Patients' involvement in health care will improve quality
Editor - Coulter suggests that patients
should be asked to provide detailed
reports of their experiences of clinical
care during a particular consultation and
that they should be asked about what
actually occurred rather than to evaluate
what occurred.1 We agree that it is a generalisation too far by Rao and colleagues
to state that patients are unable to assess
the quality of care they receive.2
A more useful approach may be
building working partnerships for care.
Coulter mentions this when she stated
that most patients prefer doctors who
involve them in treatment decisions and
those who respect patients' dignity.3
There is much scope for incorporating
into routine health care patients' views
on their health needs and their assessment of progress towards treatment
goals, particularly in chronic disease.
Encouraging patients to become active
participants who take responsibility for
working towards their treatment goal -
for example, by ensuring that their blood
pressure is regularly checked - could
contribute towards improving quality. In
this way partnership between patients
and doctors drives the quality agenda.
We recently followed up a cohort of
1000 patients with schizophrenia by
assessing patients' views in a structured
format. Although treatment alliances are
often thought to be more problematic in
mental health, we found that patients
could contribute accurate information to
their care plans on needs and accurately
comment on clinical outcomes.4 Furthermore, by using patient centred
assessment tools, effective alliances
developed between clinicians and
patients that were associated with
reduced admission and other improved
pragmatic outcomes. Such approaches
are much more likely to improve clinical
quality than relying on patient assessed
measures of quality in rating-style
questionnaires.
Competing interests: None declared.
This letter was first published in the BMJ (2006;333:147-8).
References 1-4 are on
studentbmj.com
Robert Hunter, director
Rosie Cameron, national integrated care pathways coordinator, Research and Development
Directorate, Gartnavel Royal Hospital, Glasgow
G12 0XH
Email: robert.hunter@nhs.net
studentBMJ 2006;14:309-352 September ISSN 0966-6494
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