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ACP issues guidance for physician-patient partnership in health care

Actively partnering with patients and families in care improves health outcomes, but may be challenging to implement; therefore, ACP offered four principles to solidify the role of patients and families in their care plans in its position paper recently published in Annals of Internal Medicine.

“Although the literature suggests that patient and family partnership can positively affect myriad outcomes, challenges abound for how to effectively and practically engage with patients and families in both individual care interactions and broad governance of the health care system,” Wendy K. Nickel, MPH, director of ACP’s Center for Patient Partnership in Healthcare, and colleagues wrote.

In the paper, Nickel and colleagues from the ACP conducted a comprehensive literature review to examine how patient and family partnerships in care affect health outcomes, such as adherence to care plans, satisfaction and costs.

Evidence showed that active partnerships with patients and families in care reduced utilization of health care resources, referrals and diagnostic testing, health care costs and harm and improved safety, health outcomes, practice efficiency and patient and professional satisfaction. ACP identified one study that indicated that the likelihood of reporting problems with filling prescriptions, drug effectiveness and medication-related symptoms to their physicians was greater among patients who actively participated in care.

Based on their review and a multi-stakeholder vetting process, ACP developed several principles for patient and family partnership in care, including:

• Physicians should treat patients and families with dignity and respect.
• Physicians should include patients and families as active partners in all aspects of care.
• Patients and families should help develop and improve health care systems.
• Patients and families should contribute to the education of health care professionals.

To implement these principles, the ACP recommends that physicians use language that patients can understand, create a shared agenda for visits and include patients and families in quality improvement activities.

“ACP’s principles position patients and their families in their rightful place at the center of care in partnership with their health care team with the goal of improving outcomes and satisfaction,” Ana María López, MD, president of ACP, said in a press release. “This partnership is critical for our rapidly changing health care system to be effective.”

Challenges to engaging patients and families that must be addressed include competing organizational priorities, perceived time required to engage patients in discussions, clinician training, understanding what patient and family partnership means and establishing how to implement broad concepts, according to ACP.

In an accompanying editorial, Catherine M. DesRoches, DrPH, associate professor of medicine at Harvard Medical School, and Liz Salmi, senior strategist of outreach and communications at OpenNotes, wrote that the recommendations for patient partnerships suggested by ACP will require ample work to create change.

They emphasize the importance of starting with medical education, allowing patients to have a voice, ensuring diversity, including patients and families in committees, using technology, utilizing the power of the consumer movement, being transparent, sustaining change, generating new ideas and remembering that the physicians, rather than patients, are the ones who need to make the change. – by Alaina Tedesco

Disclosures: DesRoches reports receiving grants from Cambia Foundation, Gordon and Betty Moore Foundation, Robert Wood Johnson Foundation, The Commonwealth Fund and The Peterson Center on Healthcare. Nickel and colleagues report no relevant financial disclosures. Salmi reports receiving the PCORI Pipeline to Proposal Award.