Engaging Your Patients Means Happier Doctors and Healthier Patients

During her presentation, “Leveraging Patient Engagement in the Patient-centered Medical Home,” Friday at the 2010 AAFP Scientific Assembly, Melissa Gerdes, MD, FAAFP, medical director of the Trinity Clinic Whitehouse, Whitehouse, TX, said that when it comes to engaging patients in your medical practice or as part of the patient-centered medical home, the key is to look at patients as partners in the practice.

Goals for engagement should include demonstrating respect for the patient’s preferences and autonomy, attending to the patient’s emotional needs, sharing treatment decisions with the family and care team, and supporting the free flow of information. Not only does it lead to a more satisfying experience for patients and better adherence to treatment plans, Gerdes said that promoting greater patient engagement in the patient-centered medical home (PCMH) is also important for a variety of other reasons, including the fact that the NCQA includes “patient experience” as a PCMH performance standard. She also said that many medical groups are now paying incentives linked to patient satisfaction, and the increasing external competition to the traditional medical practice is placing a higher premium on patient satisfaction.

So the question becomes, how can physicians engage patients more in their family medicine practices, and specifically in the PCMH, and what are patients looking for practices to improve? Gerdes said that one of the best ways to find out what patients want is to simply ask them. There are variety of patient surveys available (Press Ganey, the Patient Experience Assessment Tool from the TransforMed project, etc), but Gerdes also noted that self-created surveys specific to your practice are also effective. One survey the AAFP conducted found that patients value practices that offer same-day appointments, establishing a relationship with a physician who knows their history, having one doctor who helps manage the family’s chronic conditions, and practices that use technology that allows doctors to send medical records to other doctors, send information to the pharmacy, and that allows doctors and patients to communicate electronically.

It doesn’t do much good to collect this kind of information if the practice is not going to do anything with the information and knowledge that is gained. Gerdes said that practices should use the survey results by working to enact the changes and features that patients asked for. Other measures that increase patient satisfaction include reducing the amount of paperwork patients need to fill out and improving communication and access to the practice. Practices should “focus on the easiest or littlest things first” to get the process started and show improvement, Gerdes said.

Part of building a patient-centered environment in the PCMH is the use of motivational interviewing, which Gerdes said has been proven to work for diabetes, smoking, dietary change, medication adherence, exercise, HIV risk reduction, alcohol abuse, drug use, gambling, eating disorders, treatment compliance, hypertension, and other conditions. Motivational interviewing promotes patient engagement because it is a patient-centered approach that uses “strategic listening and questioning” to guide the patient to self-explore the reasons why they are not changing their health behaviors and increase their accountability for their own actions.

Effective motivational interviewing must build the patient’s own motivation for behavioral change and build the patient’s motivation to execute a change plan for treatment. Gerdes said that “It’s all about the physician-patient relationship and matching the education and information provided to the patient’s level of readiness” to change. She also said that motivational interviewing has a greater effect on patients if multiple members of the care team use it. Motivational interviewing is an important tool not only because it helps build and strengthen the physician-patient relationship and promote the medical home, but also because “patients really want it,” Gerdes said; they want a physician to listen to them and help them find a roadmap to better health.