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Tuesday, October 11, 2011

Patient Engagement in Primary Care: What Are the Next Steps?

Kathryn Nicholson is completing her Masters of Science in Epidemiology and Biostatistics at the University of Western Ontario, in particular, looking at primary care encounters among fatigue patients. Next, she plans to complete a PhD focusing on patient-centered care, electronic medical records, and how these factors will combine to influence the long-term sustainability of the Canadian health care system. After that, she hopes to combine this research with medical practice. Kathryn won first place in the Council’s Health Innovation Awards in the individual category in 2010 and last year was a student ambassador for the awards.

Achieving a patient-centred health care system is a dynamic interplay of expectations, enablers, and desirable outcomes, many of which have been identified in the Health Council’s recent report, “How Engaged are Canadians in their Primary Care?" The changes or components required for patient-centred health care delivery (from both the patient and provider perspective, as listed within the Health Council report) seem to be fairly reasonable, especially given the dividends these actions promise.  Successfully integrating a patient-centred approach into our current system will not only be beneficial for the professionals and the consumers of health care, but ultimately its long-term sustainability.  However, as a current consumer of health care and as a hopeful future family physician, ensuring that patient engagement becomes entirely enshrined in the culture of primary care practice does not seem to be straightforward. 

The doctrine of a patient-centred family physician must be complete and encompassing of all practitioners to fully shift from administering health care “to” a submissive, agreeable patient, to delivering this care with the active partnership of an engaged consumer.  Shared decision-making has been shown to be an essential component of what patients view as effective “patient-centred care,” but this process is a significantly delicate balance between the clinical expertise of the family physician and the personal views and desires of the individual patient.  Moreover, each patient must be “practiced” or literate in being engaged at each visit, and ensuring that each primary care visit is productive in meeting their needs, is tailored to their current goals, and results in a meaningful next step to improving or caring for their health.  Undoubtedly, this culture change must occur at both the physician level and patient level, in order to achieve the most sustained effects and the most positive outcomes. 

Young future family physicians are trying to establish how we can translate what we have learned from the research into innovative action.  I, for one, would be inspired by the “rolling out” of best practices currently being undertaken and applying the most appropriate approaches to each primary care practice throughout the country.  However, until this action is possible or plausible, perhaps the most practical and effective approach is to be found in some of the actions listed by the report, such as simply giving patients the opportunity to ask questions or helping coordinate patients’ care with specialist services.  There seems to be some question as to what the next steps will be in “rolling out” patient-centredness in a unified way throughout Canadian primary care centres, but whether it is that many small steps are required or one gigantic leap, a whole-hearted culture shift toward successful patient engagement is what excites me about the future of primary care practice in Canada.

Key Words: Health Innovation Challenge, Patient Engagement, Primary Care

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