Healthcare News & Insights

Unlocking the enigma of the activated and engaged patient

At the outset of World War II, British Prime Minister Winston Churchill famously said of Russia, “It is a riddle wrapped in a mystery inside an enigma.” The same could be said of patient activation and education. In this guest post, Arvind Rajan, co-founder and CEO of a developer of scalable healthcare technology services designed to transform the care and treatment of people with chronic kidney disease (CKD), explains how hospitals and their providers can create a cohesive education strategy that helps eliminate information gaps and creates engaged patients. 


Patients who are well-informed about their condition, and the care options available to them, are more likely to be pro-active decision-makers and faithful adherents to treatment and management pathways. Facilities, providers and payers who can provide the tools and resources necessary to help patients make these decisions with confidence are better positioned to improve outcomes, lower costs and enhance quality of care.

It sounds straightforward. However, despite tremendous energy expended on the subject, we have yet to crack the code of the activated patient. Millions remain vulnerable to significant information gaps, whether it’s knowledge being delivered by care providers, patients’ understanding of their conditions or both.

The case of chronic kidney disease

CKD, perhaps more than any other chronic illness, best illustrates the stark education and engagement gaps plaguing the healthcare system, as well as the opportunities to bridge them.

More than 20 million adults in the United States live with CKD. However, many patients go undiagnosed until the late stages of the disease or when they already have progressed to kidney failure — end-stage renal disease (ESRD).

The unexpected diagnosis of late-stage CKD or ESRD — and their life-altering repercussions — is an overwhelming experience. Patients are suddenly required to adhere to extraordinary dietary, behavior and lifestyle changes in order to achieve the desired outcomes. In addition to dialysis and significant medication requirements, patients often require care coordinated among multiple healthcare professionals, including primary care physicians, specialists, social workers and dieticians. It’s no surprise that depression is common in ESRD patients, with some estimates as high as 25%.

A patient’s ability to lead a happy and productive life with late-stage CKD, ESRD, or any chronic illness, requires an education and engagement strategy that, when determining treatment options, accounts for his or her lifestyle and personal values.

For example, most ESRD patients are treated with in-center hemodialysis, a costly and disruptive treatment, even though less expensive and less intrusive home dialysis modalities are available. In many cases, patients aren’t even aware that home dialysis is an option, suggesting a significant gap in shared decision-making between patient and provider.

With engagement, individuals matter

A comprehensive patient engagement and education strategy requires several key ingredients, including:

  • Customization. A one-size-fits-all education and engagement strategy won’t work for all — or even most — patients. Education about treatment and management modalities that meet patients where they are in their lives begins with a self-assessment that helps them identify personal criteria that’s important to them — and their loved ones.
  • On-demand, multi-channel engagement. In the confines of a doctor’s office, critical information may be too sparse to be useful, or worse, delivered with such volume that it’s impossible to properly absorb. Enabling patients to choose their preferred learning modality is essential to any education and engagement strategy.
    For patients who may be overwhelmed with the diagnosis or other events in their lives — such as work, school or family obligations — on-demand education platforms allow them to digest information on their own time and at their own speed.
    In addition, multi-channel content — such as video, chat and written information — take into account the different ways people learn. Some people are visual. Some people are auditory. Some people are readers. An individual’s ability to cope and manage a disease, then adhere to treatment decisions is often based on their fundamental understanding of their condition.
    Studies and self-care trials have shown that a shift toward multi-channel, patient-centric education result in demonstrated improvements in “self-efficacy, patient satisfaction, coping skills and perceptions of social support.”
  • Peer Support and Mentorship. Interactive, multi-channel platforms should provide patients with on-demand access to a host of resources — from clinically reviewed content and mentorship initiatives to guidance from myriad health professionals and a network of peers to share and interact with. Peer-to-peer support and mentorship help patients stay accountable and feel they’re not alone in their struggle.
    The same basic principles used for smoking cessation or weight loss can be applied to patients managing chronic disease, empowering them with the support and knowledge necessary to make critical and enduring treatment decisions with confidence.
  • Scalability. Finally, patient education approaches for chronic illnesses should be accessible by large and small patient populations alike, and should help eliminate inequalities by offering the same high standard of care to all patients, regardless of who they are or where they live.

Value-based partnership

A newly diagnosed chronic illness is among life’s most stressful challenges that no patient education platform can completely obviate. Inconsistent patient education on the part of the provider and poor health literacy on the part of patients often leads to delayed or incomplete plans, leaving patients prone to complications and poor outcomes.

However, facilities and their providers that place greater emphasis on a cohesive education strategy over scattered, generalized tactics are more likely to unlock activated and engaged patients who are better equipped to make enduring treatment decisions with confidence.

Arvind Rajan is co-founder and CEO of Cricket Health, a developer of scalable healthcare technology services designed to fundamentally transform the care and treatment of people with CKD who are at high-risk of progressing to ESRD. A white paper on the use of multi-channel education technology to help patients manage late-stage CKD and ESRD is available here.


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