Health Assessments in Primary Care
Section 5. How Do You Activate and Engage Patients in Using Their Health Assessment Information?
An essential part of using a health assessment in your practice will be to activate and engage patients in the process of using health assessments to help improve their health. Patients clearly want some kind of acknowledgement that you have reviewed their completed assessments; however, this is only one of several considerations to engage patients in a conversation to plan a course of action.
What do you need to tell patients about health assessments?
Patients need to hear from their clinicians that taking the time to complete the health assessment accurately is important and that health assessments will help you to work as a team to improve their health. Consider creating a script for staff and clinicians to use when talking about health assessments so they deliver a consistent, reinforcing message.
- Remind patients that health assessments give you meaningful information about their health and that it is critical that the information is accurate and complete.
- Tell patients that the information will help to identify potential health concerns, and, if needed, agree on a plan of action to address these concerns.
- Let patients know who will see the information on their health assessment.
- Clearly connect specifics on the health assessment to a patient's health or specific health concern (e.g., "This is about your diabetes and heart health.").
What do patients expect?
Patients expect health assessments to inform the conversation between a patient and his or her clinician. As part of any systematic health assessment activity, patients also want a place to state what health concerns are of most importance to them. Discussing patient priorities can help create an agenda with the patient right away, leading to a more efficient visit and a long-term plan of care. You can use the health assessment as a springboard to gauge the patient's readiness to change. A patient's motivation will help him or her follow through with mutually agreed on treatment and lifestyle recommendations. Health assessment information may also facilitate a mutually agreed on priority list and an action plan with reasonable goals. Consider adding a question to your assessment asking patients which health care issue is most important to them.
Appendix 10: Health Assessment Information for Patients includes resources for setting patient agendas and goals and a patient-developed definition of health assessments.
Do you already have a clinical relationship with your patient?
Patients and clinicians agree that health assessments, particularly those involving sensitive questions (e.g., depression, alcohol and drug use), work best when there is an established, trustful relationship between a patient and his or her clinician. Health assessments can contribute important information that only a patient knows about his or her health and that might not be routinely acquired during typical office visits.
|In terms of prioritization, the provider reviews the problem list, then talks with the patient about possible treatment plans considering all of the different problems at the same time. The patient helps prioritize, which is important, as you cannot get it done if the patient isn't participating. Depending on the decided-on plan, they will agree to do some now (e.g., prescription) or do some now and some later (e.g., lifestyle).
-Family physician, urban private practice, Colorado
What works for adolescents?
Technology! While paper-based surveys can work well for adolescents and are relatively easy to integrate into the workflow, there is some evidence that teens are more interested in answering health assessments using computers (especially tablets, like an iPad) and they might be more likely to answer sensitive questions honestly.3
Set expectations for the Medicare Annual Wellness Visit
Explain to patients that the information obtained from health assessment is valuable for setting health and wellness goals. Remind them that it is not the same as an annual physical exam. Use a standard script for staff (especially appointment schedulers) and clinicians to help set patient expectations for this new type of office visit.
|A patient's relationship with a provider is most important and is the primary consideration in terms of patients' willingness to share information on health assessments. It's not just about collecting data.
- Certified physician assistant, rural private practice, Colorado
Ask patients about their experience completing the health assessment
As part of your assessment of quality of care, consider asking for patient feedback on the health assessment process. Establishing a more formal approach to patient feedback using focus groups or a patient advisory group can provide a richer understanding of patient views. Using a brief patient feedback form (sample in Appendix 11) can provide you with a quick evaluation of what patients think of the health assessment questions and process. You may learn that completing a health assessment helps to raise awareness in your patients about important health issues. As one clinician learned from an older patient after completing a comprehensive health assessment:
"It helps me remember to take care of myself. Maybe you could suggest some activities that are age-appropriate."
This information will be valuable when considering how to improve the sustainable use of a health assessment in your practice.