The concept of patient engagement offers a unique opportunity to inform our understanding of patients' ability to be active in managing their care. However, unless promoting the active role of patients is today identified as a priority to promote care quality, a wide debate still exists on how to translate this principle into practice and how to assess initiatives aimed at increasing the level of patient participation in their care. Measuring patient engagement along the care course might ensure that the medical care truly serves patients' needs, priorities, and preferences. Unless the measurement of patient engagement is today a big issue for policy makers and healthcare practitioners, only few scientifically validated assessment tools currently exist to identify patients' level of involvement in their healthcare. In this chapter authors review the main validated tools currently available in the scientific community devoted to assess the patients' ability and availability to be actively engaged in their care, with a particular focus on the recently developed Patient Health Engagement Scale, specifically designed to assess the emotional and psychological adaptation of patients along their care process and their level of engagement in the healthcare management.
TopIntroduction
Western healthcare systems are today facing some of the greatest challenges of their history. Population growth, breakthroughs in the treatment and management of chronic disease conditions and changes concerning the levels of patients’ health needs and expectations have led to a system that is increasingly under pressure and financially unsustainable (Beaglehole et al., 2008; Blinded et al., 2013; Wiederhold et al., 2013). In considering how best to develop an effective system that delivers quality care and value for health consumers – and one that is able to meet future care demand – the role that patients play has become ever more important: giving them back a starring role is today a priority for health policies both at an ethical and pragmatic levels.
Indeed, increasing evidence has demonstrated that patients’ engagement in their health and healthcare is a key solution for leading innovative actions in the complex and mutable context of healthcare delivery and organization (Graffigna et al., 2015a). The term patient engagement encompasses a number of related concepts, including patient-centered care and shared decision-making, all of which build on the idea of involving patients as full partners in their care and health-related decisions. Patient engagement, indeed, aims at giving (back) a leading role to patients and taking them on board for a more efficient and effective process of care delivery. Under this broad umbrella term, there is evidences that patient engagement is linked with fewer adverse events, better patient self-management, fewer diagnostic tests, decreased use of healthcare services and shorter lengths of stay in hospitals. Particularly, researches have showed that those patients who are more active and engaged in their care more frequently reports better clinical outcomes (Hibbard & Greene, 2013), higher quality of life (Barello & Graffigna, 2014a), higher satisfaction with their care relationships (Becker & Roblin, 2008; Alegría et al., 2009), healthier behaviors (Hibbard et al., 2007), more effective self-management skills (Skolasky et al., 2008) and treatment adherence (Green & Hibbard, 2012). Furthermore, empirical researches have demonstrated how patient engagement may contribute to a reduction of healthcare costs and to better economically sustainable organizational processes (Coulter & Ellins, 2007; Berwick et al., 2008; Hibbard et al., 2013).
In this chapter, moving from a review of current literature about the healthcare requirements to face the ongoing societal and economic challenges, we shall introduce the concept of “person-centered care”, such as a new approach to healthcare organization able to acknowledge the complex psycho-social needs and identities representation of care recipients. We shall also discuss how this broader vision – which encompass that one merely focused on “patients” such as healthcare clients – is crucial in the context of integrated care.