This interview is the second in a series of brief chats between CFAH president and founder, Jessie Gruman and experts—our CFAH William Ziff Fellows—who have devoted their careers to understanding and encouraging people’s engagement in their health and health care.
Connie L. Davis, a geriatric nurse practitioner and health care consultant in British Columbia, advocates “a stepped approach to supporting patients’ active participation in self management.”
Ms. Davis works to improve the partnerships between patients and health care professionals, concentrating on rural, remote and underserved populations. She is also a CFAH William Ziff Fellow.
Gruman: Where is the low-hanging fruit in patient engagement – a change that is both possible to make without spending millions of dollars and that would make a real difference?
Davis: Really taking health literacy into account has great potential. This means clinicians make use of teach-back methods and all materials are produced using clear language. Addressing health literacy is excellent leverage because there is so much to be done and many of those things are pretty simple to do, so addressing them can have a significant effect.
Gruman: You have said “one size doesn’t fit all” when it comes to helping people better care for themselves. How can care be organized to take into account the diversity of needs and preferences?
Davis: We’ve been pretty successful using a stepped care approach in primary care to encourage people to care for themselves.
Two principles guide all interventions: Cultural humility and Health literacy.
Within that framework, it’s important to provide self-management support fundamentals to everyone. This means focusing on goal-setting and problem-solving for everyone, for example. If these aren’t helpful for an individual, we make available more intensive approaches, like a care manager and group visits. And for those who are still struggling, we use more expert methods, such as dialectical behavior therapy and addiction treatment.
Gruman: What changes have you seen in the past couple years that make you optimistic about patient engagement?
Davis: The rise of patient groups has been amazing. When I came to British Columbia in 2005, there really weren’t any visible patient groups. Now there are many. For example, a senior group in BC (called COSCO: Council of Senior Citizen Organizations) realized that there really wasn’t good senior-relevant health information available to them. So they worked with professionals to develop 17 different presentations that they now deliver to senior groups all over the province.
Additional Interviews with our Ziff Fellows on the challenges of patient engagement:
- Trudy Lieberman, journalist for more than 40 years and contributing editor of the Columbia Journalism Review
- Dale Shaller, Principal of Shaller Consulting Group
- Molly Mettler, Senior Vice President for Healthwise
- David Sobel, Medical Director of Patient Education and Health Promotion for The Permanente Medical Group
- Kate Lorig, Professor at the Stanford University School of Medicine and Director of the Stanford Patient Education Research Center
- Shoshanna Sofaer, Robert P. Luciano Professor of Health Care Policy at the School of Public Affairs, Baruch College
- Judith Hibbard, Professor of Health Policy at University of Oregon & lead author of the Patient Activation Measure (PAM)
- Carol Alter, Director of Policy and Community Outreach and an Associate Professor in the Georgetown University Department of Psychiatry
Tags: CFAH William Ziff Fellows, Council of Senior Citizen Organizations, health literacy, stepped care approach
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