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Patient and family engagement strategies have shown such promise that they have been incorporated into the majority of recent efforts to improve healthcare quality. CMS describes patients and their families as “essential partners in the effort to improve the quality and safety of health care.”

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The American Institutes for Research (AIR) defines patient and family engagement as patients, families, caregivers, and health providers working in active partnerships at various levels across the healthcare system to improve health and healthcare. AHRQ defines patient engagement as “the involvement in their own care by individuals (and others they designate to engage on their behalf), with the goal that they make competent, well-informed decisions about their health and health care and take action to support those decisions.”

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With the focus on healthcare value, patient engagement and education have gained prominence and are recognized as crucial components of high-quality healthcare services and better patient outcomes. And when patients are engaged, they are more likely to understand what they are being taught about their medications and to ask questions when they do not.

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Other organizations have different definitions of patient and family engagement; however, the key concepts are similar, and all emphasize that specific actions must be taken by patients, providers, and others in healthcare systems to create collaborative partnerships to improve both the individual’s health and the healthcare system. Patient engagement is now a key quality component in value-based and alternative payment incentive models, such as ACOs and PCMHs, and is key to new federal initiatives that explore ways to help patients better understand medical treatment options and share in healthcare decision making. It is important to note that, to be most effective, patient engagement should not be considered a one-time event, but rather part of an ongoing conversation.

 

KEY FACTS

 

A.  Incidence of Non-Engagement

A Deloitte report showed the following:

• One in three healthcare consumers is currently disengaged, reporting less need for care, preventive action, interest in resources, and financial preparation.

• There is an increase in the number of “passive” healthcare consumers.

• One in two healthcare consumers follows a “passive patient” approach, relying on doctors for decisions, preferring standard care, and adhering to treatment. Another cause for concern is that the number of “active” healthcare consumers is in decline. Two in five healthcare consumers are classified as more “active” in managing their health and navigating the healthcare system. However, this segment has experienced a decrease, from 51% in 2008 to 44% in 2012.

According to a study in the Annals of Internal Medicine, patients who are engaged and have a clear understanding of their after-hospital care instructions, including how to take their medicines and when to make follow-up appointments, are 30% less likely to be readmitted or visit the emergency department than patients who lack this information.

 

B.Factors for Patient Non-Engagement

There are many factors that contribute to lower levels of engagement, including the recession, which caused many families to have fewer resources to spend on healthcare. Although the economy has recovered in many parts of the country, many families are still experiencing economic hardship. Some families have to choose between food, shelter, medical costs, and medications; therefore, getting medications often drops to the bottom of their priority list.

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In addition to socioeconomic factors, there are also cultural barriers to patient engagement. These include racial and ethnic cultures that have a history of mistrusting medicine and healthcare and also have practices of traditional healing, prayer, meditation, or herbal supplements that they feel their providers will not support. Patient and family engagement can be viewed as a means of health equity, where providers and systems focus on patient-centered care, and patients and families partner in a way they choose.

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Research shows that patients and providers support engagement and believe that increased involvement in healthcare by patients and families can lead to improved experiences and outcomes. In 2012, 63% of healthcare consumers were dissatisfied with the US healthcare system, giving it a report card grade of C, D, or F. Healthcare organizations interested in boosting their scores should consider the benefits of patient and family engagement. One study found that patients who were highly engaged were 10 times more likely to report high patient satisfaction scores when compared to patients who were not engaged.  Increasing levels of patient and family engagement may lead to increases in patient satisfaction and experience of care scores.

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In addition to becoming more involved in their own care and well- being, patients and families can also be involved in the governance  and oversight of healthcare organizations and systems. Healthcare systems implementing patient engagement efforts have seen reductions in medical errors, hospital-acquired infections, and other serious safety events.

 

Despite initial awareness of the importance of patient engagement, the number of disengaged patients has grown. A report by the Deloitte Center for Health Solutions found the number of disengaged patients increased from 23% in 2008 to 34% in 2012, with disengagement defined as “reporting less need for care, preventive action, interest in resources and financial preparation.” The report found that patients in this group “are simply not engaged because they don’t see the need.” At the same time, the report found that many healthcare consumers  are, in fact, motivated to engage more fully based on individual circumstances, including experience with a new medical problem or disruption in employer-sponsored coverage. The report suggests that the trend toward greater patient engagement will increase along with these circumstances.

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For More information about Medication Engagement and Education, see the resources below: