Patient-mediated interventions to improve professional practice


Original post, click here

What is the aim of the review?

Our aim with this Cochrane review was to assess whether patients can change the performance of healthcare professionals. We collected and analysed all relevant studies to answer this question and found 25 studies.

Key message

This review suggests that patients may change healthcare professionals’ practice though the following three strategies: 1) strategies where patients give healthcare professionals information about themselves; 2) strategies where patients are given healthcare information; and 3) strategies where patients take part in patient education. Patient decision aids may make little or no difference to healthcare professionals’ practice, however, the certainty is low, and these results should be interpreted carefully. We still need more research about the best ways in which patients can change professional practice and about the impact it has on patients’ health.

What was studied in the review?

Many strategies have been tested to see if they can improve healthcare professionals’ practice and make sure that patients receive the best available care. These strategies include sending reminders to healthcare professionals, giving them further education, or giving them financial rewards. These strategies have mostly had only small or moderate effects. Another way of changing what healthcare professionals do is through the patients themselves. These strategies are called ‘patient-mediated interventions’.

What are the main results of the review?

The studies in this review assessed different patient-mediated strategies compared to usual care or no strategies.

Strategies where patients give information to healthcare professionals

In these studies, patients gave information about their own health, concerns or needs to the doctor. This was usually done by filling in a questionnaire in the waiting area before a consultation. The doctor was then given this information before or at the consultation. The review shows that these strategies:

– probably improve the extent to which healthcare professionals follow recommended clinical practice (moderate-certainty evidence).

We are uncertain about the effect of these strategies on patient health, patient satisfaction and resource use because these outcomes were not measured in the studies or because the certainty of the evidence is very low.

Strategies where information was given to patients

In these studies, patients were given information about recommended care or were reminded to use services, for instance to go for a check-up. The review shows that these strategies:

– may improve the extent to which healthcare professionals follow recommended clinical practice (low-certainty evidence);

– may have little or no effect on patient satisfaction (low-certainty evidence);

– may have little or no effect on some patient health outcomes, such as the number of patients who reach controlled blood pressure (low-certainty evidence). However, we are uncertain about the effect of these strategies on other patient health outcomes because the certainty of the evidence is very low. We also lack information to draw conclusions about resource use.

Patient education strategies

In these studies, patients took part in patient education such as self-management programmes, for instance to increase their knowledge about their condition. The review shows that these strategies:

– probably improve the extent to which healthcare professionals follow recommended clinical practice (moderate-certainty evidence);

– may slightly improve some patient health outcomes such as the number of patients who reach controlled blood pressure (low-certainty evidence). However, we are uncertain about the effect of these strategies on other patient health outcomes, patient satisfaction and resource use because these outcomes were not measured in the included studies.

Patient decision aid strategies

In the one study that assessed effect of patient decision aids, patients were given a decision aid consisting of a booklet, personal worksheet, and audiotape to make decisions about their medical management. The review shows that these strategies:

– may have little or no effect on the extent to which healthcare professionals follow recommended clinical practice (low-certainty evidence)

We are uncertain about the effect of these strategies on patient health, patient satisfaction and resource use because these outcomes were not measured in the studies or because the certainty of the evidence is very low.

How up-to-date is this review?

We searched for studies up to March 2018 and ongoing studies up to October 2017.