Patient activation improves IBD outcomes, increases cost efficiency

ORLANDO, Fla. — Gastroenterologists caring for patients with inflammatory bowel disease must increase the patients’ activation levels to further improve disease outcomes and increase cost efficiencies within the health care system, according to an expert at Advances in IBD 2017.

“It’s about understanding what our patients need and want out of their care,” Corey Siegel, MD, associate professor of medicine and director of the Inflammatory Bowel Disease Center at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, said during his presentation. “It sounds simple, but it’s not easy to do this in a busy clinic.”

Patient activation is the understanding of one’s role in the health care process, he said. Patient engagement is the interventions gastroenterologists create and the patient uses to become more activated, ranging from understanding medications to problem-solving when they encounter hurdles in their health.

“Activation improves patient outcomes. It improves the health experience so that more activated patients actually report more positive care experiences and have fewer problems with care coordination, and it actually lowers health care costs,” Siegel said. “There is an inverse relationship between activation and health care costs, and the more that you can engage and activate your patients, the better they are going to do and the cheaper they are going to be for the health care system.”

Part of activation is having a patient explain what he or she is looking for in IBD health care. Physicians are looking at mucosal healing vs. histologic healing, but patients want to enjoy daily activities and improve their quality of life, Siegel said.

“Don’t let the perceptions that you have get in the way of good care,” Siegel said. He showed a survey in which patients expressed their fears about losing their colon and colon cancer, and those ranked much higher than side effects, which is something physicians worry will be of concern.

“What’s the No. 1 concern or goal related to your IBD?” is the question Siegel said he always asks at the beginning of an office visit.

“We have to learn about our patients’ values — what matters to them at that moment. And that might change over time,” Siegel said. “You need to mesh your patients’ goals, who are experts in their disease far better than you’re an expert in their disease, but then bring your expertise and how to best care for them together instead of coming at it from different angles.”

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Siegel said patient involvement and activity in their care and shared decision-making falls on a spectrum of those who choose not to be actively involved and those who are overactive in their management.

“The idea of patient-centeredness should apply to everybody, but the idea of shared decision-making doesn’t apply to everybody,” Siegel said, noting that some patients must be guided into a collaborative relationship with the provider.

But patients with IBD are not often at that low-activation end of the spectrum, he said.

“Almost 90% of IBD patients say they want a big part in the decision-making. Please recognize that your IBD patients are probably a very special group of patients who are engaged, activated, smart, and want to take part in their care. Make sure you give them the opportunity to do so,” he said.

Spiegel said engaging in conversations to increase patient activation while also increasing physician understanding is the first step toward improving IBD outcomes.

“It’s really bringing our patients into the equation. Patients are at very different levels of activation and have different desires and needs. We have to think about what that patient needs and how we can bring them up and get them as activated as possible so that we can improve their care and their outcomes. We need to spend time in understanding our patient goals. I would argue that that’s more valuable than all the details from what happened in their IBD since the 1980s as opposed to what you’re deciding now. You need to know what they want out of their care and what their biggest concerns are.” – by Katrina Altersitz

Reference:

Siegel C. Clinical Session IA. Presented at: Advances in IBD; Nov. 9-11, 2017; Orlando, Fla.

Disclosure: Siegel reports he is a co-founder of ColonaryConcepts, a patent- and stockholder for an IBD risk prediction model, and reports financial relationships with AbbVie, American Regent, Amgen, Celgene, Janssen, Lilly, Pfizer, Prometheus, Sandoz, Takeda and UCB.