Friday, June 17, 2011

Empowering patients with data

I've been thinking more and more about the idea of engaging patients in their own care as the means to improve quality and reduce costs. Today I see that Farzad Mostashari, Director of the Office of the National Coordinator, is thinking along the same lines:
"The meta principle is putting patients at the center of information flows, literally. Achieving that means freeing the patient data, empowering patients by raising awareness that they can access their own data and teaching them to learn from it."
Perhaps the time has come....

Sunday, June 12, 2011

Is it better to prescribe or negotiate?

Engaging patients in their own care means more than just giving them a handout or teaching them how to care for their feet. The tough part is motivating them to stay engaged for the long run. This is especially difficult when they have depression which itself induces dis-engagement from the world.

Exercise is an effective treatment for depression. It is also inexpensive and has positive benefits in other spheres of health such as weight control and heart disease prevention. However, it is notoriously difficult to get depressed patients to start exercising and to keep them engaged. One reason might be that the recommended duration and intensity of exertion can seem daunting. (30 minutes on the treadmill!!!)

A team of researchers from the University of Nottingham just published the intriguing results of a controlled trial in which they compared the effects of exercise of preferred intensity with exercise of prescribed intensity in thirty-eight women living with depression. The women who chose their own level completed more sessions and had better mental AND physical health at the end of the 12 week study.

The study is quite small (only 38 subjects) and may not be the last word on this issue, but the idea certainly warrants further investigation. It suggests that engaging patients in decisions about the dose of the treatment is effective at keeping them in the treatment. And, that's better than getting them on the "right" dose.

Pragmatic randomised controlled trial of preferred intensity exercise in women living with depression. Patrick Callaghan, Elizabeth Khalil, Ioannis Morres, Tim Carter. BMC Public Health 2011; 11:465