I was a bit taken aback when listening to our DNP project presentations at the low participation rate many of us experienced. Unfortunately we have all seen this wherever we go. We introduce a great new idea or initiative only to find it poorly received or unsustainable. How can we change this paradigm? The Robert Wood Johnson Foundation found that patients who were actively engaged in their care often demonstrated better outcomes and lower costs (James, 2013). This aligns with what many of us have seen in our personal and professional experience. Taking responsibility and ownership in any situation encourages one to become more invested in the process.
The patient is the direct consumer of health care. The patients should have the most vested interests into how our health policies take shape. The evolution of Accountable Care Organizations, Patient-Centered Medical Homes and the Patient Portal have prompted providers and organizations to include patients in shared decision making. In fact, there are financial incentives for doing so. However, there are certainly barriers to promoting patient involvement in health policy. A few of these include decreased health literacy, a reluctance to consider the cost of care and the provider’s perceptions (James, 2013).
I would like to consider the effect of direct-to -consumer marketing as a means to promote consumer participation in policy making. We have seen this used ad nauseum (no pun intended!) in the pharmaceutical industry and also each year around election time. This type of advertising has received extensive criticism for misleading the public, offering false hope or inducing paranoia with regard to medications (World Health Organization, 2009). Although this could certainly be used to ‘guide’ patient choices, I wonder how affective this might be in raising public awareness of policy issues. Have you ever had a patient ask you about a certain health policy during an office visit? Can you imagine a time when offices and hospitals gathered a panel of patients to include while developing local policy?
As the way information delivery changes, perhaps the way we chose to engage patients’ needs to change. I would like to propose the use of resources such as The Conversation Project, to generate discussion about palliative care. This program was designed to help facilitate end of life discussions.
During this ‘round table’ conversation, patients could gain insight into their own wishes and be made aware of their options. Why do these important topics not come as direct mail to patients homes? Why have we never seen a commercial encouraging patients to ask their provider about the health policy that affects them most? I assume the short answer is …$$$.
I found this graphic helpful as I continue to process the levels at which individuals may be involved in policy.
Finally, as we move forward in our careers I would like to encourage each of us to consider how our patients may be involved in policy evolution at our place of work. Seek opportunities to discuss palliative care with your seriously ill patients- it’s the right thing to do.
James, J. (February 14, 2013). Health policy brief- Patient engagement. Health Affairs. Retrieved from http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=86
World Health Organization. (2009). Direct to consumer advertising under fire. Bulletin of the World Health Organization, 87(8). Retrieved from http://www.who.int/bulletin/volumes/87/8/09-040809/en/