In our recent report Vital Signs: How to deliver better healthcare across Europe, patient engagement and empowerment is included as one of the seven vital signs of a high performing health system.1 During my placement with the Deloitte Centre for Health Solutions, I worked on the final stages of this report publication. One of the quotes from the report that resonates most with me is "If patient engagement were a drug it would be the blockbuster drug of the century and malpractice not to use it".2 Indeed it reminded me of an incident that occurred last year while I was practicing as an adult psychiatrist and psychotherapist in Germany. In sharing this story I hope to demonstrate why patient engagement matters.
My last consultation of the day was a 64 year old patient suffering from severe depression. He instantly caught my attention with his opening remark "I chose not to start the new medication you prescribed." I was immediately concerned about the risks to his health as a result of him failing to adhere to the treatment but also relieved that he appeared to be quite stable.
I asked him why he had chosen not to take the medication. He explained, "I was scared of how it might interact with the medication I'm taking for my heart". I was alarmed. In my mind I wondered how I could have overlooked his heart medication. Co-prescribing the planned new antidepressant medication could in fact have led to a serious patient safety incident which would have been detrimental to the health of the patient and the progress he had been making as well as resulting in high follow-up costs.
My patient went on to explain, "My GP prescribed me some new heart tablets several weeks before my last session with you, doctor, but I didn't remember to tell you when you asked about changes in my medication." I replied that I was glad that his GP had picked up the risks. However he quickly responded that it was not his GP but his granddaughter who had looked up the prescription on the internet and found out that it was not to be taken with his heart medication. She then encouraged him to contact his GP who then advised him not to take the medication I had prescribed.
Like most doctors, I want patients to be involved in their own care and I was glad that my patient's granddaughter questioned his medication, searched online for information and had him contact his GP. Indeed I wish that more of my patients had such engaged families. However, while these actions helped my patient avoid a potential adverse reaction, encouraging her grandfather's non-adherence carried its own risks.
The incident got me thinking about what could help reduce the risks of patients taking control of their own care.
Access to trusted on-line health information
Engaging with information on the internet was entirely natural for my patient's 18 year old granddaughter. Indeed, a recent European survey found that almost eight out of ten people in the 15-39 age group made high use of the internet as a source of health information. Whereas for people in my patient's age group (over 55s) less than a third used the internet for this purpose.3 A key challenge therefore is to encourage patients to make use of quality certified information "that people can trust, make sense of and act on".4
Patient owned access and control over electronic patient records
If only my patient had had a copy of his summarised healthcare record on any of his electronic devices (in this case my patient was even the proud owner of a smartwatch) we could have looked at it together. I would have seen that he had been prescribed heart medication. He could also have used it to directly inform his GP about any medication I prescribed so that both of us could have had fully informed discussions with him. But would we have done so?
Actively engaging patients
On reflection I now consider that when meeting a patient for the first time, every doctor should assess their degree of health literacy and patient activation as a routine part of taking their health history. Indeed, there are tools that can help clinicians with this. For example, using the Patient Activation Measure (PAM®) that assesses a person's ability and preparedness to engage in their own care5 allows clinicians to tailor their communication and reduce risks occurring, rather than trusting the 'lucky' discovery of information necessary for adequate care planning.
Health outcomes should not depend on luck. As a doctor and a potential patient myself, I want the health systems I depend on to enable patients to engage in and co-produce the services on offer through measures that include:
- communication and collaboration with patients as one of the core objectives of education and training of all healthcare staff to facilitate a culture in which patients are seen as members of their own healthcare team
- adequate funding for initiatives that assess and improve health literacy and patient activation
- optimising digital health technology and services to support staff to work differently and provide patients with information, advice and understanding of their condition and the impact and importance of adherence with treatments, based on approved quality standards and fostering informed communication.
In conclusion, patient engagement is not a nice-to-have, but a must have and a measure of a high quality health system. It is fundamental to achieving the 'quadruple aim' of a sustainable health system: improving the experience of care, improving the health of the population, reducing per capita costs and improving the well-being of care teams.6
Footnotes
2. www.hl7standards.com/blog/2012/08/28/drug-of-the-century/.
4. https://www.england.nhs.uk/tis/about/
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