Krames StayWell Blog

5 Tips for Addressing the Challenges of Effective Patient Engagement

  

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I wanted to share this post from the KevinMD.com blog by Thomas Goetz.  Mr. Goetz makes it clear that we are confronting a major paradigm shift in our efforts to establish an ethos of wellness and to get people to actively manage their health - at all times and not just when they are sick.

The following quote articulates the challenges a doctor has in encouraging this new behavior from patients:

"As one physician notes, '90 percent of my job is education, and I have no training for that.  What I learned in medical school only counts for a fraction of what I'm actually doing every day.'"

Our mission at Krames is to provide tools to help providers in this effort to encourage patient engagement in health self-management.  Mr. Goetz offers five tips to help with this effort.  To find out more read the complete post How Can Doctors Effectively Engage their Patients?

Collective Efficacy, Social Media, and Patient Education

  

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I lurk on a health literacy listserv where I’ve learned lots of interesting things from lots of really smart people.  During a recent thread, I was turned onto the concept of Collective Efficacy which really struck a nerve with me (in a good way).  In an earlier post, I wrote about the importance of self-efficacy in effective patient education.   Now, I’ve been giving thought to the power collective efficacy can add to the equation. With the emergence of Health 2.0, the explosion of social media and an understanding of collective efficacy, I can begin to see how a combination of medical evidence, technology and community can really change our experience with healthcare. 

In searching for a good definition for collective literacy, this was the best one I could find which was pulled from course outline from a course at Emory College:

“Collective efficacy is defined as a group's shared belief in its conjoint capabilities to organize and execute the courses of action required to produce given levels of attainment.”

My interpretation is that collective efficacy can fill in the gaps inherent in self-efficacy.  When you think about it, there are tons of examples of collective efficacy in action.  Consider smoking cessation programs like the American Lung Association’s Freedom from Smoking, Weight Watchers or even the Team in Training Programs that raise money for the Leukemia and Lymphoma Society by gathering folks together to run a marathon or triathlon.   In these cases, people are working together – supporting the execution of proven methods – to attain a result that benefits the whole group.  The individual’s self-efficacy which can be threatened by the inherent limitation of the individual is buttressed by the group dynamic, by the collective efficacy in action.

And what’s really cool is that as the group benefits, the individual finds that their self-efficacy is ultimately strengthened as well.  A participant in the health literacy listserv put it beautifully.  . .

“while my self-efficacy was being destroyed, I was becoming an integral part of the collective efficacy which in the end brought my self-efficacy to new heights. What a blessing.”

That is powerful.  

So, I started thinking about the possibility of collective efficacy in health care and all the social media health 2.0 success stories start to make a lot of sense.  Communities are coming together online in places like PatientsLikeMe where people share their stories and the results can transcend that of a support network but also serve to accelerate science by harnessing the collective anecdotal experiences.   On the physician side, sites like Sermo enable doctors to share expertise, consult on cases, and comment on the latest literature.

From the patient education perspective, I think the power of collective efficacy can come to bear with new shared decision making tools that can leverage both the perspectives and preferences of patients with the experience and medical expertise of providers; can come to bear in wellness programs that can harness the power of community and medical science to ensure that we develop healthy nutrition habits for our kids.   When these tools and programs leverage social networking technology to create a body of knowledge that can be shared by the community, then the power of the tools to promote positive behavior change are expanded exponentially due to the impact of collective efficacy.

I wish I was more eloquent.  I really believe there is something to considering how collective efficacy can help us create tools and experiences that can really transform health care.  If you’ve seen examples of this in action or have any thoughts on this, please share below.

Combination of Medication Reminders and Patient Education Improves Adherence, Outcomes, and Quality of Life

  

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The Centers for Connected Health, a division of Partners Healthcare, just published a study regarding the use of text messaging to improve outcomes for patients with atopic dermatosis, a type of eczema.  The study was published in Volume 2010 of Dermatology Research and Practice and key findings are included in this press release.  What was unique in this study was the combination of messages – some focused on reminders to takes medication and others focused on education to promote behavior change.

This approach appears to have produced lasting results.  The reminders are promoting medication adherence which is resulting in an improvement in the patients’ condition.  The educational messages appear to be helping patients keep with their therapy even after severity has declined.  The combination of reminders and education is working to help patients develop new health habits.  As reported in the press release, “ . .  .  there was a significant improvement in skin severity, with 76% of participants realizing an improvement in their condition. Further, 72% of participants reported improvements in their quality of life.”

The implications of this study to emerging mHealth applications being developed for population health management, chronic condition management, or readmission reduction are powerful.    I’ve had the opportunity to take a look at various readmission reduction and risk factor management programs.   The centerpiece of these programs is medication adherence which, of course, is critical to avoiding bad outcomes in the short term (readmission reduction) or longer term (risk factor management).  What this study suggests is that weaving in a behavior-change education component will give these types of programs legs to avoid development of chronic conditions (risk factor management) or avoid a bad outcome after a CMS-established deadline for non-reimbursement has passed (readmission reduction).

If you’ve seen other examples of how these types of education and adherence focused programs have been implemented or care to comment on this study, please share your thoughts below.