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Wednesday May 16, 2012

The promise of online tools for self-management support

Neil Seeman is Senior Resident in health system innovation at Massey College in the University of Toronto, CEO of The RIWI Corporation, a ‘Big Data’ technology company, and CEO of the Health Strategy Innovation Cell, a non-profit research unit focused on online disease management tools.

At the Health Strategy Innovation Cell and The RIWI Corporation, my colleagues and I have been at work exploring the power of online interactions in healthcare. We are in the emergent era of this evolution. We are at the early stages of understanding the Web, just now learning, for example, how people with low literacy, poor English language skills, or little Web-enabled access can use the Web effectively.

Despite these challenges, they should be balanced against the promises, which are immense. We can better understand patient preferences by listening (ethically, on open space forums) to what patients need, want, and expect from their healthcare system. Often these are low-cost preferences. We can, for instance, better understand how the public reacts to certain information, such as vaccine information posted online. We can share collaboratively on best practices; on how to use social media within and across healthcare organizations. We can learn about what the government considers to be the best role of government in setting different types of health promotion policies.

For the Health Council of Canada, research led to understanding that online, patients can control when and where they participate, and the technology can overcome isolation due to distance, weather, physical disability, family responsibilities, or discomfort with meeting in groups. Often patients who encounter heavily stigmatized conditions, such as HIV/AIDS or psychiatric conditions, are more active online – participating with caregivers and other sufferers – than they are in live interactions.

Whatever the promise of online interactions for self-management supports, this Health Council report underscores the importance of linking the clinical live interface with the online information tools.
Have you ever used a social network to manage your chronic condition? Would you? Would you recommend online interactions for a family member? What are the opportunities – and barriers?

Contact information:
neil.seeman@utoronto.ca
http://www.linkedin.com/in/seeman

Health Council of Canada | Conseil Canadien de la Santé

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Empowering Patients - Making It Different in the UK

Dr. David Pearce is an SMS Fellow with the Health Foundation in the UK. Heis the Clinical Lead for the Co-creating Healthteam in Torbay in south-west England, part of a multi-centre programme, initiated by the Health Foundation, to promote self-management and collaborative working between patients and health service staff.

Though this programme has many facets, uppermost in my mind at present is a patient whom I saw in my clinic just last week. My first question to her was something like, “So, what’s brought you here today?” and she replied “Well, I don’t really want to be here; it’s to stop X (another health professional that she sees regularly) going on at me about it.”

This was a lady who was intelligent, independent and articulate but her long experience of the health service had somehow led her to a position where she had become a recipient of care she didn’t want. Yet it could have been different. By empowering patients and collaboratively setting goals based on a jointly set agenda, we can release the greatest underused resource our health services have, the patients themselves. I have been involved in training staff in techniques to promote this collaborative working, which we call the Advanced Development Programme. Our aim is to promote a shift in the balance of power in the health service towards each contact between patients and health professionals being a meeting between two equal and complementary experts. Here I mean the health professional being an expert on the condition, and the patient being an expert on themselves and their own particular needs and values.

However, after years of new initiatives, many health service staff are undergoing "change fatigue," which is exacerbated by the current financial stricture. In this climate, the danger is that our clinician training becomes just another course, which is quickly forgotten. Yet we have now trained the vast majority of local primary care doctors and our most effective advertising has been past attendees. They have found that working collaboratively with patients brings genuine improvements in their job satisfaction.

Using these skills, doctors have told us of their ability to help previously 'stuck' patients to move forward. One talks of being able to finish their clinic on time for the first time in their career by using joint agenda setting. Even very simple, small changes in the doctor-patient interaction can produce big improvements and financial savings. For instance, considering the patient above, as part of the training we encourage doctors to ask, "Would you like to be referred to..." as opposed to saying "I am going to refer you to ...". Using advice like this led to one practice having a 30% reduction in secondary service referrals for mental health.

Whilst we are only a small team in Torbay, we have shown that the use of self-management techniques can produce positive changes in patient health, clinician job satisfaction and financial savings. We are passionate about self-management and its promotion and would welcome comments or questions. My email address is: david.pearce3@nhs.net.

Health Council of Canada | Conseil Canadien de la Santé

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