Empowering patients for better care

When people get actively involved in their own healthcare, better decisions can be made, and quality of care and patient outcomes can improve too. Sarah Harrop explores why patient empowerment matters and how to achieve it.
Why is patient empowerment important?
“For most of the past 3,000 years, the basic style of doctoring can be described as ‘beneficent paternalism’… Doctors have acted on behalf of, and for the good of, their patients. They have also wielded power over them.
This role, which until recently has been taken for granted by society, produces behaviour that is disease-oriented with a strong tendency towards authoritarianism.” says Sarah Elizabeth Burke from the University of Birmingham’s School of Education.
Until relatively recently, it was often thought that telling patients about the uncertainties and limitations of treatments they were being prescribed would undermine their faith in health professionals. Patients would be given information selected to encourage them to consent to the medical professional’s decisions, rather than to focus on a patient’s needs for reaching a balanced, well-informed decision about their care.
Research suggests, though, that when there’s active patient participation in healthcare, there may be better patient outcomes from treatments and interventions. Results from one study in the Journal of Diabetes Research, for example, suggested that empowering patients may lead to better clinical outcomes in diabetes.
Patient empowerment, which the World Health Organization (WHO) defines as ‘a process through which people gain greater control over decisions and actions affecting their health’ is a key theme within global health and social care strategies. It’s widely acknowledged as a positive development by healthcare services and policy-makers and is now part of many healthcare systems. Empowerment of patients is a central element in the EU Health Strategy and is supported and endorsed by the National Health Authorities, EU bodies, European Council and the Euro-World Health Organisation.
The days of patients passively deferring to the decisions of clinicians are becoming a thing of the past and more active participation in people’s own care now increasingly contributes to better healthcare quality.
The benefits go both ways, too:
“Patients as active partners in their personal healthcare are key drivers to reducing costs, securing an effective usage of resources, and ensuring patient-provider satisfaction,” writes Dr Emily Hickman and colleagues in a paper published in BMC Health Services Research.
Their literature review of 17 studies suggested that patient-centredness can enhance patients’ competencies, attitudes, and behaviours towards their personal healthcare. It also concludes that allowing patients to become more empowered leads to them taking a more active role in their treatment and being more likely to stick to the treatment they have been prescribed.
And another study in PLoS One has a similar finding, suggesting that patients who are actively involved in their research are more likely to keep taking the medicines or interventions they’ve been prescribed.
How exactly do you empower patients?
According to Wolters Kluwer, a global IT provider for healthcare professionals, for a person to actively participate in their own care they need four things:
- Information: if a patient knows about their health condition and the treatment options available, they can make informed decisions with their doctor.
- Access: patients need access to resources to manage their care, from affordable medications to high quality information and educational resources on their disease or condition.
- Engagement: active patient involvement in decision-making about their treatment is empowering.
- Agency: being able to act on decisions in the healthcare process that align with the patient’s goals and values puts empowerment into action.
A patient’s care plan works best when it is a well-balanced collaboration between healthcare provider and the person being treated, driven by mutual respect.
New York-based physician Dr Tayler Sindhu says: “Empowerment benefits you as a doctor, too. You want to deliver high-quality care, and your patients want to feel heard and respected. When they are active participants in care discussions, your mutual goals align and everyone’s satisfaction improves.”
How digital health can help
A positive development in patient engagement and patient satisfaction over the past few years has been the rise of smartphone apps and wearable devices which can help track and manage long-term conditions. Examples include continuous glucose monitoring apps for diabetes, like Nutrisense and Glucose Buddy, and the FibriCheck advanced heart rhythm app for atrial fibrillation.
With these digital tools at their fingertips – literally – many patients now have the critical information they need for self-management of their conditions and active participation in their own care.
Healthcare apps can also encourage people to set goals and monitor their own progress towards them, creating incentives to self-manage their health and making the consequences of not doing so feel more tangible. What is more, patients can have their own data to hand at medical appointments, which is useful for prompting questions and asking about any concerns.
Online access to health records
Data suggests an increasing acceptance of, and reliance on, digital technologies within GP practices and communities. By November 2022, the NHS App had over 28 million sign-ups and was being used by people an average of 2.7 million times a week.
“Patients are playing a more active role in managing their health and care. The drive to improve patient empowerment has been gaining momentum in recent times and providing visibility of their health information is a part of this movement,” adds Dr Collison.
Case study: NHS England’s digital innovations in diabetes programme empowers patients to manage their own health
Diabetes is a progressive, chronic health condition that is largely self-managed. Recognising that face-to-face primary care interventions for diabetes don’t always work for everyone, the NHS is looking at digital technologies as a way to improve patient experience and health outcomes, as well as for delivering NHS services more efficiently.
The NHS digital innovations in diabetes programme is establishing the evidence base for using digital approaches to care and encouraging service users living with diabetes to use them.
One aspect of the programme is evaluating the effectiveness of digital behaviour change interventions for preventing type 2 diabetes in people who are at increased risk of the disease.
Another arm of the project offers online support for people with diabetes to empower themselves and their carers by boosting their knowledge and skills. The aim is to help motivate them to take control of their condition and self-manage it effectively.
There is also a ‘decision support tool’ to support shared decision-making conversations, helping patients decide between the different technologies available to manage diabetes. The tool provides evidence-based information about the associated benefits and risks of each and helps patients to consider what matters most to them in relation to the possible outcomes — including doing nothing.
And for people living with type 1 diabetes – a disease that people are born with and have to self-manage throughout their lives – there’s a structured education initiative. This includes the MyType1 Diabetes free digital resource that offers tailored advice, information and videos created by NHS experts and patients, as well as the DigiBete App for young people living with type 1 diabetes which allows diabetes teams to send relevant information about managing the disease at home along with care plans and future appointments.
Nursing care that empowers patients
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