Patient-centered care: is patient self-involvement necessarily good?

Posted on 5 March 2008

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(image source: Subhuti Dharmananda, Ph.D.)

An interesting study just published in the Annals of Behavioral Medicine by Dr. A. Baldwin of the University of Iowa has shown that, at least for hypertensive white male veterans in the midwest US, an increased role in determining one’s own health care is not associated with an improvement in one’s health status. (It’s not yet electronically available, but I think that it should be very soon–check PubMed for electronic issues of the journal!) This is interesting, because much of the recent push for preventive care by HMOs seems to be focused on educating the consumer and getting the consumer to take a more active role in their own health care…which may or may not have any effect on population health status at all.

Still, I was concerned by the use of hypertensives in this study. Clearly, he’s chosen a very good group to study because their health status is clearly measurable, the set consists of lots of data points, and it isn’t too rare of a condition to apply the data to a wider population. Anyway, I was wondering if these results might be partly described by the overinclusion of (what would have been called) “Type A” personalities–the ones who were classically considered to be the active, aggressive, and controlling personality types–and who, I understand, were found to have a genetic complement that provided higher testosterone, blood pressure, LDL cholesterol, etc…in other words, the ones who were in worse health to begin with.

After corresponding with the author of the study, I was made aware that there is painfully little completed research in this area. He also mentioned that he suspected something similar, and (to paraphrase) that the involvement vs. health status outcomes might be based upon the diagnosis considered and the average neuroticism of the population being studied. I hope that, in the near future, we’re able to find a number of good studies of the ramifications of patient involvement in health care relationships, as this would seem to be important to the general policy changes that may or may not take place in the imminent political elections.

Relevant Links:

http://www.news-releases.uiowa.edu/2007/August/081007patient-centered.html

Article from Reuters

Article from Reuters #2

…And a Few More Topical Links:

http://www.ihi.org/IHI/Topics/PatientCenteredCare/PatientCenteredCareGeneral/

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=307907

http://www.aafp.org/fpm/980300fm/patient.html

http://jama.ama-assn.org/cgi/content/full/296/23/2848

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