Providers, payers, the community, and patients are all obliged to get patient activation and engagement ethically right.
Providers, payers, the community, and patients are all obliged to get patient activation and engagement ethically right.
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DOI：
10.1377/hlthaff.2012.1081
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发表时间：
2013-02
期刊：
影响因子：
--
通讯作者：
Solomon M
中科院分区：
文献类型：
--
作者：
Danis M;Solomon M
积极主动的患者寻求理解，知识和技能，以促进自己的健康。努力促进这种患者的积极性和参与在道德上是合理的，因为它们符合尊重人的既定原则，而且如证据所示，因为它们可能为患者带来更好的结果。然而，患者的激活和参与也可能在伦理上出错，例如，如果不遵守的患者被遗弃或因惩罚性政策和做法而处于不利地位，或者如果成功激活和参与的条件缺失。在这篇文章中，我们讨论了伦理问题和责任，涉及到病人，临床医生，医疗保健组织，交付系统，保险公司，付款人和社区。例如，医生或付款人可能会因为患者不遵守建议而受到指责，但我们建议更好的方法是让提供者和付款人授权患者有效地分担定义目标和实现目标的责任。对患者激活和参与的道德方法不仅应使患者承担义务，还应使临床医生、医疗保健组织和交付系统、保险公司和社区承担义务。
Active and engaged patients seek the understanding, knowledge, and skills to promote their own health. Efforts to promote such patient activation and engagement are ethically justified because they are consonant with the well-established principle of respect for persons and, as the evidence shows, because they are likely to produce better outcomes for patients. Yet patient activation and engagement can also go ethically awry if, for example, nonadherent patients are abandoned or are unduly disadvantaged by punitive policies and practices, or if the conditions for successful activation and engagement are missing. In this article we discuss the ethical issues and responsibilities that pertain to patients, clinicians, health care organizations, delivery systems, insurers, payers, and communities. For example, physicians or payers could hold patients blameworthy for not following recommendations, but we suggest that a better approach would be for providers and payers to empower patients to effectively share responsibility for defining goals and achieving them. An ethical approach to patient activation and engagement should place obligations not only on patients but also on clinicians, health care organizations and delivery systems, insurers, and communities.