Enabling Patient Engagement - EBSCO Information Services

Enabling Patient Engagement WITH A SYMPTOM CHECKER

Enabling Patient Engagement WITH A SYMPTOM CHECKER

health.

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Enabling Patient Engagement WITH A SYMPTOM CHECKER

Introduction

One of the most important determinants of healthcare quality and efficiency is the quality of clinical decision making. The most underutilized resource within this process, however, is almost certainly the patient. The patient is the undisputed expert of his or her symptoms and how they are evolving. With the growing shortage of doctors around the world, ever-increasing healthcare costs, and growth in alternative channels such as virtual visits, attention is turning to how healthcare institutions can both relieve the pressure on themselves and keep patients within their networks. One of the best ways this can be done is to better support patients at the very beginning of their diagnostic journey. In this white paper we will set out how symptom checkers can help with these important first stages in a patient's journey, and how they are a crucial tool to help with true patient engagement. There is now an almost bewildering range of symptom checkers, so we will also recommend our criteria for evaluating them and describe in detail the Isabel Symptom Checker.

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Enabling Patient Engagement WITH A SYMPTOM CHECKER

Setting the Stage

What is a Symptom Checker?

`Symptom Checker' is now accepted as the generic term for tools that enable patients to see which diagnoses could be causing their symptoms. They are generally aimed at and designed for patients, and the equivalent tool for professional use is increasingly known as a `Differential Diagnosis (DDx) Generator.' In this white paper, we look at how to choose a `Symptom Checker' to be used by your patients, rather than the professional `DDx Generator' designed for clinicians.

The Start of the Patient's Journey

In 2001 the New England Journal of Medicine (NEJM) published a very interesting re-run of a study originally released in 1961 called "The Ecology of Medical Care Revisited." Against the backdrop of a sharply falling number of general practitioners in the USA in 1961, they looked at a sample of 1,000 adults and asked how many of them reported symptoms, what they did next and where they ended up. The re-analysis of this study was completed in 2001 with a wider source of data, which nevertheless came up with very similar results as shown in the graph below:

1000 persons

800 report symptoms

327 consider seeking medical care

217 visit a physician's office (113 visit a primary care physician's office)

65 visit a complementary or alternative medical care provider 21 visit a hospital outpatient clinic 14 receive home health care 13 visit an emergency department 8 are hospitalized >1 is hospitalized in an academic medical center

Both studies found that every month a staggering 80% of the US population has health problems. Of those, almost 25% visited a physician's office (Family Practice or GP Surgery) and nearly 2% visited the Emergency Department (ED). It becomes clear from this chart, as well as the exponentially increasing use of the internet for health information by consumers, that to have any real effect on the flow of patients to your health facility, you need to influence your patients early on when they first report symptoms and think about seeking care. Consumers are apt to use the internet to research health information, which can lead to losing both revenue and

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Enabling Patient Engagement WITH A SYMPTOM CHECKER

care continuity. Organizations, therefore, must help patients answer the following three basic questions through their public-facing website, patient portal or apps in order to keep them within their health system network:

1. When I am sick, where should I got to get better?

2. How can I understand my symptoms better?

3. Where can I find out more about my condition?

If the health system can't help patients at this stage in their journey, they run the risk of losing the patient to an outof-organization tele-visit or walk-in clinic, because the patient has answered these questions themselves, elsewhere on the internet, and found alternative options.

Should patients be better informed?

Over the years the medical profession has ranged from ambivalent to near hostile toward the idea of patients having more information. As far back as the 19th century when modern scientific medicine was emerging, doctors were expressing their concerns about patients trying to diagnose themselves or suggesting alternative diagnoses to their doctors. Compare this to today's age of the internet, and the patient with `the list' and pile of print-outs from Google is usually dreaded. There is a wide range of views among clinicians as to whether informed patients are helpful, or a nuisance to be tolerated. Medscape recently conducted a survey with some very interesting questions and received 1,089 responses from clinicians (28% physicians and 49% nurses).

? When asked what they felt about having more empowered patients, a significant 75% thought it was helpful. Only 10% said that they found it annoying.

? Only 25% of clinicians said that patients' research made it more difficult to provide care, while 57% said this was actually beneficial to the physician-patient relationship.

? The clinicians were most negative about the extra time, with 61% noting that it meant these patients needed more than the allotted time for the consultation. However, 43% stated that patients who do research typically have better outcomes. Only 7% thought those patients had worse outcomes, while the balance was neutral.

In summary, since 75% of medical professionals surveyed thought it was helpful overall to have better-informed patients, 57% said it helped the relationship and 43% said those patients had better outcomes, it would make sense for clinicians to encourage this process, at the very least among those patients who desire to be better informed and engaged in their care.

Providing patients with information

Some institutions support the idea of informing and providing patients with information, electronically or via leaflets, about specific diagnoses or treatments. The NHS in the UK, for example, makes very good reference material available via NHS Choices. This strategy makes the key assumption, however, that the patient knows what they are looking for; perhaps they received a diagnosis and it was correct, or they were looking for information about treatment. These efforts can assist with answering the question "Where can I find out more about my condition?" However, patients often start their journey with symptoms and won't know what is wrong with them, which means they won't know which diagnosis to look up.

So how do we help a patient determine how sick they are in the first place? How can we help them decide, without

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Enabling Patient Engagement WITH A SYMPTOM CHECKER

forcing self-diagnosis, whether they should go to the ED, an urgent care clinic, contact their primary doctor, or even just connect with a virtual visit?

Remember that according to the NEJM study, almost 1/3 of the population during any month will consider seeking medical care. A significant portion of them will have multiple symptoms and consequently won't be able to make much use of simple reference information. They need a clinically validated tool that will help them convert their symptoms into something useful, such as likely diagnoses and advice on where to seek care.

Patients will research their own health

Research from Pew shows that a large proportion of adults use the internet regularly. Incredibly, the average consumer spends 52 hours a year on the internet looking for health information, compared to visiting their doctor three times a year for a total of 30 minutes. In fact, the first port of call for many people is not their doctor, but instead a family member, a friend, an online search, or a combination of all three.

63%

of adult cell phone owners use their phones to go online

? has doubled since 2009

? 34% mostly go online using their cell phone

? 21% do most of their online browsing using their mobile phone--and not some other device such as a desktop or laptop computer

69%

of US adults track a health indicator like weight, diet, exercise routine or

symptom

? half track "in their heads"

? one-third keep notes on paper

? one in five use technology to keep tabs on their health status

35%

of US adults have gone online

to figure out a medical condition

? of these, half followed up with a visit to a medical professional

39%

of US adults provide care for a

loved one

? up from 30% in 2010

? many navigate health care with the help of technology

Most patients are motivated to try to help themselves. In the absence of health tools they are familiar with, or have been specifically recommended to use, they will start with an online search. Since many patients are likely to do their own research, whether it's searching online or talking to a family member or friend, it surely makes more sense to guide them to tools that are specifically designed to do this job that have also been medically validated.

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