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Patient engagement is a key component of integrated care. This section incorporates resources for patients, as well as resources for the providers and care teams seeking effective strategies for patient engagement.
A report by the Milbank Foundation entitled Evolving Models of Behavioral Health Integration in Primary Care describes a continuum of models of integrated care and includes a review of the available evidence. One of the conclusions they reach is that, "Delivering specialty mental health in primary care settings produces greater engagement of patients in mental health care, which is a prerequisite for better patient outcomes.”
The importance of and opportunities for patient engagement in the context of the patient-centered medical home is a topic addressed in a paper entitled Supporting Patient Engagement in the Patient-Centered Medical Home that was prepared by the Center for Advancing Health and is available on the web site of the Patient Centered Primary Care Collaborative (PCPCC). The paper outlines the opportunities for patient engagement in the Patient Centered Medical Home (PCMH) context, discusses both patient and clinician responsibilities, provides principles of shared decisionmaking, and includes a patient-clinician agreement. The PCPCC web site also provides extensive information about behavioral health integration in the context of the PCMH.
The AHRQ Health Care Innovations Exchange web site features an innovation entitled "Placing Mental Health Specialists in Primary Care Settings Enhances Patient Engagement, Produces Favorable Results Relative to Evidence-Based Care. Developed by Harvard University, SAMHSA, the University of Pennsylvania, and the Veterans Administration, the program involved placing behavioral health specialists in primary care settings to treat more than 2,000 older adults in the course of a randomized clinical trial study.
Experts in the integration of primary care and behavioral health often stress the importance of the "warm handoff" from the primary care practitioner to the behavioral health specialist as a means to establish rapport and increase the likelihood the patient will engage in behavioral health treatment. One very good description of the warm handoff process is available from the Integrated Behavioral Health Project. This web site provides sample warm handoff scripts and procedures, as well as some of the history and rationale behind the warm handoff as an initial step to build patient engagement.
Dr. Edward Wagner of the Improving Chronic Illness Care (ICIC) program talks about the importance of an informed, activated patient as an essential element in his model of the chronic care process. The ICIC web site presents the model and some of the literature documenting its effectiveness.
Shared decisionmaking is an approach to clinical decisionmaking in which both the provider and the patient are recognized as having unique expertise relevant to care decisions. The provider may be the authority on evidence-based practices to address patient problems; the patient is the undeniable authority on her or his personal preferences. The Dartmouth-Hitchcock Center for Shared Decision-Making is an excellent source of information about these principles and provides numerous resources to inform patients about the health care choices they face. The Dartmouth University Institute for Health Policy and Clinical Practice operates the Center for Informed Choice, a research and education center for the study of patients’ health care decisionmaking.
The Mayo Clinic operates the Shared Decision-Making National Resource Center whose stated goals include:
- Developing and evaluating patient decision aids
- Contributing to defining international decision aid standards
- Defining high performance organizations using shared decision making
- Educating and training care providers in communication techniques
- Adopting and using patient decision aids at the point of care
- Contributing to statewide implementation efforts
- Certifying patient decision aids through collaboration with external partners
Patient engagement is enhanced when both forms of expertise are recognized and incorporated. Resources on shared decisionmaking in the context of mental illnesses are available on the Substance Abuse and Mental Health Services Administration (SAMHSA) web site.