The Dartmouth Institute of Health Policy and Clinical Practice, Lebanon, New Hampshire, USA.
Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
BMJ Open. 2018 Oct 31;8(10):e023068. doi: 10.1136/bmjopen-2018-023068.
If patient engagement is the new 'blockbuster drug' why are we not seeing spectacular effects? Studies have shown that activated patients have improved health outcomes, and patient engagement has become an integral component of value-based payment and delivery models, including accountable care organisations (ACO). Yet the extent to which clinicians and managers at ACOs understand and reliably execute patient engagement in clinical encounters remains unknown. We assessed the use and understanding of patient engagement approaches among frontline clinicians and managers at ACO-affiliated practices.
Qualitative study; 103 in-depth, semi-structured interviews.
Sixty clinicians and eight managers were interviewed at two established ACOs.
We interviewed healthcare professionals about their awareness, attitudes, understanding and experiences of implementing three key approaches to patient engagement and activation: 1) goal-setting, 2) motivational interviewing and 3) shared decision making. Of the 60 clinicians, 33 were interviewed twice leading to 93 clinician interviews. Of the 8 managers, 2 were interviewed twice leading to 10 manager interviews. We used a thematic analysis approach to the data.
Interviewees recognised the term 'patient activation and engagement' and had favourable attitudes about the utility of the associated skills. However, in-depth probing revealed that although interviewees reported that they used these patient activation and engagement approaches, they have limited understanding of these approaches.
Without understanding the concept of patient activation and the associated approaches of shared decision making and motivational interviewing, effective implementation in routine care seems like a distant goal. Clinical teams in the ACO model would benefit from specificity defining key terms pertaining to the principles of patient activation and engagement. Measuring the degree of understanding with reward that are better-aligned for behaviour change will minimise the notion that these techniques are already being used and help fulfil the potential of patient-centred care.
如果患者参与是新的“重磅炸弹药物”，为什么我们没有看到显著的效果？研究表明，激活的患者有更好的健康结果，并且患者参与已经成为基于价值的支付和交付模式的一个组成部分，包括责任医疗组织（ACO）。然而，ACO 中的临床医生和管理人员对患者参与临床接触的理解和可靠执行程度仍不清楚。我们评估了 ACO 附属实践中的一线临床医生和管理人员对患者参与方法的使用和理解。
定性研究；对 103 名进行深入的半结构化访谈。
在两个成熟的 ACO 中采访了 60 名临床医生和 8 名管理人员。
我们采访了医疗保健专业人员，了解他们对实施三种关键患者参与和激活方法的意识、态度、理解和经验：1）目标设定，2）动机访谈和 3）共同决策。在 60 名临床医生中，有 33 名进行了两次访谈，共进行了 93 次临床医生访谈。在 8 名管理人员中，有 2 名进行了两次访谈，共进行了 10 次管理人员访谈。我们对数据采用了主题分析方法。
受访者认识到“患者激活和参与”一词，并对相关技能的实用性持有利态度。然而，深入探讨发现，尽管受访者报告他们使用了这些患者激活和参与方法，但他们对这些方法的理解有限。
如果不了解患者激活的概念以及共同决策和动机访谈的相关方法，在常规护理中实施似乎是一个遥远的目标。ACO 模式中的临床团队将受益于明确界定与患者激活和参与原则相关的关键术语。通过衡量理解程度并提供与行为改变更好匹配的奖励，可以减少这些技术已经在使用的观念，并帮助发挥以患者为中心的护理的潜力。
