WORKING WITH YOUR DOCTOR’S OFFICE

By Jessie Gruman

April 2, 2014

This interview is the seventh in a series of brief chats between CFAH president and founder, Jessie Gruman, and experts our CFAH William Ziff Fellows who have devoted their careers to understanding and encouraging people’s engagement in their health and health care.

Judith Hibbard notes that ‘People take their cues (about engagement) from medical care, but health professionals are often not aware of the implicit and explicit cues they are sending.

Gruman: What needs to be done to improve the effectiveness of interventions to improve people’s participation in their health and care?

Hibbard: I think there is great potential in trying to link engagement to what’s influential in people’s life kind of like surround sound stereo. We need to find more ways’methods, modeling’to help people understand their role and fulfill it.  This includes media, workplaces, communities, and schools.

It’s clear that one-size-fits-all doesn’t work.  Even for people who are more active, health care is overwhelming.  Breaking it down and taking it slower is easier.

Gruman: How can we get the attention of those who have little interest, willingness or even ability to engage in their care?

Hibbard: There is a segment of the population that doesn’t understand that it is important to play an active role in their health and health care’these are the people who score lowest on the Patient Activation Measure.  Depending on the population, that proportion can be between 15-30% and can be as high as 60%.  This is age-related and slightly gender related.

We tend to tell people they should do X, Y and Z’specific health-related behaviors’but don’t explicitly tell them they will do better if they are more involved in their care.

Frosch did a study the key message that was experimentally conveyed was that you will do better if you are more involved in your care.  They found a dose response being exposed to this intervention increased activation.  We need to be explicit about the benefits of engagement.  If a person doesn’t get this point, he or she won’t pay attention because they don’t see that it is their job, or may not see that it is in their interest.

Gruman: What is the role of the clinician in encouraging/helping people engage in their care?

Hibbard: People take their cues (about engagement) from medical care but health professionals are not aware of the cues they are sending, nor is the delivery system aware of them.

For example, in our Fairview Health System study we were able to link the PAM score with whether the doctor encouraged the patient to use the patient portal and then whether they used it. We found that doctors were more likely to encourage people who were more activated. Among the group that was encouraged, the more highly activated were the ones who used the portal.

This is a reminder that health plans, clinicians, employers and the government offer lots of prompts and tools and services through community and delivery system but we have no idea who they are reaching’and it looks like (here and elsewhere) it’s the people who are already activated who use them.  Because we don’t measure this, we just don’t know.’  Unfortunately, this doesn’t stop us from thinking we are doing fine.