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Doctors get higher scores from patients more involved in care

Consultants say questionnaires can gauge patients’ level of engagement. Physicians are encouraged to help passive patients take greater responsibility for their health.

By Sue Ter Maat — Posted Aug. 12, 2013

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Patients who were more knowledgeable and engaged in their health care reported more positive experiences with their doctors than those who were less involved, says a study in the July issue of Health Affairs.

Based on the findings, doctors should consider assessing patients’ engagement and approach less-confident patients differently from those who are proactive about their care, health care consultants said. That’s because more physicians are being compensated and promoted based on patient experience scores, which measure patient satisfaction with the care they receive, consultants said.

“There has been a lot of focus on office staff and primary care providers’ customer service, but there hasn’t been as much thought toward what can be done to support patients to become more involved with their care,” said study co-author Jessica Greene, MPH, PhD, a professor in the School of Nursing at George Washington University in Washington.

The study examined 5,002 patients treated by 49 primary care doctors at Fairview Health Services, a Medicare accountable care organization in Minnesota. The patients were given questionnaires at the beginning of their visits to assess patient activation measures, which gauge the knowledge, skills and confidence people have for managing their care. Respondents were asked to answer “yes” or “no” to questions such as “When all is said and done, I am the person who is responsible for taking care of my health.”

Patients also answered questions about doctors’ knowledge of their medical histories, effectiveness of care coordination and access to physicians by phone. They rated doctors on a 1 to 4 point scale, with 4 being the highest score.

Patients who scored highest on managing their own care gave doctors on average 0.4 higher scores than patients who scored the lowest, the study said. Patients with lower scores were more likely to take passive roles, believing they weren’t responsible for their health care, Greene said. Those individuals also tended to ask few questions during exams.

The approach for less-involved patients

Doctors should gather information about the level of their patients’ engagement, said study co-author Judith H. Hibbard, DrPH, a professor emerita and senior researcher in the Health Policy Research Group at the University of Oregon. Then, they should talk to low-engaged patients in a different way from those who are more engaged, she said. For instance, instead of telling patients who score low on patient engagement to lose weight, physicians should break that guidance into many steps, explaining in detail what patients must do to shed pounds.

“Low-scoring patients may think, ‘Here I am, and it’s your job [as the doctor] to figure out and fix it,’ ” Hibbard said. “Helping [these patients] understand their roles is half way to improving their patient experiences.”

If physicians don’t want to survey patients with written questionnaires, they can assess attitudes via verbal cues and facial expressions during patient encounters, said Kristin Baird, RN, president and chief executive officer of the Baird Group, a patient experience consulting firm based in Fort Atkinson, Wis.

Individuals who seem less confident will need more time to trust doctors, Baird said. Physicians may need to modify their behavior by asking patients for more input. And whenever possible, doctors should invite questions and make patients feel as if they are part of the decision-making process, she said.

Doctors don’t have a lot of time to speak to patients, so it’s difficult for them to take extra steps to engage patients who aren’t as motivated to take care of their health, said Lonnie Hirsch, co-founder of Healthcare Success Strategies, a health care marketing firm in Irvine, Calif., that specializes in patient experience consulting.

Hirsch recommends that doctors use email or text messages after patient visits as follow-ups, especially to patients who are less engaged in their care. Physicians can instill trust in such patients and get them to take a more active role, he said.

“Doctors don’t like to see themselves in the role of salesperson, but, in fact, they do some important selling to patients every time they make recommendations for treatments,” Hirsch said. “Physicians think of sales as a negative, but instead they might think of it as influencing someone to do something that’s in their own best interest.”

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External links

“When Seeing the Same Physician, Highly Activated Patients Have Better Care Experiences Than Less Activated Patients,” Health Affairs, July (link)

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