Synthesising the results of evaluations of such a diverse range of interventions is an ambitious task. Some people might say it is too ambitious to be done reliably, but policy overviews such as this—which are designed to inform planning at a system level—are inevitably “broad brush.” Nevertheless, this overview is no substitute for careful reading of the original reviews, and we hope that the newly established Health Foundation's quest for quality and improved performance database will help readers to access these.
The systematic reviews we identified varied in how they described the interventions studied, the outcomes measured, and whether outcomes were presented qualitatively or quantitatively. Some provided no clear descriptions of the interventions or the study context. Patients' demographic and clinical characteristics were sometimes missing or poorly reported; the length of follow-up was often relatively short, so the longer term effectiveness of many of the interventions is unknown; and few studies evaluated the cost effectiveness of interventions or considered their potential opportunity costs.
Nevertheless, we believe there is a substantial evidence base, albeit imperfect, on which to build strategies to strengthen patient engagement. Most reviews reported improvements in important outcomes, and several promising avenues to pursue have been identified.
Because health literacy is central to enhancing involvement of patients in their care, all strategies to strengthen patient engagement should aim to improve health literacy. Many people will have difficulty taking advantage of these new opportunities if the problem of health literacy is not dealt with. This could widen health inequalities, or even create new ones.
Thus, patients' knowledge and understanding can be improved, at least at the individual level. Patients with acute and chronic health problems benefit when they are involved in their care, both at home and in clinical settings, and evidence suggests that this can lead to better use of resources. Shared decision making and self management are mutually supportive approaches, which should be given equal importance and implemented consistently.
- A substantial evidence base exists for building strategies to strengthen patient engagement
- Any strategy to reduce health inequalities must promote health literacy and engagement
- Patients could help select treatments, manage long term conditions, and increase safety of drug use and infection control
- Interventions can improve patients' knowledge and experience, use of health services, health behaviour, and health status
Health information materials, decision aids, self management action plans, and other “technologies” of patient engagement are most effective when they supplement or augment, rather than replace, interactions between patients and professionals. As patients take on new health roles, ongoing support from health professionals may become even more important. Health professionals must be given the opportunity to develop their competencies in patient centred care—particularly their communication skills. Clinicians must also be given the resources needed to work collaboratively with their patients, to help them access and understand health information, and to offer support in making choices to those who need it.