For years, the industry has been buzzing about increasing patient engagement. Questions like “How do you do it?” and “Why is it necessary?” have come up. Of course, it seems fairly self-evident that to improve something as personal as your own health you would need to be actively engaged in the process. Yet, it doesn’t seem that within certain populations engagement has improved in any measurable way. The medical industry recognizes the importance of patient engagement. Many physicians, health organizations and activist groups work towards the mission of enhancing it but do patients really understand it? Participation inherently requires understanding and ownership of the concept itself. While many physicians and organizations are working towards this end, it can feel like the gap hasn’t closed by much.
To really increase patient engagement, we need to help them obtain the “knowledge, skill, and confidence to manage one’s health and health care.” A report from the University of Oxford Department of Public Health mentions that this includes reading, understanding and acting on health information (health literacy). It also includes working together with clinicians to select appropriate treatments or management options (shared decision making) and providing feedback on health care processes and outcomes (quality improvement). This can be very difficult for people who are accustomed to “letting their doctor handle it.”
It’s no coincidence that the most challenging populations to engage are also the highest-risk, highest-cost populations.
We see this every day when speaking with participants in our Chronic Care Management program. When patients hear from a nurse on a monthly basis, they are kept engaged, their care is more reliable and consistent and they are able to preempt and prevent additional health issues. And when it comes to outcomes the engagement shows those who joined the program were hospitalized 66% less than those who opted out.
For patients who are not engaging, the good news is that can (and should) change. Specific interventions can be made to increase engagement. Consistent communication and health education are important. Patients often do not have a full understanding of all that is discussed with their doctor. Oftentimes, physicians are limited with the amount of time they have with the patient in-office. Services offered outside of regular in-office care, like the program we mentioned above, can help boost patient engagement.
Some practices focus solely on technology like patient portals to increase engagement but access to health records likely isn’t enough. They benefit more from enhanced communication and education. Effective physician-patient communication creates improved patient health outcomes. After conducting four global case studies, HealthAffairs.org writes that: “Education will drive changes in behavior across the levels of engagement for individuals and families and also for health care professionals, who need to learn new skills for partnership and communication. ”
Patient health and engagement are also influenced at the community health level. For example, transportation and access to pharmacies and exercise facilities play a part in patient health. Sometimes patients face barriers to accessing medical care and interventions are needed. Care management programs can help in this way by connecting the patient to resources in their local community.
To improve patient outcomes through engagement we not only need to focus on education and communication – but also consistency – or continuity of care. For example, after patients have an in-office visit or a hospital stay, follow-up care is important. Sustained continuity of care is associated with patient satisfaction, decreased hospital visits, and improved receipt of preventive services. This is especially important for high-risk patients, like those with chronic conditions.
True patient engagement requires more than an app or a fully-staffed call center, though this is common for some organizations that provide care management. Implementing new technology or a call center model is not always in line with providing warm “care”. Try as they might, the environment doesn’t necessarily lend itself to warm and caring conversations. That being said, with telemedicine offering a clear-cut opportunity to provide ongoing touchpoints outside of the office, the healthcare industry would be remiss to not find a way to leverage the advances in technology while providing the same level of high-quality care found in the practice. One way around this is to utilize remote nurses working from their homes who are able to provide warmer, more focused communications, and thereby enhance patient activation and engagement.
A big part of patient engagement is goal setting. The goal may be suggested by either the patient or the provider and it gives the patient a reachable measure to agree to and strive for. The patient’s care provider can check on them on a regular basis to ensure they are progressively working towards their goal and provide them ways to reach that goal.
For example, for a patient with diabetes who wants to lower their blood pressure, it may be helpful to limit sodium and alcohol intake. The patient may be more likely to do so if this is communicated to them consistently and they feel they are being held accountable for it. The goal-setting also allows them to measure where they’re at and see where they need to be. A big part of patient engagement in self-management. Patients have to take an active part in managing their own health in order to experience positive clinical outcomes. Sometimes, patients need more education in order to understand what they should be managing. When patients are provided with information and materials, they have a better understanding of what to look out for and what to do if something isn’t right.
The goals that patients strive for once they’re engaged should progressively lead to better health, not only for the individual but universally. As more patients become engaged and begin to improve their health, we will begin to see a healthier population overall.
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