Doctor-patient relationship influences patient engagement

Patients who feel that their physicians treat them with respect and fairness, communicate well and engage with them outside of the office setting are more active in their own health care, finds a new study published in the journal Health Services Research.

The study looked at how role relationships between patients and their physicians, which traditionally have followed a passive-patient and dominant-physician model, affect patient engagement.

Patient activation is defined by patient behaviors, such as being knowledgeable about one’s health and health care and having the skills and confidence to engage in self-management of chronic conditions, according to the study.

Researchers asked 8,140 people in the U.S. with chronic illnesses about their experiences with their physicians, as well as about their socioeconomic status, overall health and how they make use of health services.

The researchers looked at four factors: the quality of the patient-physician relationship, including how well patients felt their doctors communicated with them; how much respect and fairness patients felt they received; the involvement of the patient in setting treatment goals; and the frequency of any patient-physician communications outside of the office setting, such as email or phone calls. Each of these factors was associated with greater patient engagement, with the exception of involvement in the setting of treatment goals.

The quality of the physician-patient relationship had the greatest effect on patient engagement: a one unit increase in the measurement of the quality of interpersonal exchanges led to an almost 10 unit increase in the level of activation by the patient. Patients with higher scores were more likely to monitor their blood pressure, exercise five days a week and adhere to medication regimens, among other healthy behaviors.

Physicians set the tone for making the patient aware that they have some control over their health, said lead study author Jeffrey A. Alexander, Ph.D., Richard C. Jelinek Professor of Health Management and Policy at the University of Michigan at Ann Arbor. "The patient takes a cue from what the doctor does. If the doctor conveys an all-knowing ‘I make the decisions’ attitude, the patient will revert to a passive role," he said.

Getting patients to be more active in their own care is important and this can be decreased by a power differential in the relationship between physician and patient, said Judith Schaefer, MPH, senior research associate at the MacColl Center for Health Care Innovation in Seattle. "Patients who are less activated do not understand the importance of the role they play and do not understand that they can have an effect on how their condition influences their lives," she said.

The study’s finding that the joint setting of treatment goals did not influence patient engagement was not surprising, Schaefer said. "This is an activity that requires more collaboration with the patient." Setting goals is not just about changing lab values, but requires understanding what is important to the patient and what will work in his or her life, she explained.

The authors noted that the study does not indicate whether a change in physician behavior causes greater patient engagement or whether more engaged patients have a tendency to select physicians who are more collaborative. Still, they emphasized that the study provides initial evidence that patient-physician relationships are an important factor in encouraging people to take a more active role in their health care.