Patient Engagement Article: How to Engage the Most Difficult Patients

Overview: Patient engagement is now recognized as a driving force behind quality care, compliance, patient satisfaction and improved outcomes. Given broad acceptance of this concept, why are we still having trouble improving patient engagement? Do we need to alter our engagement strategies for the most difficult to engage patients who often represent the highest risk and highest need population?

Over the past 25 years the answer has always been the same. Engage the patient where they are physically, mentally, socially and spiritually. Meet them where they are, not where you think they should be. There is more to this and this article shares what we have learned in dealing with the toughest populations.

Lessons Learned: We have learned a great deal, most of which, are familiar to all of you. They bear repeating, reinforcing and collaborating on how to execute.

1. Job number 1 is to develop a relationship of safety and trust with your patient.
2. Do not judge your patients. You do not have the insight, background or right for that privilege unless the patient grants you such privilege.
3. Remember that Adverse Childhood Events (ACE) and other trauma may have brought them to this place in their life and to you.
4. Recognize that the support systems most of us enjoy may be lacking for those most difficult to engage.
5. Those engaging the patient should be in and of the community. They should have the same background and experiences and be someone with whom the patient can relate.
6. Focus on what is important to the patient. Later, when safety and trust has been established you can jointly develop care plans that expand beyond the original focus of the patient.
7. Use motivational interviewing. It is a powerful tool.
8. For the most difficult patients, borrow lessons learned from Assertive Care Teams (ACT) protocols.
9. Patients now want their doctor(s) to consider the affordability of care.
10. Virtual Care is now accepted and important to patients.

The Problem: The lack of patient engagement can negatively impact adherence, communication and self-care, quality outcomes, utilization and cost. Conversely, improving patient engagement can have a significant positive impact on these metrics. Healthcare is moving from a venue in which the physician’s job was to develop the treatment plan and tell the patient what to do. Now it more about getting the patient to be a partner in developing that plan and following it.

The Goal: Find ways to improve patient engagement with resulting improvements in adherence, communication, outcomes and appropriate reductions in utilization and cost.

The Solution: Find out what is important to the patient and start there. Develop a relationship of safety and trust which leads to improved engagement. Leverage this to develop a joint treatment plan that is viable for the specific patient.

COVID19

The CVS Health Care Insights Study also produce significant findings due to COVID10. We all know many people have been struggling. Social isolation and economic uncertainty have impacted the mental health and wellbeing of many. A lack of resources and support for vulnerable populations, those with the highest needs, produced increased levels of substance use including increases in use of nicotine (21%), alcohol (20%) and opioids (10%) this past year.

Feelings of stress have been pervasive, especially for men. Men and women reported higher levels of stress, but for different reasons.Despite the pandemic’s impact on mental health, 74% did not seek mental health services. The data shows this gap is due to costly care — 28% of consumers said they did not visit a mental or behavioral health specialist when they needed support due to costs.

Two key findings from the CVS Study:

• During a time that required social distancing, the use of the virtual tools to seek care surged. Engaging patients will require a flexible and collaborative approach to virtual care and virtual tools by the provider.
• Providers can play a role in health care affordability for their patients.More than half of consumers (61%) said their providers have not asked about affordability of health care and/or discussed resources to assist with costs. Providers who ask about affordability and strive to make care more affordability may enjoy increased patient engagement.

While there is no one answer to improving patient engagement, listening (what we were taught in medical school), showing compassion and collaboration are once again a staple in the physician’s toolset to engage patients and improve the quality of care.