Thread by @Teknofiliac

How do move towards the triple aim (improving outcomes, satisfaction, and cost-savings) in dialysis? Let patients lead!

Some tweets about patient activation (PAM = Patient Activation Measure) #PatientActivation #PersonCenteredCare

Person-centered care shifts the focus to what patients and families need and want, and coordinates care accordingly.

From Patient-Centered to Person-Centered Care for Kidney Diseases cjasn.asnjournals.org/content/14/4/6…

Patient engagement is key to driving person-centered care and value-based medicine. What do we need to do to foster patient engagement?

Patient activation refers to patients readiness to drive his/her healthcare. Activation is not only about knowledge, but also **skill** and **confidence**.

pubmed.ncbi.nlm.nih.gov/20693726/

When we think about education, we think about the the knowledge we want to transfer. However, recitation of education material is not education. Education has to lead to change in behavior.

"Telling" patients what to do is not effective, but we revert to it because it is the easy thing to do, particularly given the time limitations. Behavior change is more likely if patients identify their goals and themselves decide what they want to learn and do.
REF: PMC7457552

Our role is to help them identify their goals and how to achieve them, then support them to achieve what they set to achieve.

Health coaching is one way to activate patients, and can be carried out face-to-face or remotely using telehealth, phone calls, txt messages, or mobile apps.

Does the Modality Used in Health Coaching Matter? A Systematic Review of Health Coaching Outcomes pubmed.ncbi.nlm.nih.gov/32904668

We still know little about activation in dialysis patients. I feel embarrassed because these are people who need these interventions the most and have plenty of interactions with healthcare providers.

jasn.asnjournals.org/content/31/7/1…

Coaching in dialysis centers will require several considerations, including staff time and training, privacy, and patient fatigue.

Involving patients in their dialysis care and supporting self-care on dialysis improves self-management, confidence, and satisfaction. In addition, more patients choose to do home dialysis.

cjasn.asnjournals.org/content/14/9/1…

It is high time for us to move away from paternalistic medicine with passive patients towards patient empowerment and support. Takes time, but more likely to be of value to patients and the healthcare system over the long run.