Engaging Patients in Their Care Decisions To Promote Better Health and Well-Being
Alex H. Krist, M.D., M.P.H.
Professor, Department of Family Medicine and Population Health
Virginia Commonwealth University
“AHRQ plays a very important role in primary care research by getting at the core principles of primary care and how we can make it better. That’s important, because most Americans get most of their care in primary care settings, so it has a tremendous health impact.”
Engaging patients in decisions about their care has been shown to contribute to positive health outcomes, but physicians and patients need tools to better guide informed conversations, according to AHRQ grantee Alex H. Krist, M.D., M.P.H.
Dr. Krist, a professor in the department of family medicine and population health at Virginia Commonwealth University (VCU) in Richmond, advocates engaging patients in care decisions that are based on the best available evidence and helping them play a more active role in creating their own care plans. His work as an AHRQ-funded primary care researcher and as a clinician and faculty member in VCU’s family medicine residency program reflects this conviction.
For example, when patients learn about the benefits and risks of screening recommendations, “they can really be active participants in managing their health and working with their care team to get the care they want,” Dr. Krist said. Engaged patients can also ask more informed questions or raise concerns about screenings for breast, prostate, and colon cancer, which collectively account for 10 percent of all U.S. primary care visits, according to Dr. Krist.
He received an AHRQ-funded grant in 2007 to create an interactive preventive health record called MyPreventiveCare that was designed to help patients better understand their care options in a manner that reflects their individual values and concerns. The health record combined information about a patient’s clinical status, family history, and health behaviors with preventive care recommendations, including those from the U. S. Preventive Services Task Force (USPSTF), of which Dr. Krist is the immediate past chair. Patients had access to a personalized overview of preventive services in plain language, as well as motivational messages, links to additional resources, decision aids, and reminders.
Initially implemented in eight primary care practices in Virginia, the tool helped prepare patients and clinicians for specific conversations or decisions, according to Dr. Krist. “Patients can go in and have a whole different discussion with their clinician, whether it’s a more shared decision, or whether it’s participating more in creating their treatment plans,” he said. The system is now used by nearly 50 practices in five States.
Engaging patients with multiple chronic conditions can be more challenging for physicians, however. These patients have complex needs that can be exacerbated by untreated mental health issues, social needs, or unhealthy behaviors.
That’s why Dr. Krist’s latest AHRQ-funded grant, awarded in 2019, will help primary care physicians better understand how to engage patients with multiple chronic conditions in creating their own care plans, with the larger goal of addressing the root causes of poor health.
In the project, patients will be screened for certain health risks and will work with clinicians to prioritize their health needs. When clinicians engage patients with multiple chronic conditions, patients generally identify one or two concerns that are most important to them, according to Dr. Krist. “There’s a reason they’re identifying it. Maybe it’s something they feel they have an ability to change.” Based on this information, clinicians will create a care plan that reflects patients’ preferences.
Dr. Krist’s work to eliminate barriers to optimal care led him to co-author the National Academy of Science report, Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care (PDF, 178 KB). Released in 2021, the report outlines five objectives to achieve high-quality primary care in the U.S. Dr. Krist is a fellow of the American Academy of Family Physicians and was elected to the National Academy of Medicine in 2018.
Principal Investigator: Alex H. Krist, M.D., M.P.H.
Institution: Virginia Commonwealth University
Grantee Since: 2007
Type of Grant: Various
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