Imagine a world where an individual’s specific needs and desired health outcomes are the driving force behind all healthcare decisions. Where care transforms from the existing episodic and need-based approach to a proactive, intuitive, and personalized experience. Where the patient is no longer the end receiver but an equal partner in shared decision-making.
A recent Diagnostics Media Forum (DMF), a platform created and powered by Roche, a global pioneer in pharmaceuticals and diagnostics focused on advancing science to improve people’s lives, asked a panel of experts dialing in from Thailand, India, Singapore and Australia, recently to connect the dots. The full streaming session can be viewed here.
During the pandemic and with health systems around the world under tremendous pressure, patients played a pivotal role in supporting public health measures. And, with rapid innovations in Covid-19 testing, the launch of patient self tests and introduction of digital tools also meant patients could take a more proactive approach towards managing their own health.
However, as experts like Dr. Suvanich Triamchanchoochai Cardiologist, Ramathibodi Hospital and Nakornthon Hospital specialised in cardiovascular and metabolic syndrome explain, Covid-19 has shown that the economic side of healthcare is still a major concern in Thailand, as for many countries. While Thailand benefits from universal healthcare where everyone can access the government-funded hospital nearest to them, the entire system faces immense pressure during health emergencies.
This is where ensuring people can live healthier lives for longer becomes important. A whitepaper titled “Asia Pacific’s Patient Engagement Dilemma”, suggests that while the ability to engage with the world of healthcare is determined by the availability, accessibility, and efficiency of healthcare systems and infrastructure; people’s willingness to engage with the healthcare sector is tied to culture, trust, and beliefs. As an approach to health promotion, it entails both the proactive involvement by health systems of patients throughout their healthcare journey and a reciprocal willingness of members of the public to engage with the healthcare ecosystem – as manifested in screening and preventive care, community-based care, health information seeking behaviours, and home-based monitoring and treatment.
Perfecting patient engagement
While patient experience is built into qualitative feedback assessments at many health institutions, the patient engagement deficit is too frequently overlooked. So what exactly is patient engagement and how does it influence outcomes?
“Patient engagement within the healthcare system is not about handing care over to the patient. Instead it is about bringing the voice of the patient, the key stakeholder in healthcare, into the conversation,” says Lance Little, Head of Region, Asia Pacific at Roche Diagnostics.
As the same whitepaper explains, patient engagement, put broadly, refers to patients’ and potential patients’ interest in, commitment to, and reliance on healthcare resources. While access to healthcare, which receives the bulk of stakeholder attention, is a measure of the supply of healthcare resources; patient engagement is a measure of demand for healthcare resources.
In the case of Thailand, we have seen engaging patients in HIV and cervical cancer can ensure timely diagnosis, early treatment and therefore better outcomes for the patient. This also reduces healthcare costs in the long term and allows people to continue being productive members of society.
The factors most acutely posing a barrier to patient engagement are accessibility & ease of access, trust in authority, and cultural factors. By focusing on how these can be addressed, health systems like ours can optimise the use of diagnostic services, such as preventive care and regular screenings to reduce or prevent serious illness, increase the quality and length of life, as well as lower long-term cost of healthcare through early diagnosis, treatment and patient compliance.
Challenges and opportunities
“Covid showed that the economic side of health care is still a major concern in Thailand, as for many countries,” explained Dr. Suvanich. “Fortunately, in Thailand, we have universal healthcare, so everyone can access the government-funded hospital nearest to them. The setup provides the main standard medications for adults and children. When you have emergency cases like a stroke, you can go directly to your nearest hospital. But because it’s free, it's over-crowded. So people with more income pay for private treatment.”
“The Asia Pacific region is extremely large and diverse, socially, economically, and culturally,” commented Dr. Ratna Devi, Immediate Past Chair of the International Alliance of Patients’ Organizations (IAPO). “We also have a mix of private and public sector healthcare provision. The private sectors, particularly in the more advanced countries, have better infrastructure, doctors and delivery mechanisms. The publicly funded systems are more accessible but the infrastructure is generally underfunded and under resourced. There are long waiting times and care quality is compromised.”
“As such patient populations, caregivers, communities and families do not see preventative health care as important and integral. Primary health care is weak and there is limited access to private healthcare due to cost. People might invest in a smartphone but not in a check-up!”
Literacy levels and gender are also known to affect patient engagement in diagnostic care.
“Health literacy is generally low in Asia Pacific and even less in certain parts among women and girls,” conceded Dr. Ratna Devi. “This means that people are not actively seeking information useful to them to be able to manage their healthcare well. People go to a hospital because they are sick and they get a diagnosis. If it isn’t life threatening, they go back home and fall out of the system again.”
Lance added that, “You end up with a passive individual imagining that at a point in time, the system will know that I am unwell and look after me.” The only good thing, he said, is that access to information is far more prevalent today than even 10-15 years ago.
The general consensus among expert stakeholders is that Asian healthcare systems are presently characterised by a paternalistic care model under which stakeholders, particularly healthcare providers, are not encouraged to view patients’ subjective perceptions of their care as being of any relevance. The primary focus is solely on the delivery of treatments and diagnoses as a series of singular events repeated by the physician in which the patient and the broader community are seen merely as the passive recipients of care. The emphasis is on the efficient discharge of the physician’s duties, prioritising their time over the comprehension of the patient. As such, the promotion of diagnostic care, inherently dependent on patient engagement, is especially ill-served.
Patients as equal partners
“Effective communication between doctors and patients about their treatment and problems is very important,” Dr. Suvanich explained. “In my practice of medicine every day, I listen to my patients’ problems and concerns. I try to be like an uncle, a brother or son, and listen to what is in their heart, in their culture. Many patients want to use herbal medicine and other things. I try to convince them about conventional medicine but I don’t go against them. We have to speak in the language patients understand, not in the language of doctors.”
“When I trained as a physician, I was never told that the patient is an equal partner in the healthcare journey,” reflected Dr. Ratna. “We just looked at clinical outcomes. That's what needs to change, so the patient is an equal partner in the decision making process.”
Gathering feedback from the patients is also pivotal to achieving positive patient engagement.
Dr. Ratna continued: “There’s the scientific community doing research, clinical trials and scientific processes with active engagement with patients to collect feedback that feeds into the research and research outcomes. However, in day-to-day practice where multidisciplinary teams are required, healthcare is siloed. There are so many specialities and sub-specialities and the doctors involved hardly speak to each other. The patient moves from one system or speciality to another and each healthcare provider offers a different message which makes everything confusing and contradictory.”
Some patient organisations are beginning to grapple with this but closing the gap will take time.
“We need to continue to work hard in bringing solutions to the healthcare community that can be deployed in a patient-centric way,” says Lance. “A great example is the self-sampling system that we have for HPV (cervical cancer). The fact that a woman can do a self-sample for a cervical screening test regardless of her access to an actual hospital breaks down a lot of barriers with one of the few cancers that is absolutely manageable and treatable.”
As for how patient engagement can be improved, says Lance, “Technology is top of the list, not only for collecting data and helping governments manage costs but also for the patient access aspect of information and monitoring.”
Getting to the roots of the issues
While Covid brought telemedicine to the fore, it has yet to realise its full potential.
“Nevertheless, point of care, diagnostics and point of treatment methodologies, are bringing healthcare out of brick and mortar hospitals into communities, to homes, so that people are able to access it much faster, and much better. We still need to talk to the patient and help them understand the value of diagnostics and screening and staying healthy. We also need to work closely with our regulators and help them be much more agile in making sure that good safe products are delivered,”according to Lance.
The good news is that patient centricity can actually reduce health system waste. An Organization for Economic Cooperation and Development report on wasteful spending in health care published in 2017 said that at least one-fifth of health care spending could be channelled towards better use. The report found that too many patients are unnecessarily harmed at the point of care. Moreover, many patients receive unnecessary care that makes no difference to their health outcomes and the same benefits could be provided using fewer resources.
Experts concluded that achieving an adequate degree of patient engagement in Asia Pacific is still going to necessitate a paradigm shift toward a patient centric model of care that has a long way to go yet. Meanwhile, all stakeholders still have vital roles to play.