Recruting Office Patients into a Participatory Model of Healthcare Delivery

Participatory medicine is defined in the following way:  a model of medical care in which the active role of the patient is emphasized. The term participatory medicine has been used...to mean one or more of four interrelated ideas:

• A group of people who suffer from a chronic disease form a community (often an online community, a support group) to share information and mutually support each other.
• Members of a patient community (or members of a community disproportionately affected by a disease) play important roles in community health decision-making.
• Patients [are required to] play a role as part of collaborative "treatment teams" addressing their diseases.
• A patient is "mindfully" involved in treatment, by making behavioral changes, meditating, or similar acts.

I am personally very enthused about this concept (see, for example: "Participatory Medicine" and Its Relationship to Clinical Lab Testing). Part of my enthusiasm is related to the fact that information technology is such a key component in the process. A recently published article described participatory medicine as creating a high-tech alliance between patients and physicians (see: Participatory medicine: A high-tech alliance with patients). Below is an excerpt from it:

As physicians experience mounting pressure to contain costs and improve outcomes while their patient loads increase, many are finding that patients can be the most cost-effective and valuable tools to help them do their jobs. The concept of participatory medicine, where patients take a more active role in their care, can enhance the physician-patient relationship and allow physicians and patients to bring their own expertise and knowledge to the table to produce the best outcomes. At its most basic level, participatory medicine means shared decision-making and deep patient engagement. Because of the rise in technology use...this has gone well beyond the traditional tell-me-where-it-hurts conversation between patient and doctor in the exam room. The business benefits of a participatory approach, especially as it relates to technology, have not been well documented. But proponents say adopting a participatory model of care can increase patient satisfaction, save time, reduce costs and improve care. Experts say the model of care also could lower liability risks for physicians. And patients who have a better understanding of their illnesses are likely to be healthier. Technology such as social networking sites, e-mail, personal health records, home monitoring devices and patient portals have made communication between patient and doctor not only more convenient but also more meaningful. Patients are able to do more independent research, making them better informed. They can compare costs, exchange information with other patients, and bring that knowledge back to their physicians. Technology even can allow physicians to monitor a patient's health without a visit to the office, creating more time to see sicker patients.

Here are three ways for pursuing the participatory medicine model in an office practice: (1) greater involvement of physician-patient interactions via email and telephone; (2) the enhanced use of office nursing staff for information triage; and (3) the use of video calls as substitutes for office visits (see: Telephone Calls and Emails as Key Components of Primary Care). As emphasized in the discussion above, all of these new aspects of practice require greater patient involvement, shared decision-making, and having patients "mindfully" engaged in treatment regimens.

To restate the obvious, not all patients are willing or able to fully participate in their care to this extent. The obvious solution to this problem, particularly as it relates to large health plans with many primary care physicians, is to create two categories of care. The first would be the standard or historical model associated with physician face-time appointments and the "tell-me-where it hurts" approach. The second would be defined as a "participatory" model. My concern is that some patients may opt for this second model, assuming that it is superior, perhaps because it's novel and has an interesting label. To counteract this effect, it may be necessary for patient to sign a "contract" in which this new model is described in detail for them, including a list of their shared responsibilities in the care process.

Comments

[Amanda Lowe]

Great minds think alike! I started to work on a blog post last week about pathology and participatory medicine, and just finished it up this morning. While I was posting mine to Twitter I noticed yours. http://digitalpathologyconsultants.com/DPCblog/2010/05/26/go-above-and-beyond-the-dx-participatory-medicine/