Effects of improved patient participation in primary care on health-related outcomes: a systematic review

Abstract

Background.In primary care, many consultations address symptom-based complaints. Recovery from these complaints seldom exceeds placebo effects. Patient participation, because of its supposed effects on trust and patient expectancies, is assumed to benefit patients’ recovery. While the idea is theoretically promising, it is still unclear what the effects of increased patient participation are on patient outcomes.Aim.To review the effects of controlled intervention studies aiming to improve patient participation in face-to-face primary care consultations on patient-oriented and/or disease-oriented outcomes.Methods.This study is a systematic review. A systematic search was undertaken for randomized controlled trials designed to measure the effects of interventions that aimed to improve adult patients’ participation in primary care visits. The CINAHL, Cochrane, EMBASE, PsycINFO and PubMed databases were searched.Results.Seven different trials fulfilled the inclusion criteria. Three of the studies were related to symptom-based complaints. Five studies measured patient-oriented outcomes, the primary outcome of interest for this review. All studies suffered from substantial bias. Studies varied widely in their aims, types of complaints/diseases, strength of the interventions and their outcomes. The effects on patient-oriented outcomes and disease-oriented outcomes were ambiguous.Conclusion.Little research has been performed on health outcomes of interventions aiming to increase patient participation in general practice visits among patients suffering from symptom-based complaints. The results still are non-conclusive. The quality of the trials has been weak, possibly due to the complexity of the concept. This weak quality may explain the lack of conclusive results. Proposals for future research designs are offered.

Key stakeholders’ views on the quality of care and services available to frail seniors in Canada

“…Despite being less used to an active role in decision-making compared to younger patients there are several examples that, with encouragement, older adults can participate in shared decision-making [22, 23]. Older patients’ active engagement in their healthcare is associated with high-quality and cost-effective healthcare [24, 25]. Identification of frailty, and engagement of seniors in decision-making can in turn offer opportunities for targeted care and services meeting their specific needs [26].…”

Outcome-Relevant Effects of Shared Decision Making

“…As the methodological quality of many studies was limited, effects may have remained hidden. Two other reviews that differed from our approach in terms of their search strategies also stated that conclusive results regarding the effects of improved patient participation in general (12) and SDM in particular (8) on patient-relevant, diseaserelated outcomes are lacking.…”

“…The current state of research regarding the clinical relevance of SDM in particular is, however, not clear. A systematic review similar to our study investigated the effect on patient-relevant, disease-related outcomes, but did not focus on SDM as a form of patient participation and limited the number of studies included to merely seven, on the basis of very strict inclusion and exclusion criteria (12). A detailed study from the Cochrane Collaboration focused primarily on the implementation of SDM as the study endpoint, but did not consider many of the outcomes and studies addressed by our own review (13).…”

Décision partagée – Médecin et patient décident ensemble

“…Néanmoins, il ne faut pas s'attendre de manière générale à une améliora-tion de l'état de santé; cependant, les patients obtiennent plus vite les résultats escomptés car les inconvénients qu'ils voulaient éviter ne se présentent pas [37]. Il n'existe toutefois aucune étude prouvant une nette amélioration de l'état de santé et de la qualité de vie [37,[50][51][52]. En général, on constate des effets positifs plutôt dans les études relatives à des patients souffrant de maladies chroniques et ayant une relation de longue durée avec leur médecin, comme aussi lorsque la démarche SDM a eu lieu lors de plusieurs consultations avec un médecin formé à cet effet [51].…”