JBJS Reviews Editor’s Choice–Patient Activation

As medical practice continues to evolve, one thing that has become clear is that teamwork is a key ingredient for achieving success. In the field of medicine, the goal is improved patient outcomes and the teamwork involves the combined efforts of the patients and their caregivers. Indeed, it has been demonstrated that highly activated patients (i.e., those who take proactive collaborative roles in maintaining their health) incur lower medical costs and achieve improved therapeutic outcomes and greater satisfaction in comparison with less-activated patients.

In this issue of JBJS Reviews, Tzeng et al. take the position that patient activation is a dynamic continuum and that clinicians can boost activation by working together with patients to overcome barriers such as social and environmental disadvantages, low self-confidence, and lack of problem-solving and self-management skills. Thus, clinicians should understand that patient activation can be used to inform and personalize plans of medical care in a way that will foster cooperation between patients and their caregivers.

The recent shift toward consumer-driven health care has led to a need to define and understand the patient’s role in health care. Historically, little attention has been paid to the key factors and research priorities that govern patient engagement. In 2012, the Patient-Centered Outcomes Research Institute brought this concept to national attention by demonstrating that the factors that govern this type of collaboration are specifically required for financial rewards from the Medicare and Medicaid Electronic Health Records Incentive Programs.

Tzeng et al. describe how there are two types of patient activation. The first type is individual patient activation, in which a patient’s ability to handle his or her health and health care is established. In the second type of activation, there is participation from the community. Community activation is a health-promotion strategy in which organizations, companies, and provider groups make a concerted effort to improve health awareness, to plan prevention programs, to allocate resources, and to involve citizens in these processes. There are, however, barriers to patient activation. In particular, the level of patient and community engagement is often lower in populations with minority backgrounds, low incomes, limited education, and poor self-reported health. As an example, Caucasians typically have higher activation levels than African Americans and other minority groups, a manifestation of the fact that activation is associated with social-environmental factors.

For orthopaedic surgeons, integrating patient activation into clinical practice may require substantial change, but the benefits of doing so are substantial. More investigation is required in order to determine the best approaches for different medical specialties and patient populations, but current evidence clearly affirms that the activated patient is healthier and happier.

Thomas A. Einhorn, MD, Editor

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