Engaging High-Need Patients in Intensive Outpatient Programs: A Qualitative Synthesis of Engagement Strategies.

Zulman DM, O'Brein CW, Slightam C, Breland JY, Krauth D, Nevedal AL
Source: J Gen Intern Med
Publication Year: 2018
Patient Need Addressed: Patient satisfaction/engagement
Population Focus: Complex care
Intervention Type: Best practices
Study Design: Other Study Design
Type of Literature: white
link: https://link.springer.com/article/10.1007%2Fs11606-018-4608-2
Abstract

BACKGROUND:
Intensive outpatient programs address the complex medical, social, and behavioral needs of individuals who account for disproportionate healthcare costs. Despite their promise, the impact of these programs is often diminished due to patient engagement challenges (i.e., low rates of patient participation and partnership in care).

OBJECTIVE:
The objective of this study was to identify intensive outpatient program features and strategies that increase high-need patient engagement in these programs.

DESIGN:
Qualitative study.

PARTICIPANTS:
Twenty program leaders and clinicians from 12 intensive outpatient programs in academic, county, Veterans Affairs, community, and private healthcare settings.

APPROACH:
A questionnaire and semi-structured interviews were used to identify common barriers to patient engagement in intensive outpatient programs and strategies employed by programs to address these challenges. We used content analysis methods to code patient engagement barriers and strategies and to identify program features that facilitate patient engagement.

KEY

RESULTS:
The most common barriers to patient engagement in intensive outpatient programs included physical symptoms/limitations, mental illness, care fragmentation across providers and services, isolation/lack of social support, financial insecurity, and poor social and neighborhood conditions. Patient engagement strategies included concrete services to support communication and use of recommended services, activities to foster patient trust and relationships with program staff, and counseling to build insight and problem-solving capabilities. Program features that were identified as enhancing engagement efforts included: 1) multidisciplinary teams with diverse skills, knowledge, and personalities to facilitate relationship building; 2) adequate staffing and resources to handle the demands of high-need patients; and 3) a philosophy that permitted flexibility and patient-centeredness.

CONCLUSIONS:
Promising clinical, interpersonal, and population-based approaches to engaging high-need patients frequently deviate from standard practice and require creative and proactive staff with adequate time, resources, and flexibility to address patients’ needs on patients’ terms.

Insights Results

Overview of article

  • The objective of this study was to identify intensive outpatient program features and strategies that increase high-need patient engagement in these programs

Methods of article

  • 20 program leaders and clinicians from 12 intensive outpatient programs in academic, county, Veterans Affairs, community, and private healthcare settings
  • A questionnaire and semi-structured interviews were used to identify common barriers to patient engagement in intensive outpatient programs and strategies employed by programs to address these challenges. Researchers used content analysis methods to code patient engagement barriers and strategies and to identify program features that facilitate patient engagement

Results

  • The most common barriers to patient engagement in intensive outpatient programs included
    physical symptoms/limitations, mental illness, care fragmentation across providers and services, isolation/lack of social support, financial insecurity, and poor social and neighborhood conditions
  • This qualitative study suggests that patient engagement efforts may be enhanced by certain program features, such as a diverse multidisciplinary team, adequate staffing and resources to support relationship-building and intensive case management, and a patient-centered structure and philosophy

Key takeaways/implications

  • Findings suggest that programs aiming to increase engagement of complex, high-need patients should seek out creative and proactive staff, and ensure that they have adequate time, resources, and flexibility to address patients’ needs on patients’ terms
  • A limitation of this study is its focus on program staff and leadership perspectives about effective engagement activities. These findings are consistent, however, with qualitative studies of patients in intensive outpatient programs that suggest that patients value the relationships with staff and their assistance navigating medical and social systems, and also report improved health-related motivation, sense of control, and perceived health
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