Good relationship, relevant information improve patient enablement in Asian setting

Patient Enablement Instrument (PEI) scores are similar between the Singapore and other Asian contexts, but the former’s is slightly higher than that recorded in Western studies, a study has shown. Moreover, enablement appears to be rated higher by participants being treated in more specialized clinics.

“Good doctor-patient relationships, efficient systems facilitating continuity of care, and motivated and informed patients all contribute to increased enablement,” the researchers said.

An embedded mixed method study was applied with primary care patients in two phases: 150 patients completed a PEI questionnaire, and a qualitative approach was used to explore factors associated with high enablement using focused group discussions and individual interviews.

Mean PEI score was 4.5±4.4, but patients attending specialized primary care clinics accorded significantly higher scores. [Singapore Med J 2019;doi:10.11622/smedj.2019125]

Doctors’ advice, attitude and relationship with the patient were physician factors significantly associated with higher PEI score. Important critical system factors were good continuity of care, workload and financial support, while patient factors included their beliefs, preparedness, inquisitiveness and trust. In addition, there was considerable impact from the influence of the community.

“These findings are similar to those reported in other studies,” the researchers said. “Some studies have noted that empathy, being ‘positive’ and having good listening skills were antecedents and key elements of enablement. [J Altern Complement Med 2003;9:869-876; African J Prim Heal Care Fam Med 2011;3:1-8; Br J Gen Pract 2002;52 Suppl:S9-12; BMC Fam Pract 2013;14:8]

Poor information exchange between doctors and patients was found to be one of the reasons for low enablement. Information presented often lacked importance to the patients, according to the results of the interview following an education intervention. [J Adv Nurs 2001;35:365-372]

Patients tend to become more committed to and own their disease if information that is relevant to them could be adequately sought out and presented, according to the researchers.

“However, doctors tend to be more task-oriented and keener on settling the medical issue in order to deliver evidence-based treatment, rather than explore the patient’s perspective so as to build a good doctor-patient relationship,” they added. [Scand J Prim Health Care 1991;9:71-77; J Med Ethics 2011;37:650-654]

Findings of the current study also showed the importance of the community in promoting enablement, with community input helping patients see beyond their current state, particularly when they witnessed older patients or those who had had the condition for a longer time manage their own disease and overcome them, the researchers said.

“We postulate that Asian communities may tend to be more communal and thus, the comments and advice from other patients are more respected and imbibed,” they noted.

According to the researchers, clinics could leverage on patients with good control over their conditions and enlist them to encourage other patients to do better or to build support groups that can provide tips on how to be healthy while dealing with their disease.