I still remember an incident involving my friend who had just moved to the US from a developing country. When he went out to buy milk for the first time from a giant superstore, he was lost in the aisle that was only dedicated to different kinds of milk – whole milk, 2% fat, 1% fat, skimmed milk, soy milk etc. Each category was sorted into various sizes and represented multiple brands. He was confused by so many choices. The store manager arrived just then, handed him a gallon of milk and said “You take this one”, without even asking what his likes and dislikes were. The manager was just keen on making a sale even without assessing what the customer sought.
Well, modern healthcare is more complex than buying a gallon of milk. It involves various stakeholders, who over a period of time assumed a paternalistic attitude towards patients. In a race to grow the armamentarium of treatment approaches, the focus somehow drifted away from the ‘patient’. Thankfully, it is now being stressed much more than ever about bringing the patient back to the centre of the paradigm, especially for chronic diseases which are long-term, variable and often degenerative. In this shifting healthcare landscape, various patient engagement activities have emerged, ranging from including patients’ preferences and needs in clinical trials (in terms of patient reported outcomes) to enabling patients with wearable healthcare technologies to monitor their condition and improve their outcomes. Novel patient engagement models have moved the doctor-patient interaction from the traditional office-based setting to a more informal setting wherein a diabetic patient on vacation can still can get the necessary advice to adjust his/her insulin dose while by the physician who is able to remotely monitor his/her blood glucose levels.
Evidence suggests that patients who are willing to take charge of their health experience better health outcomes (improvement in medication adherence and reduction in unnecessary monitoring visits to the hospital), lower medical costs and reduced drop-out rates. The essence of patient engagement dwells in keeping patients involved rather than just informed regarding their health status. However, to effectively engage patients, it is important to take decision or design healthcare technologies after taking cognizance of patient needs, willingness, health literacy level, comfort level with the treatment/technology, and expectations. An older, technologically challenged person can be kept engaged by simple phone call reminders about the next hospital visit, whereas a relatively younger patient can be taught to monitor his/her own health by keeping a log of vital parameters and transmitting this data to the provider to effectively plan the treatment. In a resource-constrained but cellular phone rich settings, preventive health-related short messaging services have provided cues to seek healthcare.
Apart from keeping patients involved, patient engagement also helps in generating the much sought ‘real-world data’ needed by regulatory agencies and pharmaceutical companies to bring the drugs that are not only safe and efficacious, but could also achieve outcomes that are relevant to patients. Successful patient engagement is beneficial for all the stakeholders and efforts should be made at each patient healthcare encounter to make it a possibility.