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FOTO Rehab Outcomes Blog

Do We Really Understand Patient Activation and Engagement?

Professionals participating in accountable care organizations and value based purchasing need better understanding when it comes to patient activation and engagement.

patient-engagementThis recent article perked my interest. I often see marketing strategies for various products using the term "patient engagement." It seems to be turning into more of a buzz word than anything else. This is sad because there are some products that truly help improve patient engagement - which means it creates difficulty in filtering the fluff products from real products.

One thing that I liked about this article was how it simplified patient activation and engagement. The more engaged a patient is, the better the outcomes.  What needs to be included for successful patient activation and engagement?

Goal Setting

Motivational Interviewing

Shared Decision Making

From the findings in the article, the medical professionals verbally stated they valued patient activation and engagement. Sadly, even though the system in which the subjects practiced was considered a system that included patient activation and engagement, the professionals really did not have a true understanding on how to include the three aspects required to enhance their patients' role in care pathways.

The abstract is included below for you to review.

How do healthcare professionals working in accountable care organisations understand patient activation and engagement? Qualitative interviews across two time points.




If patient engagement is the new 'blockbuster drug' why are we not seeing spectacular effects? Studies have shown that activated patients have improved health outcomes, and patient engagement has become an integral component of value-based payment and delivery models, including accountable care organisations (ACO). Yet the extent to which clinicians and managers at ACOs understand and reliably execute patient engagement in clinical encounters remains unknown. We assessed the use and understanding of patient engagement approaches among frontline clinicians and managers at ACO-affiliated practices.


Qualitative study; 103 in-depth, semi-structured interviews.


Sixty clinicians and eight managers were interviewed at two established ACOs.


We interviewed healthcare professionals about their awareness, attitudes, understanding and experiences of implementing three key approaches to patient engagement and activation: 1) goal-setting, 2) motivational interviewing and 3) shared decision making. Of the 60 clinicians, 33 were interviewed twice leading to 93 clinician interviews. Of the 8 managers, 2 were interviewed twice leading to 10 manager interviews. We used a thematic analysis approach to the data.


Interviewees recognised the term 'patient activation and engagement' and had favourable attitudes about the utility of the associated skills. However, in-depth probing revealed that although interviewees reported that they used these patient activation and engagement approaches, they have limited understanding of these approaches.


Without understanding the concept of patient activation and the associated approaches of shared decision making and motivational interviewing, effective implementation in routine care seems like a distant goal. Clinical teams in the ACO model would benefit from specificity defining key terms pertaining to the principles of patient activation and engagement. Measuring the degree of understanding with reward that are better-aligned for behaviour change will minimise the notion that these techniques are already being used and help fulfil the potential of patient-centred care.

 2018 Oct 31;8(10):e023068. doi: 10.1136/bmjopen-2018-023068.

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