{"id":5237,"date":"2010-03-22T05:12:21","date_gmt":"2010-03-22T10:12:21","guid":{"rendered":"http:\/\/pmedicine.org\/epatients\/?p=5237"},"modified":"2010-03-21T21:13:05","modified_gmt":"2010-03-22T02:13:05","slug":"why-is-participatory-medicine-such-a-tough-sell","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2010\/03\/why-is-participatory-medicine-such-a-tough-sell.html","title":{"rendered":"Why is participatory medicine such a tough sell?"},"content":{"rendered":"<p><em>Kevin A. Clauson, Pharm.D. is an associate professor at the College of Pharmacy and adjunct associate professor at the College of Medicine \u2013 Biomedical Informatics Program at Nova Southeastern University in Fort Lauderdale,\u00a0 FL.\u00a0 He teaches a course on Consumer Health Informatics and Web 2.0 in Healthcare and <a href=\"http:\/\/kevinclauson.wordpress.com\/\">blogs<\/a> and conducts research about related topics. Kevin can be reached via Twitter @kevinclauson.<\/em><\/p>\n<p>A lull in the pharmacy conference season is giving me an opportunity to look back and reflect on how many audiences were receptive to exploring roles of social media in healthcare.\u00a0 However, a similarly consistent observation from my <a href=\"http:\/\/www.slideshare.net\/kclauson\">presentations<\/a> was how tough of a sell participatory medicine seemed to be.\u00a0<strong> <\/strong><\/p>\n<p><strong>The same crowds and individuals who were willing to incorporate unorthodox channels of communication and engagement (i.e., Web 2.0), appeared largely unwilling to give the participatory medicine model a chance.<\/strong><\/p>\n<p>The upside is that this resistance did help stimulate several interesting conversations.<\/p>\n<p>Many of these conferences were attended by pharmacists in clinical settings.\u00a0 I think the suspension of disbelief and leap to social media was easier for them to make once they saw that the <a href=\"http:\/\/www.cdc.gov\/socialmedia\/\">Centers for Disease Control and Prevention<\/a>, <a href=\"http:\/\/socialmedia.defense.gov\/\">Department of Defense<\/a>, and <a href=\"http:\/\/ebennett.org\/hsnl\">hundreds of hospitals<\/a> were already employing these technologies.\u00a0 This held true even though there is not much in the peer-reviewed literature actually establishing the benefits of doing so.\u00a0 Hence, it is a little ironic that the same shortcoming (i.e., lack of an established model with supporting evidence) is what held up many regarding adoption of a participatory medicine model, or even a subset like <a href=\"http:\/\/www.longwoods.com\/product.php?productid=20947\">shared decision making<\/a>.<\/p>\n<p><strong>In total, three major types of barriers emerged from speaking with healthcare professionals and students: level of commitment required, confidence in patient capacity, and absence of evidence.<\/strong><!--more--><\/p>\n<p><strong>Level of commitment<br \/>\n<\/strong>One attendee summarized her reservations as, \u201cYou can dip your foot into the pool with social media, but you have to dive into participatory medicine.\u00a0 It\u2019s like being willing to listen to a new song versus trying to play a whole new musical genre.\u201d\u00a0 The perception was that adopting a collaborative approach would have to be a top down implementation.\u00a0 When pressed on the topic, some practitioners admitted they were afraid that a negative impact on patient outcomes from this approach would result in their patient \u2018partner\u2019 or family taking legal action since it was so far outside the standard of care they knew.\u00a0 Even pharmacists open to the idea felt they should receive some type of training first, but weren\u2019t sure how to pursue it.\u00a0 Pharmacists in the community setting, in particular, expressed that without corporate approval and protection that their hands were tied from workload and infrastructure perspectives.<\/p>\n<p><strong>Confidence in patient capacity<\/strong><br \/>\nWhile it may be an entertaining show, <a href=\"https:\/\/www.youtube.com\/watch?v=XjkCl3-PId8\">examples like this House episode<\/a> highlighting difficulties with patient capacity and compliance probably aren\u2019t helping those pharmacists on the fence about participatory medicine.\u00a0 I suspect almost all of us who have been in practice have encountered the occasional patient of this type.\u00a0 A common refrain I heard was, \u201cwe can\u2019t even get patients to take their meds now.\u00a0 How are they supposed to be responsible as a partner in their healthcare?\u201d \u00a0Pharmacy is as grounded as any healthcare profession in the paternalistic mindset.\u00a0 Even as it has evolved into producing pharmacotherapeutic experts with roles including patient advocacy, the advocating itself has retained a paternalistic framework.<\/p>\n<p><strong>Absence of evidence<\/strong><br \/>\nOne of the most damning reasons clinicians cited for avoiding adoption of participatory medicine is that there is virtually no published research demonstrating that it has a positive effect on key outcomes.\u00a0 Ironically, many of these same people were absolutely willing to commit the time and resources (even before it was mandated) to implementing traditional informatics tools \u2013 despite a frequent lack of evidence in that arena.\u00a0 New \u201ccutting edge\u201d technology is simply an easier sell than equipping a patient with the tools they need to be empowered, engaged, etc. and trusting them to shoulder a burden of responsibility.<\/p>\n<p><strong>Optimism looking ahead<\/strong><br \/>\nIt was encouraging that at some meetings, attendees took on the role of flag bearer for participatory medicine.\u00a0 For instance, it was pointed out that there is a fair amount of research on the shared decision making process piece.\u00a0 It has shown promise in improving the quality of interactions and patient satisfaction.\u00a0 Alternately, it was acknowledged that a positive impact on outcomes like compliance in <a href=\"http:\/\/fampra.oxfordjournals.org\/cgi\/content\/full\/21\/4\/347\">studies<\/a> and <a href=\"http:\/\/mrw.interscience.wiley.com\/cochrane\/clsysrev\/articles\/CD007297\/frame.html\">Cochrane Reviews<\/a> is unclear at best.\u00a0 Questions were also asked about the root cause of compliance issues and others urged examination of potentially flawed assumptions about patient capacity.\u00a0 There has even been work specifically investigating <a href=\"http:\/\/mdm.sagepub.com\/cgi\/content\/abstract\/30\/1\/35\">patient involvement despite lower literacy<\/a>. It was universally recognized that some patients simply don\u2019t want to be active and engaged; they prefer more traditional, passive roles.<\/p>\n<p>In many of my lectures in the College  of Pharmacy, I use an audience response system.\u00a0 I have found it can be a good tool to assess baseline knowledge, assess comprehension of a concept and generate discussion \u2013 which can be difficult in a class of 200.\u00a0 This week I posed the question in a class of first year pharmacy students, \u201cWhat is your opinion of the participatory medicine model?\u201d\u00a0 Students pressed the corresponding number on their clicker and their responses were aggregated from all three campuses.\u00a0 Choices (and corresponding student responses) were:<\/p>\n<p>1. Will result in improved outcomes if patients are partners in their health (57%)<br \/>\n2. Will only work for affluent and highly educated patients (25%)<br \/>\n3. Depends more on the specific pharmacist than the patient to determine if it will work (13%)<\/p>\n<p>4. Will never work; patients don\u2019t even take their medications correctly as it is (5%)<\/p>\n<p>The student responses were encouraging and led to some insightful questions and comments.\u00a0 One thing I do to try and foster their inquisitiveness is to include a slide citing the <a href=\"http:\/\/participatorymedicine.org\/\">Society for Participatory Medicine<\/a> and highlight the accompanying <a href=\"http:\/\/participatorymedicine.org\/journal\/\"><em>Journal<\/em><\/a>.\u00a0 For many of the groups I address, I think these are two important steps.\u00a0 The creation of the <em>Journal<\/em> was especially critical as there are a fair amount of people who won\u2019t even consider something until it appears in a traditional peer-reviewed venue.\u00a0 Similarly, one of the <a href=\"http:\/\/www.nlm.nih.gov\/medlineplus\/magazine\/issues\/winter07\/articles\/winter07pg2-3.html\">quotes<\/a> that really resonates with people is: \u201cAs opposed to the doctor-centric, curative model of the past, the future is going to be patient-centered and proactive.\u201d\u00a0 The weight given to the statement is not so much due to the words themselves as the fact that they were spoken by then Director of the National Institutes of Health (NIH), Dr. Elias A. Zerhouni.<\/p>\n<p>Overall, there was a lot of doubt expressed about participatory medicine.\u00a0 However, most pharmacists are analytical by nature, have strong critical thinking skills, and a desire to help improve patient outcomes.\u00a0 Based on those qualities, increased awareness and an emerging body of research in this area, I think more pharmacists will be embracing the best components of this model.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Kevin A. Clauson, Pharm.D. is an associate professor at the College of Pharmacy and adjunct associate professor at the College of Medicine \u2013 Biomedical Informatics Program at Nova Southeastern University [&hellip;]<\/p>\n","protected":false},"author":29,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"give_campaign_id":0,"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","_price":"","_stock":"","_tribe_ticket_header":"","_tribe_default_ticket_provider":"","_tribe_ticket_capacity":"0","_ticket_start_date":"","_ticket_end_date":"","_tribe_ticket_show_description":"","_tribe_ticket_show_not_going":false,"_tribe_ticket_use_global_stock":"","_tribe_ticket_global_stock_level":"","_global_stock_mode":"","_global_stock_cap":"","_tribe_rsvp_for_event":"","_tribe_ticket_going_count":"","_tribe_ticket_not_going_count":"","_tribe_tickets_list":"[]","_tribe_ticket_has_attendee_info_fields":false,"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[3586,2,2304],"tags":[3793,3781,169,3801,7705],"coauthors":[],"class_list":["post-5237","post","type-post","status-publish","format-standard","hentry","category-research-issues","category-trendsprinciples","category-why-pm","tag-centers-for-disease-control","tag-consumer-health-informatics","tag-participatory-medicine","tag-pharmacists","tag-social-media"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Why is participatory medicine such a tough sell? - SPM Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/participatorymedicine.org\/epatients\/2010\/03\/why-is-participatory-medicine-such-a-tough-sell.html\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Why is participatory medicine such a tough sell? - SPM Blog\" \/>\n<meta property=\"og:description\" content=\"Kevin A. 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