, namely: i) believing the patient role is important, ii) having the confidence and knowledge necessary to take action, iii) actually taking action to maintain and improve one’s health, and iv) staying the course even under stress.  The PAM is essentially developmental model of patient engagement that provides a means of assessing engagement for research or intervention purposes.  The other widely cited definition of patient engagement comes from the Engagement Behavior Framework2.  The Engagement Behavior Framework2 outlines ten categories of behaviours that individuals must perform to fully benefit from their care:  1) Find safe, decent care, 2) Communicate with health care professionals, 3) Organize health care, 4) Pay for health care, 5) Make good treatment decisions, 6) Participate in treatment, 7) Promote health, 8) Get preventive health care, 9) Plan for the end of life, 10) Seek health knowledge.   This framework is useful because it highlights the size and scope of the challenges facing individuals who want and/or need to participate in their health care.  This can be used to design interventions and policies aimed at helping and supporting individuals to become more engaged in their healthcare.

On an individual level, what does this mean for practitioners who want to improve engagement of their patients?  The practitioner should focus on the physician-patient relationship, specifically improving the dynamics of communication.  Effective strategies include: i) improving health literacy, ii) using a shared decision making model, and iii) improving the quality of care processes (e.g., gathering systematic feed-back on patients’ experiences)5.

What about health IT applications, which are increasingly a part of today’s healthcare environment – how can these tools be leveraged to facilitate patient engagement? An interesting approach to how we may be able to gauge whether a health IT application is successful in engaging patients was presented at a recent conference whereby patient engagement was mapped onto the Information Systems (IS) Success Model6.  The idea can be simply summarized as: if the quality of the health IT is good (including: system quality, information quality, and service quality) the user will be satisfied with the system and therefore use the system, resulting in better outcomes.  This highlights the key elements to design of a useful health IT application, and creating a product that patients want to use is crucial to patient engagement.  Another health IT-related tool for increasing patient engagement that has received a lot of recent attention is that of gamification (i.e., incorporating elements of gaming into various health applications) – a topic to be discussed in more detail in an up-coming blog post.

References:

  1. Kish L. 2012. The blockbuster drug of the century: an engaged patient. Available at: http://www.hl7standards.com/blog/2012/08/28/drug-of-the-century/, accessed on June 20, 2013.
  2. Center for Advancing Health, 2010. A new definition of patient engagement: What is engagement and why is it important?
  3. Clancy CM, 2011. Patient engagement in health care (editorial). HSR: Health Services Research 46(2): 389-393.
  4. Hibbard JH, Stockard J, Mahoney ER, Tusler M. 2004. Development of the Patient Activation Measure (PAM): Conceptualization and measuring activation in patients and consumers.  HSR: Health Services Resea4rch 39(4): 1005-1026.
  5. Coulter A, 2012. Patient engagement – what works? J Ambulatory Care Manage 35(2): 80-89.
  6. Zhang C, Kamal M. 2013. A lens into investigating patient engagement using health information technology. Proc Southern Assoc Info Systems Conference; Savannah, GA; March 8-9, 2013. Paper 41. http://aisel.aisnet.org/sais2013/41
  7. Hibbard JH, Greene J, Tusler M. 2009. Improving the outcomes of disease management by tailoring care to the patient’s level of activation. Am J Managed Care 15(6): 353-360.