1. International Health Policy Program -Thailand Journal Club: Patient Empowerment in Health Care Jiraboon Tosanguan

2. International Health Policy Program -Thailand Outline Introduction Definition & Types Holistic model of empowerment – Processes – Patients’ roles – Health system’s roles Conclusion 2

3. International Health Policy Program -Thailand Introduction “Empowerment have been associated with the struggle of those who held the least power”. Physician have traditionally held considerable power. Current trends of centralised decision-making and cost containment have disrupted this. However, in order for health system to function correctly, both need to be empowered and interact. 3

4. International Health Policy Program -Thailand Definition of Patient Empowerment “Having decision-making power, a range of options from which to choose, and access to information.” (Lindhorst et al, 2002) 4

5. International Health Policy Program -Thailand Types of Patient Empowerment Individual Family Community 5

6. International Health Policy Program -Thailand Model of Empowerment Empowerment AntecedantsProcessesOutcomes 6

7. International Health Policy Program -Thailand Holistic Model of Empowerment 7 The Patient Antecedents 1.Health literacy 2.Knowledge and skills 3.Patient initiative and advocacy Outcomes 1.Improvement in health status 2.Increased satisfaction 3.Self-efficacy Barriers 1.Ability to pay 2.Physical and emotional limitations 3.Environment Antecedents 1.Technology and innovation 2.Competition 3.Clinical initiatives and leadership The Process of Empowerment 1.Information Sharing 2.Doctor-Patient communication 3.Shared decision making 4.Patient self-care Barriers 1.Inertia in work practice 2.Legal constraints 3.Financing by 3 rd party payers Outcomes 1.Increased respect for patients 2.Increased adherence 3.Cost saving Patient Empowerment Health System

8. International Health Policy Program -Thailand Processes 1. Information sharing Availability of information Needs for patients to be informed about health and what the system can do for them Information sharing between patients can also play a role 8

9. International Health Policy Program -Thailand Processes 2. Doctor-patient communications Brief encounter to become lasting relationship A mean to solve problems such as uncertainty and information asymmetry Allow doctors to serve both clinical needs and human needs This will lead to informed choice and positive health and non-health outcomes for patients 9

10. International Health Policy Program -Thailand Processes 3. Shared decision making This has become more necessary as decision are more complex and can be different from patient to patient. Patient involvement can have an impact on effectiveness in screening, treatment and disease control Information on treatment options can help to encourage patient’s participation. Information sharing between patients can also help 10

11. International Health Policy Program -Thailand Processes 4. Patient self-care or self management Best defined if a patient is empowered or not It promotes personal initiative and responsibility for one’s health and allow them to make therapeutic choices that are relevant to them However, the patients need to be sufficiently supported for their self-care activities 11

12. International Health Policy Program -Thailand Patients’ Roles Patients’ antecedents Health literacy Knowledge and skills Patient initiative and advocacy 12

13. International Health Policy Program -Thailand Patients’ Roles Patient barriers Ability to pay Physical and emotional limitations Environment 13

14. International Health Policy Program -Thailand Patients’ Roles Patient outcomes Health status Satisfaction Self-efficacy 14

15. International Health Policy Program -Thailand Health System’s Roles Health system antecedents Technology and innovation Competition Clinical initiative and leadership 15

16. International Health Policy Program -Thailand Health System’s Roles Barriers Inertia in work practices Legal constraints Financing by 3 rd party payers 16

17. International Health Policy Program -Thailand Health System’s Roles Outcomes Increased respect for patients Increased adherence Cost savings 17

18. International Health Policy Program -Thailand Conclusion Patients are the key stakeholders in health care system and the system should be responsive to the needs and preference of the patients Health system reform is required to institutionalise empowerment concepts, approaches, and processes, and to correct power imbalance in the system. Choice (in selecting treatment, insurance scheme, etc) is important in patient empowerment 18