Potential benefits of “well engaged patients” are akin to those from a blockbuster drug, say experts

BMJ 2013; 346 doi: (Published 08 February 2013) Cite this as: BMJ 2013;346:f886
  1. Bob Roehr
  1. 1Washington, DC

Patient engagement could become “the blockbuster drug of the century,” researchers have said. This was because well informed and engaged patients were better at self management and were associated with lower healthcare costs, they told a forum on the topic held in Washington, DC, to unveil the February issue of Health Affairs, which focuses on patient engagement.1

“We believe that outcomes of quality, safety, and cost will be improved—and improved in a sustainable fashion—by meaningfully focusing on patients and their families,” said George Bo-Linn, chief program officer of the Gordon and Betty Moore Foundation, which aims to “create positive outcomes for future generations” in the San Francisco Bay area and elsewhere.

But achieving that potential “requires us to change fundamentally our perspectives, structures, and processes,” he said, and to use “a systems engineering approach to make healthcare more efficient and more effective.”

The US assistant secretary for health, Howard Koh, said, “Only about 12% of Americans are proficient in completing tasks that are essential to successfully navigating the healthcare system. If you are uninformed, you are less likely to use preventive services and manage your conditions well.”

Doctors overestimated patients’ understanding of their condition and their grasp of the information given to them, Koh told the forum. “We assume that they understand what we are saying,” in describing their condition and the steps they should take toward their own care, “when in fact they often do not.”

Koh embraced a new paradigm, a “health literate care model,” that takes a systems approach alongside the “assumption that everybody is at risk of not understanding.” A key element of this was the “teach back method,” where patients are asked to explain back to the care provider what they have learnt, their understanding of their own condition, and the options available to them. “It is important to start where the patients are. It is the only way to engage them and activate them,” Koh said.

In one of the articles on the topic in Health Affairs Judith Hibbard, a health policy researcher at the University of Oregon, reviewed the literature on patient engagement and found strong evidence that patients who were actively engaged in their own healthcare were less likely to be hospitalized or to need to visit an emergency department and that their biometrics were much more likely to be normal.2

Such patients also expressed better experiences of care, said Hibbard. “One possible interpretation is that patients who are more skilled are more able to get what they need from their providers,” she said.

“Patient engagement is an unnatural act,” said Robert Nease, chief scientist at Express Scripts, a pharmacy benefit management organization. The human brain “is wired for inattention and inertia,” so information needed to be used to create “system defaults” that promoted the optimal course of action while still allowing patients to choose otherwise, he said. For example, default information could help direct patients toward use of generic drugs and delivery of drugs by mail instead of retail dispensing, as these were more cost effective ways to refill prescriptions.

Similarly, in birth control, all options have roughly similar effectiveness when used properly, but a decision tree has helped many young women choose an intrauterine device as the best option for them, he said.


Cite this as: BMJ 2013;346:f886