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UNHAPPY WITH CARE? PARTICIPATE MORE:STUDY SHOWS THAT PATIENTS WHO ARE MORE ENGAGED HAVE BETTEREXPERIENCES

Do you ever feel like you are "playing the odds" when you choose a physician, go to a hospital or schedule a surgery? How do you know you are making the right decisions? What if you make the wrong choices? How do you know who to trust? Can you increase your odds of getting good care?

A 2009 study done by the AARP looked at levels of patient involvement in their own health care. The results were significant. Patients over age 50 with chronic conditions who take an active role in managing their health have significantly fewer complications than those less involved in their health care. By being more knowledgeable, skilled and confident, these seniors are increasing their odds of getting good care.

The Patient Activation Measure asks 13 different true-or-false questions to measure patient involvement. Take a moment to answer these questions for yourself:

1. When all is said and done, I am the person responsible for taking care of my health.

2. Taking an active role in my own health care is the most important thing that affects my health.

3. I am confident I can prevent or reduce problems associated with my health.

4. I know what each of my prescribed medicines do.

5. I am confident I know when to go to the doctor and when I can take care of a problem myself.

6. I am confident I can tell a doctor my concerns, even if he or she doesn't ask.

7. I am confident I can follow through with medical treatments I may need to do at home.

8. I understand my health problems and what causes them.

9. I know what treatments are available for my health problems.

10. I have been able to maintain lifestyle changes, like eating right or exercising.

11. I know how to prevent problems with my health.

12. I am confident I can figure out solutions when new problems arise with my health.

13. I am confident I can maintain lifestyle changes, like eating right and exercising, even during times of stress.

Answering the first two as "true" means you are starting to take a role in your own state of health. "True" to questions through No. 8 shows you are building knowledge and confidence. If you answered "true" through question No. 11, you have the key facts and are beginning to take action. And finally, if you answered all 13 questions "true," you have adopted new behaviors and are as engaged as you could be in managing your health. When the study responses to these questions were analyzed, significant patterns were exposed. The more engaged a patient is, the more likely he is to get effective health care. For example, almost half of the least engaged respondents who had chronic health conditions reported that they needed health-care attention for a serious condition but did not get it. In contrast, only 11 percent of the highly engaged respondents reported this difficulty in getting care. Patients less involved in their care were twice as likely to be readmitted to the hospital within 30 days of discharge. They were more than twice as likely to experience a medical error in diagnosis or treatment plans. They were three times more likely to have poor care coordination and communication among their providers. Those less involved were four times more likely to lose confidence in the health care system. Less-engaged people with chronic conditions were likely to say that transportation problems kept them from getting the care they needed, indicating that they were more vulnerable to any obstacle that could derail their efforts. They also had less confidence in their ability to address problems. Highly engaged patients did not always seek care in a timely manner, either. But they more often said that a family member's advice -- "Don't be concerned" -- was the reason for not seeking care. Engaged people are more likely to recognize problems before they become medical errors. Clearly, it pays to be involved in your own health care.

We can feel helpless when we are at the mercy of a failing body, a changing health care system, and the fine print in insurance policies, but we are not helpless when it comes to our personal involvement. It would be foolish to play high-stakes poker without knowing the rules of the game. There's no need to be foolish when it comes to high-stakes health care. By becoming knowledgeable and involved, you are doing all you can to increase your odds of getting the best care your community has to offer.

Dr. Stacey Kerr, a longtime Sonoma County family physician, graduated from UC Davis Medical School and has been certified in her specialty by the American Board of Family Medicine. Her columns are not intended as a substitute for hand-on medical advice or treatment. Consult your health care provider before adhering to any recommendations in this column. E-mail comments to drkerr@the-doctors-inn.com.

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