Importance Of Patient Involvement And Integration In Healthcare System: An Annotated Bibliography

Patient-centered approach in nursing

Write about the Annotated Bibliography on Mental Health for Healthcare.

This annotated bibliography is on the theme of involvement and integration of patient in the healthcare system

This paper discusses about the importance of the integration of the participation and knowledge of patients in the healthcare system. The engagement of patients in the healthcare system has galvanized momentum in the recent policy and research practise. It has been recognized an instrumental in disseminating high-quality healthcare services. Patients are at the forefront of the government policies and the government has shown intervention through prioritizing the voice of the patients and incorporating the active role of the patients within the healthcare agenda. The authors argue that from the perspective of nursing, the incorporation of the patients in providing accurate information regarding their health conditions is particularly emphasized. Nurses need to develop on a patient-centred approach by involving in the family members of the patients. This would facilitate in the formulation of an appropriate plan that would enable the nurses to address the concerns of the patients with greater alacrity by addressing the issues of drug management and discharge goals. The incorporation of the patients within the framework of the healthcare system is will be done by patient-oriented approaches that would lead to the better management of the disease, and the policy of partnership and cooperation, therefore fostering on the professional-patient relationship. The method adopted for this study is a critical review of literature concerning the keywords of engagement and patient using reputed databases namely Google Scholar, SCOPUS, Medline and so on. The results of the study demonstrated that there has been an increase in interest in the theme of patient engagement both in the managerial and academic domains. This was evident in the growing number of literature between the period of 2002 and 2012 indicating the empowerment of the patients. It was further revealed that that there has been a robust involvement from the academic communities in conducting health research about the engagement of patients as an effective strategy in the improvement of the health of the patients. Another trend that emerged through the review of literature is that there has been a focalization of mental health. The limitation of this research is that it has not focussed on patient care from multiple perspectives which could have provided a more insightful understanding.

In this, paper the authors  discuss about the importance of patient and family interventions in creating a more efficient healthcare care system. The authors are of the opinion that the there is ambiguity regarding the definition of patient engagement. For some scholars,  patient engagement indicates the promotion of public engagement and patient care in the aspects of healthcare and the strengthening of influences at the macrocosm of the collectivity and at the microcosm of the individual. Then there scholars who are interested in the settings in which the engagement of the patients take place. Patient engagement is also used synonymously with patient –and-family-centred care and  patient activation. However, the author s warn that these terms should not be compounded and thee needs to be an effort to understand each of these words individually. The authors have defined patient and family engagement as collaboration and working in partnerships operating at different levels of the healthcare system that includes the direct, indirect, policymaking and governmental approach in bolstering the healthcare system. To provide a more perspicacious understanding of the healthcare system, the authors have generated a framework that is in consonance with the development of policies and interventions that would foster family and patient engagement. The authors developed a multi-dimensional framework that comprises of the three critical elements of the patient engagement. These elements are continuum, consultation to partnership and the multiple factors of willingness of the patients. The authors note that there are certain factors that inform patient engagement, this includes patients, organizations and the society. The continuum engagement is helpful in characterizing the degree to which the patients are involved in the decision-making process. Secondly, the framework emphasizes on the possibility of greater impact that could be accomplished through the implementations of interventions across the different levels of engagement. Thirdly, interventions can be formulated based on the  engagement of the patients through motivation, knowledge and addressal of the societal and organizational constraints. The authors argue for patient engagement as a pathway for the achievement of better quality healthcare. Initiatives of engagement challenge the notions of norms, needs and the pre-conceived assumptions about healthcare professionals in the treatment. 

Framework for patient engagement

In this paper, the authors provide an overview of the degree to which healthcare providers are involved in incorporating the patients within the framework of the decision-making regarding the variegated aspects about their health. For this purpose, there was the designing of the Observing Patient involvement Decision Making instrument (OPTION) to understand this process and the scenario. The authors deployed the OPTION instrument to study the degree to which the healthcare providers collaborated with the patients in the process of decision-making across the range of clinical contexts that includes various healthcare professions along with the length of their consultations. The authors adopted secondary data research through an online literature search option that includes multiple databases ranging between 2001 and 2012 that collected further data through the means of networking. It can be said that according to the multiple clinical contexts, there is involvement of the patients. The authors have found 33 eligible studies and 29 of these studies are on the revised scale. The extracted data in this case are OPTION outcomes and the study of the participant characteristics. The author argue that healthcare providers in the clinical context persistently to foster the healthcare development through the involvement of the patients. The SDM interventions can be improved through the loner interventions

In this paper, the authors argue that governments in North America and Western Europe have been encouraging about the formulation and development of the healthcare services. In case of Wales and England, it was found that concerted efforts are being made to improve the healthcare system. There is an increasing belief by the government that inclusion of the patients in making the healthcare service more acceptable and the overall healthcare system as accessible in improvement in the quality of the healthcare system. The government have understood the importance of incorporating the patients with the intention of more responsive services and greater outcome of the care service. There are many guides suggesting and proposing about the different ways to incorporate patients within the framework of the healthcare service. Although the involvement of patients is becoming common, it is definitely not an easy task but demands rigour and alacrity. The method adopted by the authors for the purpose of the study is that secondary data analysis. The papers were selected through electronic databases, communication with the insiders on the field and making hand searches through a list of references. Some of the keywords used for searching the pertinent materials are empowerment, patient, representation, healthcare, health, organizational change organizational delivery, provision, planning and development. The criterion selection adopted by the authors were literature that were concerned with the involvement of the patients, and planning and delivery of healthcare services. The exclusion criteria adopted for the review of literature is the evaluation of the satisfaction level of the patients and papers that dealt with the preferences of the patients in regard to the usage of this information for further purpose. The reviewed of the articles were conducted through a qualitative analysis. The authors found that there are 3337 studies pertaining to the patients in the planning and development of the healthcare system. 294 papers out of this were excluded and it was found that 42 papers elaborated on the impact of initiatives that incorporate the patients. It was stated in a large number of papers that patients embraced this step of incorporating them with the larger model of the healthcare system and recognizing their contributions in the improvement of the system. Incorporation of patients within the framework of the healthcare model generated information that would be important in making the healthcare services more accessible. This also led to the encouragement of the advocacy of the people. This type of initiative helps in improving the culture of an organization by making the staff more accountable and empathic towards the needs of the patients.

Observing Patient involvement Decision Making instrument (OPTION)

Elg et al (2012) aimed to develop a study that evaluated the patient-centred model in healthcare intervention. Their research made an attempt to assess the model for learning and co-creation derived through the diaries of the patients for further development in the healthcare system. This paper tried to delve into the process of patient co-creation and the variegated mechanisms that have developed so that the healthcare workers can derive information and understand about the condition of the patients. The research design of this study is action design research. The first step was to develop a phase for the patient through learning and co-creation that led to the proposed model. In the second stage, a diary-based research was conducted on the 53 patients who were admitted in the departments of gastroenterology, rehabilitation and orthopaedic care. It was found that there is a need to develop learning and co-creation model through three learning methods. This model may be the generation and collection of data in the form of ideas of the patients. Secondly, there is the possibility of illustrating a single patient’s lived experience that can serve a guideline to necessary healthcare intervention and the designing of patient-centred care. Thirdly, a large amount of diaries were analysed along with the surveys conducted on the patients and is provided an understanding of the experiences of the healthcare of the patients. The highlight of the study lies in offering new and diverse insights through the incorporation if the diary method. Secondly, the paper recommends the co-creation approach that includes the patients for the development of healthcare services through collaboration with the patients. Some of the important methodological issues that emerged are that diaries need to be handled carefully and there is a need to maintain confidentiality by anonymisation of the patients. This is an ethical code that should be adhered to by the researchers. The ways in which the patients are approached for the study and their response underline their interest in participation.

This paper discusses about the multiple interventions adopted by the countries like United States and Canada to foster the best method of decision-making is through the involvement of patients for exchange of information and shared values. The first step in this endeavour as discussed by the authors is that the importance of shared decision-making during the sensitive situations. In this step, the patients will be informed about the best possible choice that can be made and assessment of the different alternatives. The following step is to discuss the benefits and perils of each and the probabilities. A patient may find it difficult to decide between watchful waiting and surgery in the face of not being aware of the nature and consequences of the situation. The key goal is to inform the patients about the benefits and the potential danger related to a particular medical activity and thereby, sweep away their anxieties. The authors suggest that clinical practise guidelines have the potential of promoting the value of shared decision-making and communication involving the patients. Providing the clinicians with the adequate skills can help in improving their approach towards shared decision-making. It has been found that communication of risk and understanding the preference of the patients remains largely included in the field of medicine. Therefore, it is important to identify this lacuna and incorporate shared decision-making into the framework of medicine that would prepare clinicians better for the co-creation healthcare model. Shared decision-making is a complex concept as argued by the authors and therefore, it is important that all the stakeholders are aware about the imperative of shared decision-making in the dissemination of healthcare. The limitation of the study is that it does not engage in any primary data analysis that could have entrenched the position of the authors and supplement the secondary data research.

References

Barello, S., Graffigna, G. and Vegni, E., 2012. Patient engagement as an emerging challenge for healthcare services: mapping the literature. Nursing research and practice, 2012.

Carman, K.L., Dardess, P., Maurer, M., Sofaer, S., Adams, K., Bechtel, C. and Sweeney, J., 2013. Patient and family engagement: a framework for understanding the elements and developing interventions and policies. Health Affairs,32(2), pp.223-231.

Couët, N., Desroches, S., Robitaille, H., Vaillancourt, H., Leblanc, A., Turcotte, S., Elwyn, G. and Légaré, F., 2015. Assessments of the extent to which health?care providers involve patients in decision making: a systematic review of studies using the OPTION instrument. Health Expectations,18(4), pp.542-561.

Crawford, M.J., Rutter, D., Manley, C., Weaver, T., Bhui, K., Fulop, N. and Tyrer, P., 2002. Systematic review of involving patients in the planning and development of health care. Bmj,325(7375), p.1263.

Elg, M., Engström, J., Witell, L. and Poksinska, B., 2012. Co-creation and learning in health-care service development.Journal of Service Management, 23(3), pp.328-343.

Stiggelbout, A.M., Van der Weijden, T., De Wit, M.P., Frosch, D., Légaré, F., Montori, V.M., Trevena, L. and Elwyn, G., 2012. Shared decision making: really putting patients at the centre of healthcare. Bmj, 344, p.e256.